Botulinum toxin has been shown to effectively treat several types of
pain associated with
neurologic disorders. It has recently been evaluated for the treatment of various types of
headaches. In studies of
migraine headache,
chronic daily headache (more than 15 days of
headache per month),
tension-type headache, and post-whiplash
headache, patients have reported decreased
pain after treatment with
botulinum toxin type A. A more recently available preparation,
botulinum toxin type B, has also been shown to provide relief to patients with transformed
migraine headache and post-whiplash
headache. Additional study is under way to determine the effectiveness of
botulinum toxin for the treatment of
chronic cluster headaches. Although the pathophysiology of
headache is incompletely understood, muscle tension may trigger or aggravate
migraine headaches.
Botulinum toxin, which reduces muscle hyperactivity, may reduce
headache pain by decreasing muscle tension. It may also provide peripheral and central neurogenic effects and reduce
inflammation. Large, rigorously controlled trials of
botulinum toxin are needed to better characterize its effects on various types of
headaches and its role as a therapeutic agent. Current data suggest that
botulinum toxin is safe and does not produce systemic effects associated with other types of
headache treatments.