Botulinum Toxin (DYSPORT) in Tension-Type Headaches
Objectives. Botulinum toxin type A is effective in the reduction of muscle tenderness and pain in many diseases associated with myofascial pain. Since increased muscle tension may contribute to tension-type headaches, injections of botulinum toxin could b
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Botulinum Toxin (DYSPORT) in Tension-Type Headaches J. D. Rollnik and R. Dengler Medical School of Hannover, Department of Neurology and Clinical Neurophysiology, Hannover, Germany
Summary Objectives. Botulinum toxin type A is effective in the reduction of muscle tenderness and pain in many diseases associated with myofascial pain. Since increased muscle tension may contribute to tension-type headaches, injections of botulinum toxin could be of therapeutic value. Methods/Patients. Results of own investigations are presented, in particular a double-blind, placebo-controlled study with 21 patients fulfilling the International Headache Society criteria for tensiontype hedaches. Participants were randomly assigned to verum (pericranial injection of 10 x 20 MU DYSPORT) or placebo condition (injection of isotonic saline in the same manner). Results. After 4, 8, and 12 weeks no significant differences between placebo and verum could be observed. Nevertheless, both groups significantly improved. Discussion. The findings strongly suggest that higher doses or other injection sites might be necessary to achieve therapeutic effects of botulinum toxin in tension-type headaches. Actually, we are participating in a multi-center study using 500 MU ofDYSPOR T. Besides dose-finding problems, another explanation could be that peripheral mechanisms - such as increased pericranial muscle tension - only playa minor role in the pathogenesis of tension-type headaches. Keywords: Botulinum toxin; headache.
Introduction The clinical, epidemiologic, and societal impact of tension-type headache (TTH) is immense. It poses a problem in neurological rehabilitation, e.g. after head injuries. Chronic post-traumatic headaches have no special features, but are symptomatically identical to chronic tension-type headache [4]. The lifetime prevalence of TTH is up to 30% in a general population [3]. The clinical symptoms are consisting of ache or sensations of tightness, pressure, or constriction, widely varied in intensity, frequency, and duration [7]. The
International Headache Society classification [5] excludes typical symptoms of migraine, and differentiates between episodic and chronic (more than 180 days per year) tension-type headache. The pathophysiology is complex but increased pericranial muscle tension may contribute to the development of tension headaches at least in a fraction of patients [7]. Botulinum toxin type A is a potent drug in the treatment of several diseases associated with inreased muscle tone, such as dystonia, facial hemispasm, spasticity, and unvoluntary co-contractions [9]. Botulinum toxin has also been found useful in the treatment of painful muscle spasms and myofascial pain syndrome [1, 2]. Some studies suggested that botulinum toxin could be of therapeutic value in tension-type-headache as well [8, 11, 12]. However, the results of these studies are conflicting. Zwart and colleagues [12] could not find any significant reduction in pain intensity nor in pressure pain threshold in six patients with tension headache (injec
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