Botulinum Toxin for Headache: a Comprehensive Review
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USE OF BOTULINUM TOXIN IN OTORHINOLARYNGOLOGY (A D’SOUZA AND CL NG, SECTION EDITORS)
Botulinum Toxin for Headache: a Comprehensive Review P. P. Cheang 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Headache disorders are among the most prevalent disorders of mankind. They incur huge costs in terms of disability, days loss to work, and quality of life. In recent years, usage of botulinum toxin (BTX-A) has been extended to the management of various headaches. This review sets out to examine the evidence and role of BTX-A in the different headache disorders. Recent Findings BTX-A is effective in reducing the frequency of chronic migraine days per month, with statistically significant improvement in quality of life. No difference was seen in patients with episodic migraine. The evidence of BTX-A on tensiontype headache, cluster headache, and trigeminal neuralgia is emerging, but high quality large-scale studies are lacking at present. The mechanism of action of BTX-A on headaches is found to be independent of its effect on muscle contraction, where BTX-A is found to have direct anti-nociceptive effect on sensory nerves. Summary BTX-A should be considered in the most refractory forms of chronic headaches. However, more RCTs are required in the future for higher-quality evidence and to guide injection sites and doses. Keywords Headache . Migraine . Botulinum toxin . Botox . Review
Introduction Botulinum toxin (BTX) is a neurotoxic protein produced by the bacterium Clostridium botulinum and related species. When released, it causes inactivity of muscles or glands by preventing the release of acetylcholine neurotransmitter from cholinergic nerve endings. There are eight types of BTX, A– H. Types A and B are the most often used, both commercially and medically [1]. BTX-A was first used in medicine in 1980 to treat strabismus, due to its effect on muscular relaxation. Further application expanded in neurology-related muscular problems such as dystonia and blepharospasm [2]. The cosmetic effects on Botox on wrinkles were noticed in 1989; by 2002, it has
gained approval from FDA and is recognized globally as a potential cosmetic therapeutic agent [2]. The effect of BTX-A treatment for the ageing face is well documented. At the same time, there has also been an exponential rise of the use of BTX-A for an extensive variety of medical and surgical conditions; this remains less well introduced in the facial plastic domain. The effects of BTX-A on headache was first described as an incidental finding by Binder et al. when describing the cosmetic applications of BTX-A, noting improvement on several patients with a history of migraine or chronic headache pain [3]. This paper sets out to review the evidence of BTX-A in the area of headaches.
Headache This article is part of the Topical collection on Use of Botulinum Toxin in Otorhinolaryngology * P. P. Cheang [email protected] 1
Maidstone and Tunbridge Wells NHS Trust, ENT Department, Tunbridge Wells Hospital, Tonbridge Road,
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