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Botulinum toxin A for prophylactic treatment of migraine and tension headaches in adults: a meta-analysis

updated

Tags: treatment, headache, medications, injections, head, head/neck, pain problems, self-treatment, medicine

Two articles on PainSci cite Jackson 2012: (1) The Complete Guide to Trigger Points & Myofascial Pain(2) The Complete Guide to Chronic Tension Headaches

PainSci summary of Jackson 2012: ?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided at the bottom of the page, as often as possible.

This review of many scientific studies found that having Botox injections for chronic daily headaches or migraines was only slightly more beneficial than using a placebo. Not dramatic results at all. Disappointing, in fact, after years of believing that Botox was “probably” a good evidence-based option for migraine. •sigh•

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

CONTEXT: Botulinum toxin A is US Food and Drug Administration approved for prophylactic treatment for chronic migraines.

OBJECTIVE: To assess botulinum toxin A for the prophylactic treatment of headaches in adults.

DATA SOURCES: A search of MEDLINE, EMBASE, bibliographies of published systematic reviews, and the Cochrane trial registries between 1966 and March 15, 2012. Inclusion and exclusion criteria of each study were reviewed. Headaches were categorized as episodic (<15 headaches per month) or chronic (≥15 headaches per month) migraine and episodic or chronic daily or tension headaches.

STUDY SELECTION: Randomized controlled trials comparing botulinum toxin A with placebo or other interventions for headaches among adults.

DATA EXTRACTION: Data were abstracted and quality assessed independently by 2 reviewers. Outcomes were pooled using a random-effects model.

DATA SYNTHESIS: Pooled analyses suggested that botulinum toxin A was associated with fewer headaches per month among patients with chronic daily headaches (1115 patients, -2.06 headaches per month; 95% CI, -3.56 to -0.56; 3 studies) and among patients with chronic migraine headaches (n = 1508, -2.30 headaches per month; 95% CI, -3.66 to -0.94; 5 studies). There was no significant association between use of botulinum toxin A and reduction in the number of episodic migraine (n = 1838, 0.05 headaches per month; 95% CI, -0.26 to 0.36; 9 studies) or chronic tension-type headaches (n = 675, -1.43 headaches per month; 95% CI, -3.13 to 0.27; 7 studies). In single trials, botulinum toxin A was not associated with fewer migraine headaches per month vs valproate (standardized mean difference [SMD], -0.20; 95% CI, -0.91 to 0.31), topiramate (SMD, 0.20; 95% CI, -0.36 to 0.76), or amitriptyline (SMD, 0.29; 95% CI, -0.17 to 0.76). Botulinum toxin A was associated with fewer chronic tension-type headaches per month vs methylprednisolone injections (SMD, -2.5; 95% CI, -3.5 to -1.5). Compared with placebo, botulinum toxin A was associated with a greater frequency of blepharoptosis, skin tightness, paresthesias, neck stiffness, muscle weakness, and neck pain.

CONCLUSION: Botulinum toxin A compared with placebo was associated with a small to modest benefit for chronic daily headaches and chronic migraines but was not associated with fewer episodic migraine or chronic tension-type headaches per month.

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