Botulinum toxin A for prophylactic treatment of migraine and tension headaches in adults: a meta-analysis
Two pages on PainSci cite Jackson 2012: 1. The Complete Guide to Trigger Points & Myofascial Pain 2. The Complete Guide to Chronic Tension Headaches
PainSci commentary on 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 wherever possible.
This review of several scientific studies found that having Botox injections for chronic daily headaches or migraines was only slightly more beneficial than using a placebo. Not very promising results at all, unfortunately. Rather disappointing, in fact (after years of believing that Botox was “probably” a good evidence-based option for migraine).
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.
related content
- “Botulinum toxin in the treatment of myofascial pain syndrome,” Cheshire et al, Pain, 1994.
- “Botulinum toxin A for myofascial trigger point injection: a qualitative systematic review,” Ho et al, European Journal of Pain, 2007.
- “An update on botulinum toxin A injections of trigger points for myofascial pain,” Zhou et al, Curr Pain Headache Rep, 2014.
- “Botulinum toxin treatment of myofascial pain: a critical review of the literature,” Gerwin, Curr Pain Headache Rep, 2012.
- “Botulinum toxin for myofascial pain syndromes in adults,” Soares et al, Cochrane Database of Systematic Reviews, 2014.
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- Topical glyceryl trinitrate (GTN) and eccentric exercises in the treatment of mid-portion achilles tendinopathy (the NEAT trial): a randomised double-blind placebo-controlled trial. Kirwan 2024 Br J Sports Med.
- Placebo analgesia in physical and psychological interventions: Systematic review and meta-analysis of three-armed trials. Hohenschurz-Schmidt 2024 Eur J Pain.
- Recovery trajectories in common musculoskeletal complaints by diagnosis contra prognostic phenotypes. Aasdahl 2021 BMC Musculoskelet Disord.
- Cannabidiol (CBD) products for pain: ineffective, expensive, and with potential harms. Moore 2023 J Pain.
- Moderators of the effect of therapeutic exercise for knee and hip osteoarthritis: a systematic review and individual participant data meta-analysis. Holden 2023 The Lancet Rheumatology.