Skip to main content

Advertisement

SpringerLink
Log in

Is there a role for botulinum toxin in the treatment of migraine?

  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

In this review, the studies and case reports that are available from reference systems and published congress contributions on the treatment of migraine with botulinum toxin are evaluated. The studies and reports were analyzed with respect to the study design, the efficacy parameters, and the significance of results. One double-blind, placebocontrolled, randomized study with negative (for a 75 U dose of botulinum toxin) and positive (for a 25 U dose of botulinum toxin) evidence of efficacy, one that was a partly positive controlled study (pain intensity, but not attack-frequency improved), and four positive open studies were available. For the acute treatment of migraine with botulinum toxin, only positive case reports were published. As a result of this analysis, there is no sufficient scientific evidence for a treatment recommendation of migraine with botulinum toxin. Further studies are needed for a definite evaluation of subgroups with probable benefit from such a treatment and for the comparison of botulinum toxin with other migraine prophylactic drugs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Tfelt-Hansen P, Block G, Dahlöf C, et al.: International Headache Society Clinical Trials Subcommittee: guidelines for controlled trials of drugs in migraine, edn 2. Cephalalgia 2000, 20:765–786.

    Article  PubMed  CAS  Google Scholar 

  2. Schoenen J: Guidelines for trials of drug treatments in tension-type headache: First Edition. Cephalalgia 1995, 15:165–179.

    Article  PubMed  CAS  Google Scholar 

  3. Silberstein SD: Review of botulinum toxin type A and its clinical applications in migraine headache. Expert Opin Pharmacother 2001, 2:1649–1654. Comprehensive review of the literature on botulinum toxin in the treatment of migraine.

    Article  PubMed  CAS  Google Scholar 

  4. Binder WJ, Brin MF, Blitzer A, Pogoda JM: Botulinum toxin type A (BOTOX) for treatment of migraine. Dis Mon 2002, 48:323–335.

    Article  PubMed  Google Scholar 

  5. Mauskop A: The use of botulinum toxin in the treatment of headaches. Curr Pain Headache Rep 2002, 6:320–323.

    Article  PubMed  Google Scholar 

  6. Evers S, Rahmann A, Vollmer-Haase J, Husstedt IW: Treatment of headache with botulinum toxin A: a review according to evidence-based medicine criteria. Cephalalgia 2002, 22:699–710. A complete review on all of the studies and case reports focusing on the treatment of different headache disorders with botulinum toxin. The studies and reports are categorized according to evidence-based medicine criteria.

    Article  PubMed  CAS  Google Scholar 

  7. Göbel H, Heinze A, Heinze-Kuhn K, Jost WH: Evidence-based medicine: botulinum toxin A in migraine and tension-type headache. J Neurol 2001, 248(suppl 1):34–38.

    Article  PubMed  Google Scholar 

  8. Mathew NT, Kaup AO: The use of botulinum toxin type A in headache treatment. Curr Treat Options Neurol 2002, 4:365–373. A review on all of the studies, reports, and congress contributions dealing with headache and botulinum toxin. Short, but precise description of the literature.

    PubMed  Google Scholar 

  9. Headache Classification Committee of the International Headache Society: Classification and diagnostic criteria for headache disorders, cranial neuralgias, and facial pain. Cephalalgia 1988, 8(suppl 7):1–92.

    Google Scholar 

  10. Krusz J: Intradermal Botulinum toxin, type A, treatment for cervicogenic migraine. Eur J Neurol 2002, 9(suppl 2):158.

    Google Scholar 

  11. Krusz J: Intradermal botulinum toxin, type B, treatment for cervicogenic migraine. Eur J Neurol 2002, 9(suppl 2):188.

    Google Scholar 

  12. Fadeyi MO, Adams QM: Use of botulinum toxin type B for migraine and tension headaches. Am J Health Syst Pharm 2002, 59:1860–1862.

    PubMed  Google Scholar 

  13. Silberstein S, Mathew N, Saper J, Jenkins S: Botulinum toxin type A as a migraine preventive treatment. Headache 2000, 40:445–450. The only fully published randomized, placebo-controlled, and double-blind study on botulinum toxin in the prophylaxis of migraine. Significant efficacy was found only for the low dose of botulinum toxin A, not for the high dose.

    Article  PubMed  CAS  Google Scholar 

  14. Brin MF, Swope DM, O’Brian C, et al.: Botox, for migraine: double-blind, placebo-controlled, region-specific evaluation. Cephalalgia 2000, 20:421–422.

    Article  Google Scholar 

  15. Binder WJ, Brin MF, Blitzer A, et al.: Botulinum toxin type A (BOTOX) for treatment of migraine headaches: an openlabel study. Otolaryngol Head Neck Surg 2000, 123:669–676.

    Article  PubMed  CAS  Google Scholar 

  16. Mauskop A, Basdeo R: Botulinum toxin A is an effective prophylactic therapy for migraines. Cephalalgia 2000, 20:422.

    Google Scholar 

  17. Smuts JA, Barnard PWA: Botulinum toxin type A in the treatment of headache syndromes: a clinical report on 79 patients. Cephalalgia 2000, 20:332–337.

    Article  Google Scholar 

  18. Guyuron B, Tucker T, Davis J: Surgical treatment of migraine headaches. Plast Reconstr Surg 2002, 109:2183–2189.

    Article  PubMed  Google Scholar 

  19. Robbins L: Botulinum toxin A for refractory chronic daily headache. Neurology 2001, 56(suppl 3):A349.

    Google Scholar 

  20. Wheeler AH: Botulinum toxin A, adjunctive therapy for refractory headaches associated with pericranial muscle tension. Headache 1998, 38:468–471.

    Article  PubMed  CAS  Google Scholar 

  21. Klapper JA, Mathew NT, Klapper A, Kailasam J: Botulinum toxin type A (BTX-A) for the prophylaxis of chronic daily headache. Cephalalgia 2000, 20:291–292.

    Article  Google Scholar 

  22. Poungvarin N: The first world report of botulinum A toxin injection for status migrainosus. J Med Assoc Thai 2001, 84:1199–1203.

    PubMed  CAS  Google Scholar 

  23. Guyer BM: Mechanism of botulinum toxin in the relief of chronic pain. Curr Rev Pain 1999, 3:427–431.

    PubMed  Google Scholar 

  24. Ceballos-Baumann AO, Petri S, Toelle T, et al.: Neues in der Botulinum toxin-Therapie: Von der Dystonie bis zur Migräneprophylaxe. Nervenheilkunde 2001, 20:151–157.

    Google Scholar 

  25. Pacchetti C, Albani G, Martignoni E, et al.: “Off” painful dystonia in Parkinson’s disease treated with botulinum toxin. Mov Disord 1995, 10:333–336.

    Article  PubMed  CAS  Google Scholar 

  26. Wissel J, Müller J, Dressnandt J, et al.: Management of spasticity associated pain with botulinum toxin A. J Pain Symptom Manage 2000, 20:44–49.

    Article  PubMed  CAS  Google Scholar 

  27. Barwood S, Baillieu C, Boyd R, et al.: Analgesic effects of botulinum toxin A: a randomized, placebo-controlled clinical trial. Dev Med Child Neurol 2000, 42:116–121.

    Article  PubMed  CAS  Google Scholar 

  28. Filippi GM, Errico P, Santarelli R, et al.: Botulinum A toxin effects on rat jaw muscle spindles. Acta Otolaryngol 1993, 113:400–404.

    PubMed  CAS  Google Scholar 

  29. Rosales RL, Arimura K, Ikenaga S, Osame M: Extrafusal and intrafusal muscle effects in experimental botulinum toxin A injection. Muscle Nerve 1996, 19:488–496.

    Article  PubMed  CAS  Google Scholar 

  30. Blersch W, Schulte-Mattler WJ, Przywara S, et al.: Botulinum toxin A and the cutaneous nociception in humans: a prospective, double-blind, placebo-controlled, randomized study. J Neurol Sci 2002, 205:59–63. An interesting and well-designed study showing that botulinum toxin A does not influence the cutaneous nociception in a human pain model.

    Article  PubMed  CAS  Google Scholar 

  31. Wiegand H, Erdmann G, Wellhöner HH: 125I-labelled botulinum A neurotoxin: pharmacokinetics on cats after intramuscular injection. Naunyn Schmiedebergs Arch Pharmacol 1977, 298:235–238.

    Article  PubMed  CAS  Google Scholar 

  32. Verderio C, Coco S, Rossetto O, et al.: Internalization and proteolytic action of botulinum toxins in CNS neurons and astrocytes. J Neurochem 1999, 73:372–379.

    Article  PubMed  CAS  Google Scholar 

  33. Welch MJ, Purkiss JR, Foster KA: Sensitivity of embryonic rat dorsal root ganglia neurons to Clostridium botulinum neurotoxins. Toxicon 2000, 38:245–258.

    Article  PubMed  CAS  Google Scholar 

  34. Goadsby PJ, Edvinsson L: The trigeminovascular system and migraine: studies characterizing cerebrovascular and neuropeptide changes seen in humans and cats. Ann Neurol 1993, 33:48–56.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurology, University of Münster, Albert-Schweitzer-Str. 33, 48129, Münster, Germany

    Stefan Evers MD

Authors
  1. Stefan Evers MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Evers, S. Is there a role for botulinum toxin in the treatment of migraine?. Current Science Inc 7, 229–234 (2003). https://doi.org/10.1007/s11916-003-0078-1

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11916-003-0078-1

Keywords

Search

Navigation