Curr Treat Options Neurol. 2003 Nov;5(6):483-492.   

 
The Use of Botulinum Toxins for Chronic Pain and Headaches.

Argoff CE.

Cohn Pain Management Center, North Shore University Hospital and New York University School of Medicine, 4300 Hempstead Turnpike, Bethpage, NY 11714, USA. pargoff@optonline.net

The use of botulinum toxin in the management of various neurologic and non-neurologic disorders has grown considerably over the past decade. At the same time, new information regarding the mechanism of action of these toxins has evolved allowing for a greater understanding of the versatility of these agents. Although two types of botulinum toxin (type A Botox and type B Myobloc ) are commercially available in the US, most studies of the use of these toxins for the management of chronic pain and headache have been completed with type A. Data from open-label and retrospective studies as well as clinical practice suggest as strongly as possible that there is a role for these agents, especially Botox, in the management of several chronic headache disorders, including chronic migraine, chronic tension-type, cervicogenic, and cluster headache. Emerging data regarding the use of these agents for so-called "analgesic-rebound" headache also appear impressive; however, as of yet, no multicenter, randomized, controlled studies for any headache type have been published that confirm the results seen in noncontrolled studies. Nevertheless, the benefit that some patients experience from this agent is impressive, and this drug appears for many to modify the disorder in a very positive manner. In a similar fashion, data for other pain states are often restricted to open-label and case study approaches; however, clinical experience and some of the available studies (even small controlled studies) suggest a role for the toxins in the management of various chronic pain states, such as myofascial pain, low back pain, and neuropathic pain. One of the greatest challenges ahead for all interested in this area is confirming the benefit seen clinically through appropriately designed multicenter, randomized, controlled studies.

PMID: 14516525 
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J Neurol. 2004 Feb;251 Suppl 1:I19-30.
Botulinum toxin in the treatment of rare head and neck pain syndromes: a systematic review of the literature.

Sycha T, Kranz G, Auff E, Schnider P.

Department of Neurology, Division of Neurological Rehabilitation, University of Vienna, Austria.

[90% of this abstract has been deleted because of the technical data ref. methods of study and data analysis. --Bob Johnson]

REVIEWERS' CONCLUSIONS: There is convincing evidence for the effectiveness of BoNT in the treatment of pain associated with cervical dystonia. Due to the frequent adverse effects predominantly observed with higher doses, the trade off in risk and benefit should be carefully considered in each case. For all other rare head and neck pain syndromes we found no [randomized controlled trials for] (CLUSTER HEADACHE, chronic paroxysmal hemicrania, trigeminal neuralgia) and only a few small sized trials (cervicogenic headache, chronic neck pain, temporomandibular disorders). We were therefore unable to draw any definite conclusions.

Publication Types:
Review

PMID: 14991339 [PubMed]