Prophylactic treatment of chronic tension‐type headache using botulinum toxin type A

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Abstract
Chronic tension‐type headache is a common condition, the pathophysiology of which is not well understood. Over‐activity of the pericranial muscles is thought to play a role, although sustained muscle contraction is probably a consequence, rather than a cause, of headache. Botulinum toxin type A (BTX‐A) is useful in many conditions involving excessive muscle contraction and may therefore be effective in relieving the pain associated with this type of headache. To investigate the efficacy of BTX‐A in relieving pain associated with chronic tension‐type headache, a double‐btind, randomised, placebo‐controlled study was carried out, in which 37 patients received BTX‐A, injected into the temporalis or cervical muscles of the neck. Clinical outcome was measured over a 4‐month study period using headache diaries and chronic pain index scores. Patients treated with BTX‐A showed an improvement in headache severity over the 4‐month study period, with 13 out of 22 patients showing a 25, 50 or >50% improvement in headache score at Month 3 compared with two out of 15 patients in the placebo group. The number of headache‐free days increased significantly in the BTX‐A‐treated patient group, and patients recorded an improvement in quality of life following BTX‐A injection. It can be concluded that intramuscular injection of BTX‐A is an effective treatment for chronic tension‐type headache.