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Botulinum Neurotoxin Type A in the
Preventive Treatment of Refractory Headache:
A Review of 100 Consecutive Cases
Tepper SJ, Bigal ME, Sheftell FD, Rapoport AM
Posted: December 2004  
Headache 2004;44:794-800

Objectives:   To review the efficacy of botulinum neurotoxin type A (BoNT-A) in the preventive treatment of refractory headache.

Background:   Even after receiving expert care, some patients with refractory headache continue to have high disability and persistent headaches.

Results:   There was a statistically significant reduction of the frequency of headache days 1 month after BoNT-A was administered, which was maintained through the 3 months of study; similarly, a significant reduction in the headache index and number of severe days with headache per month were found at 1 month and maintained through the 3 months of study. MIDAS scores were reduced from 34.5 at baseline to 15.9 at 3 months. A similar pattern was found in those overusing versus nonoverusing acute medication, though the response was more dramatic in the nonoverusing group.

Conclusion:   BoNT-A may play a role in the preventive treatment of refractory headache. A significant number of patients showed decrease in clinically important measurements of their headaches as well as reduced headache-related disability with this treatment. Prospective, controlled studies must be considered for severely disabled, refractory patients.