The Efficacy of Botulinum Toxin in Patients with Cervicogenic Headache: a Placebo-Controlled Clinical Trial

Abstract

Objective: Botulinum toxin type-A (BoNTA) has been considered a treatment option for CH. The aim of this study was to assess the effectiveness of BoNTA treatment in patients with medically resistant CH. Materials and Methods: Forty patients with CH were included in the study. Patients in the BoNTA group (n=20) were administered 10 U of BoNTA bilaterally to the frontal muscles, 20 U to the temporal muscles, 15 U to the semispinalis capitis, 15 U to the splenius capitis, and 15 U to the trapezius muscles (total: 150 U). Patients in the placebo group (n=20) received 0.2 mL of saline administrated to the same sites. All participations were evaluated 6 and 12 weeks after treatment; side effects, the number of painful days, severity (by visual analogue scale, VAS) and frequency of pain were evaluated. Results: In the BoNTA group, the severity and frequency of pain 6 and 12 weeks post treatment were significantly lower than pre-treatment levels (p<0.05). At 12 weeks post treatment, the severity and frequency of pain in the BoNTA group were lower than in the placebo group (p<0.05). Conclusion: The findings suggest that BoNTA was an effective treatment for CH.

Keywords

• Cervicogenic headache, Botulinum toxin A

The Efficacy of Botulinum Toxin in Patients with Cervicogenic Headache: a Placebo-Controlled Clinical Trial

Öz

Kaynakça

1. Sjaastad O, Saunte C, Hovdahl H, Breivik H, Grİnbaek E. “Cervi- cogenic” headache. An hypothesis. Cephalalgia 1983;3:249-56. [CrossRef]
2. Fredriksen TA, Hovdal H, Sjaastad O. “Cervicogenic headache”: clinical manifestation. Cephalalgia 1987;7:147-60. [CrossRef]
3. IHS, Headache Classification Committee of the International Headache Society. The international Classification of headache disorders:2nd edition. Cephalalgia 2004;24:9-160.
4. Wight S, Osborne N, Breen AC. Incidence of ponticulus posterior of the atlas in migraine and cervicogenic headache. J Manipul Physiol Ther 1999;22:15-20. [CrossRef]
5. Hack G. Cervicogenic headache: new anatomical discovery pro- vides the missing link. Chiroprac Rep 1998;12:1-3.
6. Mitchell BS, Humphreys BK, O’Sullivan E. Attachments of the lig- amentum nuchae to cervical posterior spinal dura and the lateral part of the occipital bone. J Manipul Physiol Ther 1998;21:145-8.
7. Alix ME, Bates DK. A proposed etiology of cervicogenic head- ache: the neurophysiologic basis and anatomic relationship between the dura mater and the rectus posterior capitis minor muscle. J Manipul Physiol Ther 1999;22:534-9. [CrossRef]
8. Leone M, D’Amico D, Moschiano F, Farinotti M, Filippini G, Bus- sone G. Possible identification of cervicogenic headache among patients with migraine: an analysis of 374 headaches. Headache 1995;35:461-4. [CrossRef]

9. Rothbart P. Cervicogenic headache: a pain in the neck. Can J Diagnos 1996;13:64-6.
10. Sjaastad O, Fredriksen TA. Cervicogenic headache: criteria, clas- sification and epidemiology. Clin Exp Rheumatol 2000;18:3-6.
11. Nilsson N. The prevalence of cervicogenic headache in a random population sample of 20-59 year olds. Spine 1995;20:1884-8. [CrossRef]
12. IHS, Headache Classification Committee of the International Headache Society. Classification and diagnostic criteria for head- ache disorders, cranial neuralgias, and facial pain. Cephalalgia 1988;8:1-96.
13. Kränzlin P, Wälchli B. The concept of cervicogenic headache. An- nual postgraduate course of the association of Swiss chiroprac- tors, vol. 13. Interlaken, Switzerland: 1993.
14. Anthony M. Cervicogenic headache: prevalence and response to local steroid therapy. Clin Exp Rheumatol 2000;18:59-64.
15. Shah PA, Nafee A. Clinical profile of headache and cranial neural- gias. J Assoc Physicians India 1999;47:1072-5.
16. Bono G, Antonaci F, Ghirmai S, D’Angelo F, Berger M, Nappi G. Whiplash injuries: clinical picture and diagnostic work-up. Clin Exp Rheumatol 2000;18:23-8.
17. Oqince M, Hall T, Robinson K, Blackmore AM. The diagnostic validity of the cervical flexion-rotation test in C1/C2 related cervi- cogenic headache. Man Ther 2007;12:256-62. [CrossRef]
18. Bovim G. Cervicogenic headache: Studies on clinical, anatomical and differential diagnostic factors. Tapir, Trondheim 1993.
19. Sjaastad O, Fredriksen T.A, Bono G, Nappi G. Cervicogenic Headache, Basic Consepts.European Headache Federation. Smith-Gordon, London 2003.
20. Bovim G, Berg R, Dale LG. Cervicogenic headache: anesthetic blockades of cervical nerves (C2-C5) and facet joint (C2/C3). Pain 1992;49:315-20. [CrossRef]
21. Freund BJ, Schwartz M. Treatment of chronic cervical-associat- ed headache with botulinum toxin A: a pilot study. Headache 2000;40:231-6. [CrossRef]
22. Sand T, Bovim G, Helde G. Intracutaneous sterile water injections do not relieve pain in cervicogenic headache. Acta Neurol Scand 1992;86:526-8. [CrossRef]
23. Hobson DE, Gladish DF. Botulinum toxin injection for cervico- genic headache. Headache 1997;37:253-5. [CrossRef]
24. Whittingham W, Ellis WB, Molyneux TP. The effect of manipu- lation (toggle recoil technique) for headaches with upper cer- vical joint dysfunction: a pilot study. J Manipul Physiol Ther 1994;17:369-75.
25. Vernon HT. Spinal manipulation and headaches of cervical origin. J Manipul Physiol Ther 1989;12:455-68.
26. Farina S, Granella F, Malferrari G, Manzoni GC. Headache and cervical spine disorders: classification and treatment with trans- cutaneous electrical nerve stimulation. Headache 1986;26:431-3. [CrossRef]
27. Nilsson N. A randomized controlled trial of the effect of spinal manipulation in the treatment of cervicogenic headache. J Ma- nipul Physiol Ther 1995;18:435-40.
28. Nilsson N, Christensen HW, Hartvigsen J. The effect of spinal ma- nipulation in the treatment of cervicogenic headache. J Manipul Physiol Ther 1997;20:326-30.
29. Howe D, Newcombe R, Wade M. Manipulation of the cervical spine a pilot study. J R Coll Gen Pract 1983;33:574-9.
30. Evers S, Rahmann A, Vollmer-Haase J, Husstedt IW. Treatment of headache with botulinum toxin A--a review according to ev- idence-based medicine criteria. Cephalalgia 2002;22:699-710. [CrossRef]
31. Schnider P, Moraru E, Bittner C, Vigl M, Wöber C, Maly J et al. Physical therapy and botulinum toxin type A in patients with cervical associated headache according to IHS criteria: double- blind, placebocontrolled study. Neurology 2001;56:A349.
32. Evers S. Status on the use of botulinum toxin for headache disor- ders. Curr Opin Neurol 2006;19:310-5.
33. Brunton LL, Lazo JS, Parker KL. Goodman & Gilman’s Teda- vinin farmakolojik temeli. Süzer Ö, Akın D, Süzer AH, Dedeoğlu BD, Küçükhüseyin C. (Çevirenler) 1. Baskı, İstanbul: Nobel Matbaacılık, 2009;225-30.
34. Colhado OC, Boeing M, Ortega LB. Botulinum toxin in pain treat- ment.Rev Bras Anestesiol 2009;59:366-81.
35. Aoki KR. Review of a proposed mechanism for the antinociceptive action of botulinum toxin type A. Neurotoxicology 2005;26:785-93. [CrossRef]
36. Mathew NT, Frishberg BM, Gawel M, Dimitrova R, Gibson J, Turkel C. Botulinum toxin type A (BOTOX) for the prophylactic treatment of chronic daily headache: A randomized, double- blind, placebo-controlled trial. Headache 2005;45:293-307. [CrossRef]
37. Dodick DW, Mauskop A, Elkind AH, DeGryse R, Brin MF, Silber- stein SD; BOTOX CDH Study Group. Botulinum Toxin Type A for the Prophylaxis of Chronic Daily Headache: Subgroup Analysis of Patients Not Receiving Other Prophylactic Medications: A Randomized Double-Blind, Placebo-Controlled Study. Headache 2005;45:315-24. [CrossRef]