Treatment of tension-type headache with botulinum toxin: a pilot study

We studied if injections of botulinum toxin into multiple pericranial muscles reduce pain of patients with tension-type headache. Nine patients with tension-type headache not sufficiently responding to physical therapy or to amitriptyline were studied. Patients kept a headache diary that was used to calculate the area under the headache curve (AUC) of 4 weeks before and after treatment. After a run-in phase of 4 weeks equal doses of 25 units (0.25ml) of botulinum toxin type A (Dysport) were injected into both frontal, temporal, occipital, and sternocleidomastoid muscles. Mean AUC of the 8 patients who completed the study was significantly reduced from 404 to 196 (p = 0.039). No major side effects were reported by the patients. These results justify further studies of botulinum toxin therapy in patients with tension type headache. The presented scheme for injections of botulinum toxin into multiple pericranial muscles is a rational basis for the design of such studies.