Botulinum toxin (DYSPORT) in tension-type headaches

Botulinum toxin type A is effective in the reduction of muscle tenderness and pain in many diseases associated with myofascial pain. Since increased muscle tension may contribute to tension-type headaches, injections of botulinum toxin could be of therapeutic value.

Results of own investigations are presented, in particular a double-blind, placebo-controlled study with 21 patients fulfilling the International Headache Society criteria for tension-type hedaches. Participants were randomly assigned to verum (pericranial injection of 10 x 20 MU DYSPORT) or placebo condition (injection of isotonic saline in the same manner).

After 4, 8, and 12 weeks no significant differences between placebo and verum could be observed. Nevertheless, both groups significantly improved.

The findings strongly suggest that higher doses or other injection sites might be necessary to achieve therapeutic effects of botulinum toxin in tension-type headaches. Actually, we are participating in a multi-center study using 500 MU of DYSPORT. Besides dose-finding problems, another explanation could be that peripheral mechanisms--such as increased pericranial muscle tension--only play a minor role in the pathogenesis of tension-type headaches.