Treatment of chronic cervical-associated headache with botulinum toxin A: A pilot study

Objective.-To see whether therapy with botulinum toxin A may prove to be an effective treatment for headache of musculoskeletal origin. Background.-Headache is a common finding associated with neck injury. Cervi cogenic headache, which is believed to be attributable to injury of the lig aments, muscles, or joints of the cervical spine, is centered in the occipi tal region with pain referred to the frontotemporal region. Botulinum toxin A produces prolonged muscle relaxation, which is dose dependent and can be easily targeted to affected muscles. Methods.-This randomized, double-blind, placebo-controlled study compares o utcome measures in 26 patients suffering from chronic headache subsequent t o a cervical whiplash injury. One half of the patients received botulinum t oxin A, 100 units, diluted in 1 mL of saline, while the other half received just saline (1 mt). Five cervical trigger points received 0.2 mL each of i njectant via a 30-gauge needle. Outcome measures included subjective head p ain based on visual analog scales, as well as range of neck motion. Follow- up assessments were carried out at 2 and 4 weeks after treatment. Results.-Fourteen subjects who received botulinum toxin A and 12 who receiv ed saline completed the study. At both 2 and 4 weeks post injection, the tr eatment group showed a significant improvement in pain and range of motion from preinjection levels (P < .01). The placebo group demonstrated no stati stically significant changes at any posttreatment time.