Treatment of tension-type headache with botulinum toxin type A: A double-blind, placebo-controlled study

Objective.-To determine whether injections of botulinum toxin could be of t herapeutic value in the treatment of tension-type headache. Background.-Botulinum toxin A is very effective at reducing muscle tenderne ss and pain In many diseases. Increased muscle tension may contribute to te nsion-type headache. Methods.-We performed a double-blind, placebo-controlled study with 21 pati ents fulfilling the International Headache Society criteria for tension-typ e headache. Participants were randomly assigned to treatment (pericranial i njection of 10 x 20 mouse units botulinum toxin A) or placebo (injection of isotonic saline in the same manner). Results.-After 4, 8, and 12 weeks, no significant differences between place bo and treatment could he observed (with respect to visual analog scale, fr equency and duration of headache attacks, consumption of analgesics, pressu re pain threshold, total tenderness score, and quality-of-life parameters). Conclusions.-The findings of our study strongly support the hypothesis that peripheral mechanisms, such as increased muscle tenderness, only play a mi nor role in the pathogenesis of tension-type headache.