Botulinum Toxin for Chronic Daily Headache
About 2% of the world's population suffers from one of the most disabling headache, the chronic headache due to its ceaseless activity. In neurological practice, the people undergoing these headaches are considered among the most difficult and labor-intensive patients. The psychiatric comorbidities like depression and anxiety, are clinical entities related to chronic daily headache (CDH). An FDA approved drug for the treatment of chronic migraine is the botulinum toxin A (BTA), a subtype form of CDH. The potential efficacy and safety of BTA for controlling psychiatric symptoms in CDH patients have been well explained in this study.
This prospective, open-label, pilot study comprised of total of 30 individuals (7 males and 23 females). At many places, a single low-dose of BTA (40–120 U) was injected into the pericranial muscle. After BTA treatment, the patients were examined before and after 1, 4, 8, 12, 16, 20 and 24 weeks. The primary outcomes rendered were: (1) headache severity as understood by a visual analog scale; (2) depression and anxiety severity, analyzed via the Hamilton Depression and Anxiety Rating Scales (HAM-D and HAM-A, respectively); (3) headache frequency per month and (4) single headache episode term.
The intensity of headache was appreciably improved one week after treatment. The depression and anxiety symptoms were truncated one month after treatment. At the fourth month, headache incidence per month diminished from 28.83 ± 2.95 to 17.57 ± 11.30 d (p < 0.001), and the single headache duration decreased from 12.03 ± 9.47 to 6.63 ± 8.98 h (p < 0.001). Also, the analgesic requirement by the patients reduced. BTA was well tolerated, and the adverse events were mild and short-termed.
It was concluded that the BTA treatment eased the severity and frequency of CDH, with improvements in depression and anxiety. These novel discoveries points-out that BTA may constitute an effective and safe intervention to target psychiatric comorbidities in CDH.