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Dhanasekara CS, Payberah D, Chyu JY, Shen CL, Kahathuduwa CN. The effectiveness of botulinum toxin for chronic tension-type headache prophylaxis: A systematic review and meta-analysis. Cephalalgia 2023; 43:3331024221150231. [PMID: 36786349 DOI: 10.1177/03331024221150231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
BACKGROUND A systematic and meta-analysis was conducted to examine the evidence of the effects of botulinum toxin A on chronic tension-type headache. METHODS Cochrane, Embase, Ovid, ProQuest, PubMed, Scopus, Web-of-Science databases, and ClinicallTrials.gov registry were systematically searched for studies examining the effects of botulinum toxin A on tension-type headaches. The records were screened by two independent reviewers using pre-determined eligibility criteria. DerSimonian Liard random-effects meta-analyses were performed using the 'meta' package (5.2-0) in R (4.2.0). Risk of bias and quality of evidence were assessed using the Cochrane Collaboration's Tool RoB 2 and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Clinical significance was determined using pre-defined minimal clinically important differences. RESULTS Eleven controlled trials were included (390 botulinum toxin A, 297 controls). Botulinum toxin A was associated with significant improvements in standardized headache intensity (-0.502 standard deviations [-0.945, -0.058]), headache frequency (-2.830 days/month [-4.082, -1.578]), daily headache duration (-0.965 [-1.860, -0.069]) and the frequency of acute pain medication use (-2.200 days/month [-3.485, -0.915]) vs controls. Botulinum toxin A-associated improvements exceeded minimal clinically important differences for headache intensity, frequency, and acute pain medication use. A 79% (28%, 150%) greater response rate was observed for botulinum toxin A vs controls in improving chronic tension-type headache. Treatment of eight chronic tension-type headache patients was sufficient to elicit a therapeutic response in one patient. CONCLUSIONS Corroborating the current mechanistic evidence, our meta-analysis supports the utility of botulinum toxin A for managing chronic tension-type headaches. However, due to limitations in the quality of evidence, adequately-powered high-quality controlled trials examining the effects of Botulinum toxin A on chronic tension-type headache are warranted. REGISTRATION Protocol preregistered in PROSPERO International Prospective Register of Systematic Reviews (CRD42020178616).
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Affiliation(s)
- Chathurika S Dhanasekara
- Department of Surgery, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Daniel Payberah
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Joanna Y Chyu
- School of Medicine, University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Chwan-Li Shen
- Department of Pathology, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA.,Center of Excellence for Integrative Health, Texas Tech University Health Sciences Center, Lubbock, TX, USA.,Center of Excellence for Translational Neuroscience and Therapeutics, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Chanaka N Kahathuduwa
- Center of Excellence for Integrative Health, Texas Tech University Health Sciences Center, Lubbock, TX, USA.,Center of Excellence for Translational Neuroscience and Therapeutics, Texas Tech University Health Sciences Center, Lubbock, TX, USA.,Department of Psychiatry, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA.,Department of Neurology, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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Karaoğlan M. Three men in a boat: The comparison of the combination therapy of botulinum toxin and greater occipital nerve block with bupivacaine, with botulinum toxin monotherapy in the management of chronic migraine. Clin Neurol Neurosurg 2023; 226:107609. [PMID: 36731164 DOI: 10.1016/j.clineuro.2023.107609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/31/2022] [Accepted: 01/02/2023] [Indexed: 01/22/2023]
Abstract
OBJECTIVE This study compared the impact of the combination therapy of onabotulinum toxin A and greater occipital nerve block (GoNT-A) with onabotulinum toxin A monotherapy (BoNT-A) based on its efficacy and safety in relation to the quality of life of adult chronic migraine (CM) patients. BACKGROUND Prophylactic treatment of CM is still difficult and complex. Combination treatments do not have an evidence base yet. METHODS This retrospective study included 85 patients. For greater occipital nerve block (GONB), 4 ml of the solution prepared using 1 ml of 0.5% bupivacaine and 3 ml of saline on both sides were bilaterally applied to 30 patients. For BoNT-A treatment, a total of 155 units of onabotulinum toxin A (BOTOX®) was intramuscularly injected into 31 specific points around the head and neck in 27 patients. Both protocols were similarly applied to 28 patients for GoNT-A treatment. MIDAS and HIT-6 scores were evaluated to measure patients' quality of life three months after the treatment. RESULTS When MIDAS and HIT-6 score groups were statistically compared, both GONB and GoNT-A applications showed a statistically significant reduction compared to the BoNT-A application (p < 0.05). The decrease in the MIDAS and HIT-6 scores of GONB and GoNT-A applications did not show a statistical difference (p > 0.05). CONCLUSION The combination of BoNT-A and GONB was superior to BoNT-A applied as monotherapy. Alternately, no significant difference was found between GONB therapy and combination therapy in all data. Combination treatments were well tolerated.
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Fan X, Fu G, Wang L, Shen W, Zhang Y. A bibliometric analysis and visualization of tension-type headache. Front Neurol 2022; 13:980096. [PMID: 36119709 PMCID: PMC9471986 DOI: 10.3389/fneur.2022.980096] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 08/08/2022] [Indexed: 12/04/2022] Open
Abstract
Background Tension-type headache (TTH) is the most prevalent headache in the clinical practice, leading to impaired social activities, work-related disability, and heavy financial burdens. Previous studies have described possible inducement, potential pathophysiology, and clinical management of TTH; however, due to the lack of attention, literature involving bibliometric analysis is sporadic. Therefore, this study aimed to explore the current hotspots and future directions of the TTH field by bibliometric analysis. Methods By using CiteSpace and VOSviewer, literature regarding TTH between 2002 and 2021 from the Web of Science database was summarized and extracted. Annual publication trend, the most productive countries/regions and institutions, distribution of categories, co-citation of journals and references, and co-occurrence of keywords were analyzed. Results A total of 3,379 publications were included in the final visualization, indicating a stable trend in current research and a lack of breakthroughs over the past decades. These studies were mainly conducted in 120 countries/regions led by the United States and more than 600 institutions. Four eternal core themes were identified in TTH, including neurosciences, nursing, developmental psychology, and general/internal medicine. Cephalalgia ranked first, with the highest number of literature, and is the most influential journal in this area. Keyword analysis demonstrated that the similarities and differences between migraine and TTH, epidemiological studies, clinical double-blind trials, and potential populations have become key issues in the TTH field. Conclusion TTH has received less attention and breakthroughs in the past 20 years. To promote coordinated development between regions to fight headaches, cooperation and exchanges between countries and institutions are essential in the future. Relevant studies about headaches in children and adolescents, inducing factors such as emotional triggers and sleep disorders, concomitant diseases, possible pathogenesis, and headache treatments, are in the spotlight in recent years. This study offers a powerful roadmap for further research in this field.
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Romero-Godoy R, Romero-Godoy SR, Romero-Acebal M, Gutiérrez-Bedmar M. Psychiatric Comorbidity and Emotional Dysregulation in Chronic Tension-Type Headache: A Case-Control Study. J Clin Med 2022; 11:jcm11175090. [PMID: 36079022 PMCID: PMC9457147 DOI: 10.3390/jcm11175090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/18/2022] [Accepted: 08/25/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Chronic tension-type headache (CTTH) is frequently associated with a psychiatric comorbidity of depression and anxiety. Most studies focus their attention on this association, and only few link CTTH with psycho-affective emotional regulation disorders. Objective: To evaluate the association of CTTH with anxiety, depression, positive and negative affectivity, and emotional management in CTTH patients with neither a previous diagnosis of psychiatric disorder nor use of psychoactive drugs or abuse of analgesics. Design: Case-control study. Methods: Validated scores for state and trait anxiety, depression, positive and negative state and trait affect, cognitive reappraisal, and expressive suppression were assessed in 40 subjects with CTTH and 40 healthy subjects. Associations between CTTH and psychological status were assessed through linear multivariate regression models. Results: CTTH was associated with higher scores for depression (Beta = 5.46, 95% CI: 1.04–9.88), state and trait anxiety (Beta = 12.77, 95% CI: 4.99–20.56 and Beta = 8.79, 95% CI: 2.29–15.30, respectively), and negative state affect (Beta = 5.26, 95% CI: 0.88–9.64). Conclusions: CTTH is directly associated with depression, anxiety, and negative affectivity signs despite the absence of a previously diagnosed psychiatric disorder or psychopharmacological intake. The recognition of these comorbid and psycho-affective disorders is essential to adapt the emotional management of these patients for better control.
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Affiliation(s)
- Rosalinda Romero-Godoy
- Department of Nursing and Physiotherapy, University of Balearic Islands, 07122 Palma, Spain
- Cognitive Affective Neuroscience Clinical Psychology Research Group, Institute of Health Science Research (IUNICS-IdISBa), ECYCS Research Group, University of Balearic Islands, 07120 Palma, Spain
- Correspondence: (R.R.-G.); (M.G.-B.)
| | | | - Manuel Romero-Acebal
- Neurology Department, Virgen de la Victoria University Hospital, 29010 Malaga, Spain
| | - Mario Gutiérrez-Bedmar
- Preventive Medicine and Public Health Department, School of Medicine, University of Málaga, 29010 Malaga, Spain
- Biomedical Research Institute of Malaga-IBIMA, 29010 Malaga, Spain
- CIBERCV Cardiovascular Diseases, Carlos III Health Institute, 28029 Madrid, Spain
- Correspondence: (R.R.-G.); (M.G.-B.)
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Roland SB, Pripp AH, Msomphora MR, Kvarstein G. The efficacy of botulinum toxin A treatment for tension-type or cervicogenic headache: a systematic review and meta-analysis of randomized, placebo-controlled trials. Scand J Pain 2021; 21:635-652. [PMID: 34090319 DOI: 10.1515/sjpain-2021-0038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 05/04/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The pathogeneses of chronic tension-type headache (CTTH) and cervicogenic headache (CEH) are not well established. Peripheral activation or sensitization of myofascial nociceptors is suggested as a potential mechanism and injections of botulinum toxin (BONTA) have thus been used in the treatment for both headache conditions. BONTA inhibits the release of acetylcholine at the neuromuscular junction and inhibits contraction of skeletal muscles. If the pain is precipitated by increased tone in cervical muscles, local injections of BONTA could represent a prophylactic measure. However, the treatment is still controversial, and a thorough assessment of the current evidence is required. This review aims to assess the evidence of BONTA injection as a prophylactic treatment for CTTH and CEH by reviewing and examining the quality of placebo-controlled, randomized trials. METHODS Data sources: we searched in the following databases: PubMed (including Medline), Embase, Cochrane Central register of Controlled Trials, Cinahl, Amed, SCOPUS and Google Scholar including other repository sources. Both MeSH and free keywords were used in conducting the systematic search in the databases. The search covered publications from the root of the databases to November 2020. STUDY ELIGIBILITY CRITERIA The review included RCTs, comparing single treatment of BONTA with placebo on patients with CTTH or CEH above 18 years of age, by measuring pain severity/relief or headache frequency. DATA EXTRACTION The following data were extracted: year of publication, country, setting, trial design, number of participants, injection procedure, BONTA dosages, and clinical outcome measures. STUDY APPRAISAL To assess validity and quality, and risk of bias, the Oxford Pain Validity Scale, Modified Jadad Scale, last version of Cochrane Collaboration's tool for assessing risk of bias (RoB 2), and the CONSORT 2010 Checklist were used. The trials were assessed, and quality scored independently by two of the reviewers. A quantitative synthesis and meta-analyses of headache frequency and intensity were performed. RESULTS We extracted 16 trials, 12 on prophylactic BONTA treatment for CTTH and four on CEH. Of these 12 trials (8 on CTTH and 4 on CEH) were included in the quantitative synthesis. A majority of the trials found no significant difference on the primary outcome measure when BONTA treatment was compared with placebo. Three "positive" trials, reporting significant difference in favor of BONTA treatment, but two of these were hampered by low validity and quality scores and high risk of bias. CONCLUSIONS There is no clear clinical evidence supporting prophylactic treatment with BONTA for CTTH or CEH.
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Affiliation(s)
- Sissel Breivold Roland
- Department of Orthopedics, Finnmark Hospital Trust, Hammerfest, Norway.,Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.,Pain Clinic, Division of Surgical Medicine and Intensive Care, University Hospital of North Norway, Tromsø, Norway
| | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Mbachi Ruth Msomphora
- Research and Publishing Support, Department of Library services, UiT The Arctic University of Norway, Tromsø, Norway
| | - Gunnvald Kvarstein
- Pain Clinic, Division of Surgical Medicine and Intensive Care, University Hospital of North Norway, Tromsø, Norway.,Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
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Sinus, disabling tension-type, and temporomandibular joint headaches. Curr Opin Neurol 2021; 34:344-349. [PMID: 33709975 DOI: 10.1097/wco.0000000000000918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Clinicians frequently face questions from headache patients regarding the roles played by sinus issues, muscle tension, and temporomandibular joint (TMJ) problems. This review highlights new concepts regarding the diagnosis and management of these headache conditions and their differentiation from migraine. RECENT FINDINGS Recent research has clarified the roles played by pathology in the paranasal sinuses and TMJ in patients reporting headache. Additional information from physiologic studies in patients with tension-type headache (TTH) has improved the understanding of this condition. SUMMARY Improved understanding of sinus headache, disabling TTH, and TMJ headache and their differentiation from migraine will lead to reductions in unnecessary diagnostic procedures and unwarranted medical and surgical procedures. More expedient recognition of the origin of headache should lead to improved therapeutic outcomes.
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Botulinum Toxin in the Treatment of Headache. Toxins (Basel) 2020; 12:toxins12120803. [PMID: 33348571 PMCID: PMC7766412 DOI: 10.3390/toxins12120803] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/08/2020] [Accepted: 12/11/2020] [Indexed: 12/20/2022] Open
Abstract
Botulinum toxin type A has been used in the treatment of chronic migraine for over a decade and has become established as a well-tolerated option for the preventive therapy of chronic migraine. Ongoing research is gradually shedding light on its mechanism of action in migraine prevention. Given that its mechanism of action is quite different from that of the new monoclonal antibodies directed against calcitonin gene-related peptide (CGRP) or its receptor, it is unlikely to be displaced to any major extent by them. Both will likely remain as important tools for patients with chronic migraine and the clinicians assisting them. New types of botulinum toxin selective for sensory pain neurons may well be discovered or produced by recombinant DNA techniques in the coming decade, and this may greatly enhance its therapeutic usefulness. This review summarizes the evolution of botulinum toxin use in headache management over the past several decades and its role in the preventive treatment of chronic migraine and other headache disorders.
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Primaries non-migraine headaches treatment: a review. Neurol Sci 2020; 41:385-394. [PMID: 33021705 DOI: 10.1007/s10072-020-04762-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In the "headache world," great attention has always been paid to migraine patients, especially for the research and development of new therapies. For the other forms of primary headaches, especially those of Chapters 2 and 3 of the classification, there are however therapies that, even if not specific, can give significant results. Tension-type headache recognizes in NSAIDs the most effective drugs to treat acute attack, while prevention is based on the use of tricyclic antidepressants and muscle relaxants. For TACs, the discussion is more complex: first of all, there are two forms of primary headache that respond absolutely to indomethacin. For these, the main problem is how to manage the possible side effects arising from prolonged treatments and possibly what to use as an alternative. For cluster headaches and short-lasting unilateral neuralgiform headache attacks, we have drugs with good efficacy as regards medical therapy, such as verapamil or lamotrigine, but in recent years, neuromodulation techniques, both surgical and non-invasive, have also been affirming themselves, which represent a more possibility for forms of headache that are often very disabling and resistant to common analgesics.
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Abstract
AIMS To conduct a review of the literature on the use of botulinum toxin for the treatment of pediatric chronic migraine. METHODS A review of the literature was performed using EMBASE, PubMed, and Cochrane/Ovid. Using our inclusion and exclusion criteria, we targeted any study, published before April 2020, evaluating the efficacy of botulinum toxin in migraineurs younger than 18 years. RESULTS Seven studies were included: 2 retrospective analyses, 3 case series, a case report, and a randomized control trial. Studies included 1 to 125 patients, with the number of botulinum toxin treatments ranging from 1 to 11 treatments. The results of the randomized controlled trial showed nonsuperiority between placebo and botulinum toxin. Results of the other studies were generally favorable but were difficult to compare because of lack of standardization of botulinum toxin dosing, injection paradigm, frequency and duration of treatment, usage of accompanying prophylaxis, and variation in outcome measures across studies. There was low-quality evidence that botulinum toxin improved headache frequency and intensity, though some studies demonstrated efficacy in treatment with botulinum toxin. CONCLUSION This review is the first of its kind, updating the literature on the efficacy of botulinum toxin in pediatric patients. Given evidence of its utility in treating pediatric migraines, off-label use should be considered in certain cases. Further study is warranted to better characterize injection paradigms and patient selection because of the limited and inconsistent data available.
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Affiliation(s)
- Raymundo Marcelo
- 158147Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Brin Freund
- 158147Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,Department of Neurology, 1501Johns Hopkins Hospital, Baltimore, MD, USA
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Robblee J, Singh RH. Headache in the Older Population: Causes, Diagnoses, and Treatments. Curr Pain Headache Rep 2020; 24:34. [DOI: 10.1007/s11916-020-00866-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Yuan H, Silberstein SD. The Use of Botulinum Toxin in the Management of Headache Disorders. Handb Exp Pharmacol 2020; 263:227-249. [PMID: 32562057 DOI: 10.1007/164_2020_365] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Tremendous progress has been made in the past decades for the treatment of headache disorders. Chronic migraine is the most disabling type of headache and requires the use of acute and preventive medications, many of which are associated with adverse events that limit patient adherence. Botulinum toxin (BoNT) serotype A, a neurotoxin derived from certain strains of Clostridium, disrupts neuropeptide secretion and receptor translocation related to trigeminal nociception, thereby preventing pain sensitization through peripheral and possibly central mechanisms. Ever since the first randomized controlled trial on onabotulinumtoxinA (onabotA) for migraine was published two decades ago, onabotA has been the only BoNT formulation approved for use in the prevention of chronic migraine. Superior tolerability and efficacy have been demonstrated on multiple migraine endpoints in many controlled trials and real-life studies. OnabotA is a safe and efficacious treatment for chronic migraine and possibly high-frequency episodic migraine. Further research is still needed to understand its mechanism of action to fully develop its therapeutic potential.
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Affiliation(s)
- Hsiangkuo Yuan
- Jefferson Headache Center, Thomas Jefferson University, Philadelphia, PA, USA
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