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      Evidence to Use Botulinum Toxin Injections in Tension-Type Headache Management: A Systematic Review

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          Abstract

          Tension-type headache (TTH) is the most common type of chronic recurring head pain. It can occur twice as often in women as in men. It is the most common type of headache. Its lifetime prevalence is 30% to 78% in the general population. TTH treatment should be multilevel. It often consists of taking pain medication, muscle relaxants, antidepressants, using biofeedback therapy, acupuncture, and attending behavioral therapy. Several clinical trials also suggest that botulinum toxin (BTX) may be an effective treatment option for such patients. The aim of this study was to evaluate if BTX can be used as a treatment method in TTH in the light of current medical literature. The authors searched the PubMed, EBSCOhost, OVID, Web of Knowledge, Cochrane Library and CINAHL databases to identify relevant publications. The authors finally included 11 papers—prospective and retrospective cohort studies. Among most of the selected studies, there was a significant correlation between using BTX and reduction of TTH pain intensity and severity. By analyzing qualified studies, it can be concluded that botulinum toxin seems to be effective in TTH management.

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          Most cited references20

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          Epidemiology of tension-type headache.

          Tension-type headache is a highly prevalent condition. Because few population-based studies have been performed, little is known about its epidemiology. To estimate the 1-year period prevalence of episodic tension-type headache (ETTH) and chronic tension-type headache (CTTH) in a population-based study; to describe differences in 1-year period prevalence by sex, age, education, and race; and to describe attack frequency and headache pain intensity. Telephone survey conducted 1993 to 1994. Baltimore County, Maryland. A total of 13 345 subjects from the community. Percentage of respondentswith diagnoses of headache using International Headache Society criteria. Workdays lost and reduced effectiveness at work, home, and school because of headache, based on self-report. The overall prevalence of ETTH in the past year was 38.3%. Women had a higher 1-year ETTH prevalence than men in all age, race, and education groups, with an overall prevalence ratio of 1.16. Prevalence peaked in the 30- to 39-year-old age group in both men (42.3%) and women (46.9%). Whites had a higher 1-year prevalence than African Americans in men (40.1% vs. 22.8%) and women (46.8% vs 30.9%). Prevalence increased with increasing educational levels in both sexes, reaching a peak in subjects with graduate school educations of 48.5% for men and 48.9% for women. The 1-year period prevalence of CTTH was 2.2%; prevalence was higher in women and declined with increasing education. Of subjects with ETTH, 8.3% reported lost workdays because of their headaches, while 43.6% reported decreased effectiveness at work, home, or school. Subjects with CTTH reported more lost workdays (mean of 27.4 days vs 8.9 days for those reporting lost workdays) and reduced-effectiveness days (mean of 20.4 vs 5.0 days for those reporting reduced effectiveness) compared with subjects with ETTH. Episodic tension-type headache is a highly prevalent condition with a significant functional impact at work, home, and school. Chronic tension-type headache is much less prevalent than ETTH; despite its greater individual impact, CTTH has a smaller societal impact than ETTH.
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            Botulinal neurotoxins: revival of an old killer.

            Botulinal neurotoxins (BoNTs) produced by anaerobic bacteria of the genus Clostridium are the most toxic proteins known, with mouse LD(50) values in the range of 1-5 ng/kg. They are responsible for the pathophysiology of botulism. BoNTs are metalloproteinases that enter peripheral cholinergic nerve terminals, where they cleave one or two of the three core proteins of the neuroexocytosis apparatus and elicit persistent but reversible inhibition of neurotransmitter release. Their specificity of action has made them useful therapeutic agents for many human syndromes caused by hyperactivity of cholinergic nerve terminals. Their range of clinical applications is continuously growing, and BoNT/A is being used extensively as a pharmaco-cosmetic.
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              Botulinum toxin type A (BOTOX) for treatment of migraine headaches: an open-label study.

              The object of this clinical experience was to evaluate the correlation between pericranial botulinum toxin type A (BOTOX, Allergan Corp, Irvine, CA) administration and alleviation of migraine headache symptoms. A nonrandomized, open-label study was performed at 4 different test sites. The subjects consisted of 106 patients, predominantly female, who either (1) initially sought BOTOX treatment for hyperfunctional facial lines or other dystonias with concomitant headache disorders, or (2) were candidates for BOTOX treatment specifically for headaches. Headaches were classified as true migraine, possible migraine, or nonmigraine, based on baseline headache characteristics and International Headache Society criteria. BOTOX was injected into the glabellar, temporal, frontal, and/or suboccipital regions of the head and neck. Main outcome measures were determined by severity and duration of response. The degrees of response were classified as: (1) complete (symptom elimination), (2) partial > or =50% reduction in headache frequency or severity), and (3) no response [neither (1) nor (2)]. Duration of response was measured in months for the prophylactic group. Among 77 true migraine subjects treated prophylactically, 51% (95% confidence interval, 39% to 62%) reported complete response with a mean (SD) response duration of 4.1 (2.6) months; 38% reported partial response with a mean (SD) response duration of 2.7 (1.2) months. Overall improvement was independent of baseline headache characteristics. Seventy percent (95% confidence interval, 35% to 93%) of 10 true migraine patients treated acutely reported complete response with improvement 1 to 2 hours after treatment. No adverse effects were reported. BOTOX was found to be a safe and effective therapy for both acute and prophylactic treatment of migraine headaches. Further research is needed to explore and develop the complete potential for the neuroinhibitory effects of botulinum toxin.
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                Author and article information

                Contributors
                Role: Academic Editor
                Role: Academic Editor
                Journal
                Toxins (Basel)
                Toxins (Basel)
                toxins
                Toxins
                MDPI
                2072-6651
                15 November 2017
                November 2017
                : 9
                : 11
                : 370
                Affiliations
                [1 ]Department of Experimental Dentistry, Wroclaw Medical University, 50-425 Wroclaw, Poland; joannasmardz1@ 123456gmail.com
                [2 ]Department of Prosthetic Dentistry, Wroclaw Medical University, 50-425 Wroclaw, Poland; natgrychowska@ 123456gmail.com
                [3 ]Department of Periodontology, Wroclaw Medical University, 50-425 Wroclaw, Poland; marekzietek@ 123456gazeta.pl
                [4 ]City Hospital No. 4, 44-100 Gliwice, Poland; gniewkowieckiewicz@ 123456gmail.com
                Author notes
                [* ]Correspondence: m.wieckiewicz@ 123456onet.pl ; Tel.: +48-660478759
                Article
                toxins-09-00370
                10.3390/toxins9110370
                5705985
                29140286
                bc553da0-82f9-427d-9929-fca0628cfc94
                © 2017 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 23 September 2017
                : 10 November 2017
                Categories
                Review

                Molecular medicine
                tension type headache,botulinum toxin,injections
                Molecular medicine
                tension type headache, botulinum toxin, injections

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