EFFICACY OF BOTOX INJECTION AROUND SCALP NERVES AS PROPHYLAXIS FOR CHRONIC DAILY HEADACHE

Objective To assess the efficacy and safety of low doses of botulinum toxin type A (BoNT-A) for the prophylaxis of headaches in patients with chronic daily headache (CDH) in a new mapping of infiltration. Design and Methods This was a prospective -controlled 6 months study for 112 patients with CDH. Compared between two groups of patients, Group I - 65 patients treated with medication (classic method) and Group II - 47 patients treated by BoNTA. Patients monthly recorded for day occurrence, frequency, severity and associated headache symptoms. Results All time points of the 6-month study, there was a statistical significant decrease in the mean change from baseline for the frequency, number and severity of headaches for BoNT-A group as compared with classical one. In the classical group frequency decreased from 11.57 to 8.94 (22 % reduction) while in BoNT-A the frequency decreased from 12.19 to 3.85 (68 % reduction) p= .001. Regarding mean number of headaches per month, classical group from 21.25 to 11.23 (47% reduction); BoNT-A: from 22.11 to 5.91 (73 % reduction); P = .001. Mean headache severity in the BoNT-A group: no pain 24 (51.1%), mild 22 (46.8%), moderate 1 (2.1%) and no one severe pain as compare with classical method no pain 22 (33.8%), mild 29 (44.6%), moderate 13 (20.0%) and one case severe pain (1.5%) P= 021. Except for sensitivity to light, sound other associated symptom nausea, vomiting and headache with physical activity there was statistical significant decrease in the BoNT-A as compared to classical group P=.042, .032 and .021 respectively. Conclusions The small doses of the BoNT-A without using other prophylactic medications is an effective and well-tolerated prophylactic treatment in patients with CDH.