0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Review |

Botulinum Toxin A for Prophylactic Treatment of Migraine and Tension Headaches in Adults: A Meta-analysis

Jeffrey L. Jackson, MD, MPH; Akira Kuriyama, MD; Yasuaki Hayashino, MD, DMSc, MPH
JAMA. 2012;307(16):1736-1745. doi:10.1001/jama.2012.505.
Text Size: A A A
Published online

Context Botulinum toxin A is US Food and Drug Administration approved for prophylactic treatment for chronic migraines.

Objective To assess botulinum toxin A for the prophylactic treatment of headaches in adults.

Data Sources A search of MEDLINE, EMBASE, bibliographies of published systematic reviews, and the Cochrane trial registries between 1966 and March 15, 2012. Inclusion and exclusion criteria of each study were reviewed. Headaches were categorized as episodic (<15 headaches per month) or chronic (≥15 headaches per month) migraine and episodic or chronic daily or tension headaches.

Study Selection Randomized controlled trials comparing botulinum toxin A with placebo or other interventions for headaches among adults.

Data Extraction Data were abstracted and quality assessed independently by 2 reviewers. Outcomes were pooled using a random-effects model.

Data Synthesis Pooled analyses suggested that botulinum toxin A was associated with fewer headaches per month among patients with chronic daily headaches (1115 patients, −2.06 headaches per month; 95% CI, −3.56 to −0.56; 3 studies) and among patients with chronic migraine headaches (n = 1508, −2.30 headaches per month; 95% CI, −3.66 to −0.94; 5 studies). There was no significant association between use of botulinum toxin A and reduction in the number of episodic migraine (n = 1838, 0.05 headaches per month; 95% CI, −0.26 to 0.36; 9 studies) or chronic tension-type headaches (n = 675, −1.43 headaches per month; 95% CI, −3.13 to 0.27; 7 studies). In single trials, botulinum toxin A was not associated with fewer migraine headaches per month vs valproate (standardized mean difference [SMD], −0.20; 95% CI, −0.91 to 0.31), topiramate (SMD, 0.20; 95% CI, −0.36 to 0.76), or amitriptyline (SMD, 0.29; 95% CI, −0.17 to 0.76). Botulinum toxin A was associated with fewer chronic tension-type headaches per month vs methylprednisolone injections (SMD, −2.5; 95% CI, −3.5 to −1.5). Compared with placebo, botulinum toxin A was associated with a greater frequency of blepharoptosis, skin tightness, paresthesias, neck stiffness, muscle weakness, and neck pain.

Conclusion Botulinum toxin A compared with placebo was associated with a small to modest benefit for chronic daily headaches and chronic migraines but was not associated with fewer episodic migraine or chronic tension-type headaches per month.

Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Figures

Place holder to copy figure label and caption
Figure 1. Change in Number of Monthly Headaches Among Adults in Randomized Controlled Trials of Botulinum Toxin A vs Placebo
Graphic Jump Location

Size of data markers is proportional to study weight.

Place holder to copy figure label and caption
Figure 2. Relative Risk of 50% Reduction in Number of Headaches per Month Among Adults in Randomized Controlled Trials of Botulinum Toxin A vs Placebo
Graphic Jump Location

Size of data markers is proportional to study weight.

Tables

References

CME


You need to register in order to view this quiz.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

15,620 Views
44 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles
Jobs
JAMAevidence.com

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Quick Reference

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Who Should Be Assessed for Migraine?

×
brightcove.createExperiences();