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Medline ® Abstract for Reference 50

of 'Cervicogenic headache'

Onabotulinum toxin A treatment of cervicogenic headache: a randomised, double-blind, placebo-controlled crossover study.
Linde M, Hagen K, SalvesenØ, Gravdahl GB, Helde G, Stovner LJ
Cephalalgia. 2011 May;31(7):797-807. Epub 2011 Feb 7.
AIMS: Preliminary reports regarding injections in the neck of onabotulinum toxin A have been positive in cervicogenic headache (CeH). The aim was to perform the first methodologically rigorous trial.
METHODS: A randomised, placebo-controlled, patient-, injector- and evaluator-blinded crossover study included 28 adult patients with a long-standing and treatment-resistant CeH. After a baseline period, injections of either onabotulinum toxin A or placebo were given in fixed sites in the neck muscles on the pain side. Second injections were given after≥8 weeks. Patients were thereafter followed for another 8 weeks. A detailed headache calendar was filled in, and patients were followed with quality-of-life (QoL) questionnaires, algometry and neck mobility measurements.
RESULTS: There was no significant difference between verum and placebo in a mixed linear model analysis (p = 0.084) with regard to the primary end-point, reduction of days with moderate to severe headache. Six patients withdrew from the study before the second injections, but an intention-to-treat (ITT)analysis gave a similar result (p = 0.27). There were no significant differences favouring verum in any of the secondary efficacy measures. Side-effects of onabotulinum toxin A were minor and short-lasting.
CONCLUSION: Onabotulinum toxin A in neck muscles does not seem to be beneficial in CeH.
Norwegian University of Science and Technology, Norway. mattias.linde@ntnu.no