Chronic Headache with Psychiatric Comorbidities: Is Botulinum Toxin A Effective?

Botulinum toxin A (BTA) alleviated the severity and frequency of chronic daily headache and improved depression and anxiety, a study in the International Journal of Neuroscience found.

Chronic daily headache is associated with psychiatric comorbidities such as depression and anxiety. BTA is currently approved by the Food and Drug Administration (FDA) to treat chronic migraine, a subtype of chronic daily headache. 

Researchers conducted a prospective, open-label, pilot study to investigate the potential efficacy and safety of BTA for controlling psychiatric symptoms in patients with chronic daily headache. Thirty patients received a single low dose of BTA (40–120U) injected into the pericranial muscle at multiple sites. They were evaluated prior to, and at 1, 4, 8,12,16, 20, and 24 weeks post-treatment. The study’s primary outcomes included headache severity determined by a visual analog scale (VAS), depression and anxiety assessed via the HAM-D and HAM-A scales, headache frequency per month, and single headache episode duration. 

Study results showed that the severity of headache was significantly reduced one week post-treatment, and symptoms of depression and anxiety were significantly reduced one month post-treatment. Headache incidence per month decreased from 28.83 to 17.57 days (P<0.001) at Month 4. Also, the single headache duration decreased from 12.03 to 6.63 hours (P<0.001). The percent of patients who needed analgesics significantly decreased as well. 

Overall, BTA treatment was well tolerated with mild and transient adverse events. Study findings support BTA as a potentially safe and effective treatment option to address psychiatric comorbidities in chronic daily headache. 

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