PMID- 17868356
OWN - NLM
STAT- MEDLINE
DCOM- 20080613
LR  - 20191210
IS  - 0017-8748 (Print)
IS  - 0017-8748 (Linking)
VI  - 48
IP  - 2
DP  - 2008 Feb
TI  - Predictors of response to botulinum toxin type A (BoNTA) in chronic daily 
      headache.
PG  - 194-200
AB  - OBJECTIVE: To evaluate predictors of response to botulinum toxin type A (BoNTA; 
      BOTOX, Allergan Inc., Irvine, CA, USA) in patients with chronic daily headache 
      (CDH). BACKGROUND: Chronic migraine (CM) and chronic tension-type headache (CTTH) 
      form the majority of CDH disorders. Controlled trials indicate that BoNTAis 
      effective in reducing the frequency of headache and number of headache days in 
      patients with CDH disorders. A recent migraine study found that patients with 
      imploding or ocular types of headaches were responders to BoNTA, whereas those 
      with exploding headaches were not. To date, there are no data on factors that 
      might predict response to BoNTA in patients with CDH. METHODS: A total of 71 
      patients with CM and 11 patients with CTTH were treated with 100 units BoNTA. 
      Every patient received at least 2 sets of injections at intervals of 12-15 weeks; 
      fixed sites, fixed dose, and "follow-the-pain" approaches were used for the 
      injections. A detailed medical history was taken for each patient in addition to 
      recording Migraine Disability Assessment Scale (MIDAS) scores at baseline and 
      every 3 months after each set of injections. Headache frequency was assessed 
      throughout the study from baseline to weeks 24-27. Patients recorded the 
      frequency, severity, and duration of headaches in Headache Diaries. Patients were 
      divided into responders (> or = 50% reduction in both headache frequency and 
      MIDAS scores compared with baseline) and nonresponders (< 50% reduction in either 
      of the above variables). Variables analyzed for predictors of response include 
      headache that is predominantly unilateral or bilateral in location, presence of 
      cutaneous allodynia (scalp allodynia), and presence of pericranial muscle 
      tenderness (also referred to as muscle allodynia). Chi-square analysis was used 
      for parallel-group comparisons (proportion of CM responders vs proportion of CM 
      nonresponders and proportion of CTTH responders vs proportion of CTTH 
      nonresponders). RESULTS: In the CM group, 76.1% (54 /71) of patients were 
      responders to BoNTA, of which 68.5% (37/54) had headache that was predominantly 
      unilateral in location and the remaining 31.5% (17/54) had headache that was 
      predominantly bilateral in location (both P < .01 vs CM nonresponders). Of the 
      23.9% (17/71) CM nonresponders, 76.5% (13/17) reported predominantly bilateral 
      headache and in the remaining 23.5% (4/17) the headache was unilateral. In the CM 
      responders group, 81.5% (44/54) had clinically detectable scalp allodynia, while 
      pericranial muscle tenderness was present in 61.1% (33/54) (both P < .01 vs CM 
      nonresponders). The presence of scalp allodynia and pericranial muscle tenderness 
      in the CM nonresponders was 11.8% (2/17) and 17.6% (3/17), respectively. In the 
      CTTH group where all patients (100%, 11/11) had bilateral headache, 36.4% (4/11) 
      of patients were responders to BoNTA. All of those CTTH responders (100%, 4/4) 
      had pericranial muscle tenderness (P < .05 vs CTTH nonresponders). None of the 
      CTTH nonresponders had pericranial muscle tenderness. No clinically significant 
      serious adverse events (AEs) were reported. Mild AEs, eg, injection-site pain 
      that persisted for 1-9 days, were reported in 11 patients. One patient had 
      transient brow ptosis. CONCLUSIONS: A greater percentage of patients with CM 
      responded to BoNTA than patients with CTTH. Headaches that were predominantly 
      unilateral in location, presence of scalp allodynia, and pericranial muscle 
      tenderness appear to be predictors of response to BoNTA in CM, whereas in CTTH, 
      pericranial muscle tenderness may be a predictor of response.
FAU - Mathew, Ninan T
AU  - Mathew NT
AD  - Houston Headache Clinic, Houston, TX 77004, USA.
FAU - Kailasam, Jayasree
AU  - Kailasam J
FAU - Meadors, Lori
AU  - Meadors L
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
DEP - 20070912
PL  - United States
TA  - Headache
JT  - Headache
JID - 2985091R
RN  - 0 (Neuromuscular Agents)
RN  - EC 3.4.24.69 (Botulinum Toxins, Type A)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Botulinum Toxins, Type A/*therapeutic use
MH  - Disability Evaluation
MH  - Drug Administration Schedule
MH  - Female
MH  - Headache Disorders/*drug therapy
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Neuromuscular Agents/*therapeutic use
MH  - Outcome Assessment, Health Care
MH  - Pain Measurement
MH  - Predictive Value of Tests
MH  - Tension-Type Headache/*drug therapy
EDAT- 2007/09/18 09:00
MHDA- 2008/06/14 09:00
CRDT- 2007/09/18 09:00
PHST- 2007/09/18 09:00 [pubmed]
PHST- 2008/06/14 09:00 [medline]
PHST- 2007/09/18 09:00 [entrez]
AID - HED914 [pii]
AID - 10.1111/j.1526-4610.2007.00914.x [doi]
PST - ppublish
SO  - Headache. 2008 Feb;48(2):194-200. doi: 10.1111/j.1526-4610.2007.00914.x. Epub 
      2007 Sep 12.