Clinical Study Of Botulinum Toxin Type A Treating Patients With Chronic Daily Headache

Objective and background:Chronic Daily Headache (CDH)is commonly defined as headaches occurring on15or more days in a month for at least three months.Chronic daily headache attracts frequently, the duration is long, seriously affected the health and quality of life of patients. Currently, there has been a large number of preventative medicine, but the efficacy is uncertain, the adverse reactions is too much, and the compliance of patients is poor, there is still a considerable number of patients with chronic daily headache disturbed by frequent headache. Botulinum toxin A (BTX-A) is obtained from bacteria Clostridium Botulinum.,widely used in in the field of dystonic disorders and beauty. The efficacy of Botulinum Toxin A in headache date back to early90’s when patients’receiving cosmetic treatment reported improvement in migraines. In recent years, the research of botulinum toxin A applied in the treatment of headache has been widely carried out, has become one of the hotspots in the related field. At home and abroad, only a minority of research of BTX-A used in the treatment of chronic daily headache have been reported, and the results are different, even opposite, the results are different, even opposite. The research in this field is still in its initial stage, lack of a large number of animal experiments and clinical trials.This study is to observe and evaluate the therapeutic effect and safety of local multipoint injection of domestic botulinum toxin A (Hengli) in patients with chronic daily headache, and discussing the analgesic mechanism of botulinum toxin A (BTX-A) treating of chronic daily headache(CDH). To providing a new approach for the treatment of chronic daily headache.Methods:The patients with chronic daily headache come from the outpatient and inpatient patients of neurology in First affiliated hospital of zhengzhou university from March2012to September2012, totally30cases. The research content and safety aspects of the study were explained to each of the patients, and the informed consent documents was signed of each patient. Prior to the start of the research, require the patients to stop all acute analgesic drug.Perform an open study, to the30patients with chronic daily headache in the study, botulinum type A was injected into multiple sites of Pericranial muscles according to the Pain Points with the doses varied from40to120U.The injection dose of every varied from5-10U. Patients were asked to record a headache diary. Use outpatient or telephone follow-up for6～12months, to evaluate the the degree, the frequency, the duration of headache attacks before and after the treatment.The research also evaluate the change of taking painkillers,anxiety and depression before and after the treatment. The headache condition and the status of the anxiety and depression after the treatment was compared with the conditon before the treatment. The adverse reactions of the study was also been observed. Results:The VAS score was reduced in the lweek, lmonth,2months,3months,4months,5months,6months after the treatment,and the difference is significant (p<0.01). The headache frequency was reduced in the1month,2months,3months,4months,5months,6months after the treatment, and the difference is significant (p<0.01). The duration of headache was reduced in the lmonth,2months,3months,4months,5months,6months after the treatment, and the difference is significant (p<0.01).The total effective rates of lmonth,2months,3months,4months,5months,6months after the treatment were separately60.00%、66.67%、73.33%、76.67%、76.67%、73.33%.The case of use acute pain medications was decreased after the treatment. The days of use acute pain medications was decreased after the treatment, and the difference was statistically significant(p<0.01). The grades of HAMA and HAMD greatly decreased in thelmonth,2months,3months,4months,5months,6months after the treatment, and the difference was statistically significant(p<0.01). The total adverse reaction rate was20%in30cases, and the side effects disappeared within2months.Conclusion:1. The therapeutic effect is significant that local multipoint injection of botulinum toxin A in patients with chronic daily headache.The headache degree, headache frequency and the duration of headache are reduced.2.BTX-A can relieve the chronic daily headache patients from anxiety and depression, and improve the living quality.3. The side effects Of BTX-A applied in the treatment of chronic daily headache is mild, transient, have no systemic adverse reactions. This new method is safe and effective.