Loder Elizabeth, Biondi David
Harvard Medical School, Headache and Pain Management Programs, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA.
Clin J Pain. 2002 Nov-Dec;18(6 Suppl):S169-76. doi: 10.1097/00002508-200211001-00009.
Botulinum toxin has been shown to effectively treat several types of pain associated with neurologic disorders. It has recently been evaluated for the treatment of various types of headaches. In studies of migraine headache, chronic daily headache (more than 15 days of headache per month), tension-type headache, and post-whiplash headache, patients have reported decreased pain after treatment with botulinum toxin type A. A more recently available preparation, botulinum toxin type B, has also been shown to provide relief to patients with transformed migraine headache and post-whiplash headache. Additional study is under way to determine the effectiveness of botulinum toxin for the treatment of chronic cluster headaches. Although the pathophysiology of headache is incompletely understood, muscle tension may trigger or aggravate migraine headaches. Botulinum toxin, which reduces muscle hyperactivity, may reduce headache pain by decreasing muscle tension. It may also provide peripheral and central neurogenic effects and reduce inflammation. Large, rigorously controlled trials of botulinum toxin are needed to better characterize its effects on various types of headaches and its role as a therapeutic agent. Current data suggest that botulinum toxin is safe and does not produce systemic effects associated with other types of headache treatments.
肉毒杆菌毒素已被证明能有效治疗几种与神经系统疾病相关的疼痛。最近它被评估用于治疗各种类型的头痛。在偏头痛、慢性每日头痛（每月头痛超过15天）、紧张型头痛和挥鞭样损伤后头痛的研究中，患者报告在接受A型肉毒杆菌毒素治疗后疼痛减轻。一种最近可用的制剂，B型肉毒杆菌毒素，也已被证明能缓解转化型偏头痛和挥鞭样损伤后头痛的患者的症状。正在进行进一步的研究以确定肉毒杆菌毒素治疗慢性丛集性头痛的有效性。尽管头痛的病理生理学尚未完全了解，但肌肉紧张可能引发或加重偏头痛。肉毒杆菌毒素可减轻肌肉过度活动，可能通过降低肌肉紧张来减轻头痛疼痛。它还可能产生外周和中枢神经源性作用并减轻炎症。需要进行大规模、严格对照的肉毒杆菌毒素试验，以更好地描述其对各种类型头痛的影响及其作为治疗药物的作用。目前的数据表明肉毒杆菌毒素是安全的，不会产生与其他类型头痛治疗相关的全身作用。
