Evers Stefan
Department of Neurology, University of Münster, Germany.
Curr Opin Neurol. 2006 Jun;19(3):310-5. doi: 10.1097/01.wco.0000227044.08447.c3.
Reports and studies on botulinum toxin A in headache treatment are increasing. The studies available from reference systems and published congress contributions on the prophylactic treatment of idiopathic and symptomatic headache with botulinum toxin were analyzed with respect to the study design, the headache diagnosis, and the significance of results.
For the prophylactic treatment of tension-type headache and migraine, no sufficient positive evidence for a treatment with botulinum toxin A is obtained from randomized, double-blind, and placebo-controlled trials to date. For the treatment of chronic daily headache (including medication overuse headache), there is inconsistent positive evidence for subgroups (e.g. patients without other prophylactic treatment).
The majority of double-blind and placebo-controlled studies do not confirm the assumption that botulinum toxin A is efficacious in the treatment of idiopathic headache disorders. It is possible that subgroups of patients with chronic daily headache benefit from a long-term treatment with this substance. Future clinical trials should focus on these defined patient groups.
关于A型肉毒毒素治疗头痛的报告和研究日益增多。对参考系统中的现有研究以及发表的关于用肉毒毒素预防性治疗特发性和症状性头痛的大会论文，从研究设计、头痛诊断和结果的意义方面进行了分析。
迄今为止，从随机、双盲和安慰剂对照试验中，未获得足够的阳性证据证明A型肉毒毒素可用于预防性治疗紧张型头痛和偏头痛。对于慢性每日头痛（包括药物过量使用性头痛）的治疗，在亚组（如未接受其他预防性治疗的患者）中存在不一致的阳性证据。
大多数双盲和安慰剂对照研究并未证实A型肉毒毒素可有效治疗特发性头痛疾病这一假设。慢性每日头痛患者亚组可能会从该物质的长期治疗中获益。未来的临床试验应聚焦于这些明确的患者群体。
