Linde M, Hagen K, Stovner L J
Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.
Acta Neurol Scand Suppl. 2011(191):50-5. doi: 10.1111/j.1600-0404.2011.01544.x.
Recent scientific data support an effect of botulinum neurotoxin (BoNT) on pain and headache.
We sought to conduct a systematic review of BoNT in the secondary headaches and cranial neuralgias.
MEDLINE, EMBASE, Cochrane, ClinicalTrials.gov and reference lists were searched up to December 2010 to identify all relevant publications.
Only two papers were rated as highest evidence (Level 1). The absolute majority (30/38, 79%) of identified publications yield only low evidence (Level 4).
No treatment recommendations of Grade A or Grade B can be made based on available research. Grade C treatment recommendations in support of BoNT can be made for chronic headache attributed to whiplash injury, cephalalgic alopecia areata, headache and facial pain in blepharospasm, trigeminal neuralgia, occipital neuralgia and nummular headache. As a result of studies being troublingly inconsistent or inconclusive, only the weakest rank of recommendations (Grade D) can be made for using BoNT in medication overuse headache, cervicogenic headache, headache attributed to craniocervical dystonia, pain in masticatory hyperactivity and headache or facial pain attributed to temporomandibular disorder.
At present, BoNT cannot be firmly recommended as an evidence-based treatment in secondary headaches or cranial neuralgias.
近期科学数据支持肉毒杆菌神经毒素（BoNT）对疼痛和头痛有影响。
我们试图对BoNT在继发性头痛和颅神经痛方面进行系统评价。
检索截至2010年12月的MEDLINE、EMBASE、Cochrane、ClinicalTrials.gov及参考文献列表，以识别所有相关出版物。
仅有两篇论文被评为最高证据级别（1级）。已识别出版物中的绝大多数（30/38，79%）仅产生低证据级别（4级）。
基于现有研究无法做出A级或B级治疗推荐。对于因挥鞭样损伤所致慢性头痛、斑秃性头痛、眼睑痉挛中的头痛和面部疼痛、三叉神经痛、枕神经痛和钱币状头痛，可做出支持BoNT的C级治疗推荐。由于研究结果存在令人困扰的不一致性或不确定性，对于在药物过量使用性头痛、颈源性头痛、颅颈肌张力障碍所致头痛、咀嚼肌功能亢进性疼痛以及颞下颌关节紊乱所致头痛或面部疼痛中使用BoNT，只能做出最弱等级的推荐（D级）。
目前，不能将BoNT作为继发性头痛或颅神经痛的循证治疗方法予以强烈推荐。
