Patients with chronic migraine, chronic daily headache and cervicalgia headache often find limited relief from conventional treatment options. After combinations of different therapies--including trigger point injections, antidepressants, calcium channel blockers, beta blockers, triptans and antiepileptic drugs--many patients continue to have severe episodes of headaches. These patients are defined as having a Refractory Headache Syndrome (RHS). Botulinum Toxin Type A (Botox) recently has gained popularity as a option for patients with RHS, often as a treatment of last resort after having limited success with other modalities.

The goal of our review was to determine if the administration of Botox had any effects on the number of headaches per week, or on the average duration of the headache episodes. The charts of all patients receiving Botox from 1999-2005 at the Arnold Pain Management Center at Beth Israel Deaconess Medical Center, a tertiary pain clinic, were reviewed. A positive response was considered if four to six weeks after treatment the patient reported a 30% reduction in the number of headaches per week (HPW) and/or a reduction of 30% of the headaches hours per headache episode (HHrs). Patients' sex, age, total dose of botox in one session, sites injected, and other current therapies (including interventional and medical therapies) were recorded.

Of the 105 patients, 36 patients (34%) had a decrease in the number of headaches per week of 30% or more; 14 patients (13%) had a decrease in the number of headache-hours per week of 30% or more; 9 patients (9%) had a decrease in HPW and HHrs. 99 patients (94%) were receiving trigger point injections as part of their treatment during the same period of time when receiving Botox, and all patients received two or more medications including antidepressants, antiepileptics, opioids, triptans, calcium channel blocker, beta blockers, non-steroidal anti-inflammatory drugs, and acetaminophen.