Evidence-based medicine: botulinum toxin A in migraine and tension-type headache

J Neurol. 2001 Apr;248 Suppl 1:34-8. doi: 10.1007/pl00007818.


The therapeutic effect of botulinum toxin in headache was observed coincidentally. The rationale for this new indication initially met with a great deal of scepticism, because the toxin's mechanism of action, cholinergic chemodenervation, does not fit the pathophysiological concept of migraine and other forms of headache. Meanwhile a fair number of studies have been published which indicate efficacy for botulinum toxin and recommend its use for the treatment of tension headache and migraine. According to the evidence-based medicine criteria, grade I evidence has been demonstrated. In addition the use of botulinum toxin for cluster-headache and secondary headache is discussed. Further large scale studies will be regarded to demonstrate the long-term efficacy.

Publication types

  • Review

MeSH terms

  • Animals
  • Botulinum Toxins, Type A / therapeutic use*
  • Controlled Clinical Trials as Topic / statistics & numerical data
  • Evidence-Based Medicine / statistics & numerical data*
  • Humans
  • Migraine Disorders / drug therapy*
  • Neuromuscular Agents / therapeutic use*
  • Tension-Type Headache / drug therapy*


  • Neuromuscular Agents
  • Botulinum Toxins, Type A