Botulinum toxin, lidocaine, and dry-needling injections in patients with myofascial pain and headaches

Cranio. 2009 Jan;27(1):46-53. doi: 10.1179/crn.2009.008.


Trigger point injections with different solutions have been studied mainly with regard to the management of myofascial pain (MFP) patient management. However, few studies have analyzed their effect in a chronic headache population with associated MFP. The purpose of this study was to assess if trigger point injections using botulinum toxin, lidocaine, and dry-needling injections for the management of local pain and associated headache management. Forty-five (45) myofascial pain patients with headaches that could be reproduced by activating at least one trigger point, were randomly assigned into one of the three groups: G1, dry-needling, G2, 0.25% lidocaine, at 0.25% and G3 botulinum toxin and were assessed during a 12 week period. Levels of pain intensity, frequency and duration, local postinjection sensitivity, obtainment time and duration of relief, and the use of rescue medication were evaluated. Statistically, all the groups showed favorable results for the evaluated requisites (p < or = 0.05), except for the use of rescue medication and local post injection sensitivity (G3 showed better results). Considering its reduced cost, lidocaine could be adopted as a substance of choice, and botulinum toxin should be reserved for refractory cases, in which the expected effects could not be achieved, and the use of a more expensive therapy would be mandatory.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Anesthetics, Local / administration & dosage*
  • Botulinum Toxins / administration & dosage*
  • Headache / classification
  • Headache / drug therapy*
  • Headache / etiology
  • Humans
  • Injections, Intramuscular
  • Lidocaine / administration & dosage*
  • Myofascial Pain Syndromes / complications
  • Myofascial Pain Syndromes / drug therapy*
  • Needles
  • Neuromuscular Agents / administration & dosage*
  • Statistics, Nonparametric
  • Treatment Outcome


  • Anesthetics, Local
  • Neuromuscular Agents
  • Lidocaine
  • Botulinum Toxins