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Chapter 26 - The use of botulinum neurotoxin in the management of headache disorders

Published online by Cambridge University Press:  05 February 2014

By
Stephen D. Silberstein
Edited by
Daniel Truong ,
Dirk Dressler ,
Mark Hallett  and
Christopher Zachary
Stephen D. Silberstein
Affiliation:
Jefferson Headache Center, Thomas Jefferson University, Philadelphia, PA, USA
Daniel Truong
Affiliation:
The Parkinson’s and Movement Disorders Institute, Fountain Valley, California
Dirk Dressler
Affiliation:
Department of Neurology, Hannover University Medical School
Mark Hallett
Affiliation:
George Washington University School of Medicine and Health Sciences, Washington, DC
Christopher Zachary
Affiliation:
Department of Dermatology, University of California, Irvine
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Summary

Clinical aspects of headache disorders

Headache affects more than 45 million individuals in the USA, which makes it one of the most common nervous system disorders (National Institute of Neurological Disorders and Stroke, 2002). The International Headache Society’s diagnostic criteria for headache disorders (ICHD-II, Headache Classification Committee, 2004) classifies primary headache disorders as those in which headache itself is the illness, with no other etiology diagnosed. Examples include migraine and tension-type headache (TTH). Headache disorders can be further classified as episodic (<15 headache days per month) or chronic (≥15 headache days per month for more than 3 months).

Migraine is a primary headache disorder characterized by enhanced sensitivity of the nervous system (Silberstein, 2000) associated with a combination of neurological, gastrointestinal and autonomic disturbances (Silberstein, 2004). The ICHD-II has provided criteria for a total of seven subtypes of migraine (including migraine with and migraine without aura). The ICHD-II diagnostic criteria for migraine without aura (Headache Classification Committee, 2004) include

  • headache associated with at least two of the following: unilateral location, pulsating quality, moderate or severe pain intensity and aggravation by or causing avoidance of routine physical activities

  • at least one of the following during headache: nausea and/or vomiting, photophobia and phonophobia

  • headache not attributable to another disorder.

It is estimated that 28 million Americans, including 18% of women and 7% of men, are afflicted with severe, disabling migraines (Lipton et al., 2001). The World Health Organization (2012) ranked migraine as one of the world’s most disabling illnesses, profoundly impacting quality of life and causing functional impairment and disruption of household or social activities. The economic burden of the disease to society is also considerable. In the USA, the yearly medical costs exceed 1 billion dollars, and costs to employers due to migraine-related absenteeism and reduced productivity is 13 billion dollars (Hu et al., 1999).

Type
Chapter
Information
Manual of Botulinum Toxin Therapy , pp. 222 - 232
Publisher: Cambridge University Press
Print publication year: 2014

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