• J A de Ru and J Buwalda.
• Department of Otorhinolaryngology-Head Neck Surgery, University Medical Center Utrecht, The Netherlands. j.a.deru@kmb.azu.nl
• J Laryngol Otol. 2009 Apr 1; 123 (4): 412-7.

ObjectiveTo describe our results with botulinum toxin type A injection for headache in carefully selected patients, and to present the rationale behind this therapy.SettingTertiary referral centre.Patients And MethodsThis article describes a case series of 10 consecutive patients with frontally localised headache, whose pain worsened when pressure was applied at the orbital rim near the supratrochlear nerve. The patients received a local anaesthetic nerve block with Xylocaine 2 per cent at this site. If this reduced the pain, they were then offered treatment with botulinum toxin.InterventionInjection with 12.5 IU of botulinum toxin A into the corrugator supercilii muscle on both sides (a total of 25 IU).Main Outcome MeasurePain severity scoring by the patients, ranging from zero (no pain) to 10 (severe pain) on a verbal scale.ResultsFollowing injection, all patients had less pain for approximately two months. This treatment did not appear to have lasting side effects.ConclusionXylocaine injection is a good predictor of the effectiveness of botulinum toxin injection into the corrugator muscle as treatment of frontally localised headache. We hypothesise that this pain is caused by entrapment of the supratrochlearis nerve in the corrugator muscle. Furthermore, we found botulinum toxin injection to be a safe and effective means of achieving pain relief in this patient group.

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