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A Pilot Study of Botulinum Toxin A for Headache in Cervical Dystonia


  • William G. Ondo MD,

  • Stephen Gollomp MD,

  • Nestor Galvez-Jimenez MD

  • From the Department of Neurology, Baylor College of Medicine, Houston, TX (Dr. Ondo); Department of Neurology, The Lankenau Hospital/Thomas Jefferson University, Wynnewood, PA (Dr. Gollomp); and Department of Neurology, Cleveland Clinic Florida, Weston, FL (Dr. Galvez-Jimenez).

Address all correspondence to Dr. William G. Ondo, 6550 Fannin, Ste 1801, Houston, TX 77030.


Objective.—To evaluate the prevalence of associated headache (HA) pain with craniocervical dystonia and the therapeutic effect of BoNT-A injections on the HA component when injected for cervical dystonia.

Background.—HA associated with craniocervical dystonia is a recent formally codified entity, but has not been systematically studied.

Methods.—We identified 44 subjects from three movement disorder clinics who presented with craniocervical dystonia and concurrent HA pain. The subjects were injected with botulinum toxin type A (BoNT-A) and prospectively evaluated with the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS), headache diaries, Headache Impact Test (HIT-6), and Migraine Disability Assessment Scale (MIDAS), along with HA pain anatomy and adverse events, at baseline, and at 4, 8, and 12 weeks post-injection.

Results.—As expected, all aspects of the TWSTRS robustly improved. Headache diaries and the HIT-6 also improved at 4, 8, and 12 weeks post-injection. Sections of the MIDAS improved, and adverse events were minimal.

Conclusion.—BoNT-A safely improves headache associated with craniocervical dystonia when administered for the primary condition of craniocervical dystonia.