Open Access

Botulinum toxin injections for the treatment of frontal tension headache

  • Mimi S. Kokoska1Email author,
  • Dee A. Glaser2,
  • Christine M. Burch3 and
  • Christopher S. Hollenbeak4
The Journal of Headache and PainOfficial Journal of the Italian Society for the Study of Headaches5:77

Received: 28 February 2003

Accepted: 15 March 2004


We performed a randomized, double-blind, placebo-controlled trial to determine the efficacy of botulinum toxin type A (BOTOX; Allergan) in treating frontal tension-type headache (TTH). A total of 40 patients attending a headache treatment center were randomized to receive 50 U botulinum toxin type A or saline, injected at 10 sites of the forehead. Frequency and severity of headaches before and after injection were compared. The intensity of headaches in the botulinum toxin type A group, but not the placebo group, fell significantly from an average score of 5.19 to 4.65 (p<0.0001). Botulinum toxin type A patients and placebo patients experienced an average reduction in the number of headaches per month, but these reductions were not significantly different between groups. Botulinum toxin type A was well tolerated, with no significant adverse events. Botulinum toxin type A injections in the management of frontal TTH has been shown by this study to be both effective and well tolerated. It should be noted that the effect of botulinum toxin on intensity of headache, although statistically significant, was relatively small.

Key words

Botulinum toxin type ATension headacheTreatment