Reality is merely an illusion, albeit a very persistent one.—Albert Einstein
Since the first anecdotal reports1 of headache improvement in individuals receiving botulinum injections for facial wrinkles, several controlled and uncontrolled trials of botulinum neurotoxin (BoNT) in headache patients have been published. These studies have yielded generally disappointing and conflicting results, and there continues to be controversy about the usefulness of BoNT in individuals with headache. In this “Controversies in Neurology,” Ashkenazi and Silberstein2 argue that BoNT is a safe and effective headache treatment for some individuals with episodic or chronic migraine while Pakalnis and Couch3 believe that the available randomized clinical trials provide little evidence that botulinum injections benefit individuals with either migraine or tension headache. Although Pakalnis and Couch acknowledge that a small subset of headache patients might benefit from BoNT therapy, there is presently no way to identify these individuals short of treating them.
Roach ES. Questioning Botulinum Toxin for Headache: Reality or Illusion. Arch Neurol. 2008;65(1):151–152. doi:10.1001/archneurol.2007.24
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