Peri-Incisional Botulinum Toxin Therapy for Treatment of Intractable Head Pain After Lateral Skull Base Surgery: A Case Series

Sabina Dang, Justin R. Shinn, Justin Sowder, William Russell Ries, Scott J. Stephan

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: The objective of this case series was to describe botulinum toxin therapy as a novel treatment of intractable head pain following lateral skull base surgery. Background: Intractable headaches following lateral skull base surgery are described in 23%-75% of patients and can significantly impact quality of life. Currently, the etiology of the headaches is unclear and treatment options are limited. Botulinum toxin is indicated for a multitude of functional and cosmetic reasons, including chronic migraine, and has been further described in treatment of various postsurgical pain syndromes. Methods: In this case series, 4 patients underwent subcutaneous peri-incisional injections of botulinum toxin for intractable headache and head pain syndromes. Three patients had undergone lateral skull base surgery and the fourth patient had undergone a temporoparietal fascial flap harvest. Average injection dose ranged from 20 to 60 units with an average duration of effect ranging from 2 weeks to 4 months. Results: All patients experienced significant relief of chronic head pain and returned for additional peri-incisional botulinum toxin injections, suggesting meaningful patient-perceived value. Conclusions: Botulinum toxin therapy may represent a novel treatment for intractable head pain following lateral skull base surgery and temporoparietal fascial flap harvest. This study represents a small case series and, although 100% of the patients who were treated significantly improved, future inquiry is necessary to confirm these findings.

Original languageEnglish (US)
Pages (from-to)1624-1630
Number of pages7
JournalHeadache
Volume59
Issue number9
DOIs
StatePublished - Oct 1 2019
Externally publishedYes

Keywords

  • botulinum A toxin
  • botulinum toxin
  • craniotomy
  • intractable headache
  • postoperative pain
  • skull base neoplasms

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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