Onabotulinum toxin a for post-traumatic headache: A systematic review of case reports and case series

Abstract

Introduction Post-traumatic headache (PTH) is a debilitating condition following traumatic brain injury (TBI), leading to chronic pain and a significant reduction in quality of life. Onabotulinumtoxin A (OnaBTX-A), widely approved for chronic migraine treatment, has shown potential in reducing headache frequency and intensity in PTH cases. Still, its efficacy remains less studied in this population. Methods This systematic review examines four case reports and series involving a variety of patient populations, including athletes, military personnel, gunshot survivors, and a patient with severe TBI. These studies collectively investigate the effectiveness of OnaBTX-A in reducing PTH symptoms. Results OnaBTX-A was consistently associated with symptom relief in patients with PTH. A 15-year-old athlete reported complete resolution of headaches and reduced reliance on pain medication after treatment. Three gunshot survivors with both PTH and cervical dystonia showed 70% to 100% improvement with sustained benefits over 90-day injection intervals. In a case series of 64 military personnel with mild TBI, 64% experienced symptom improvement, particularly in mixed headache types. A 62-year-old woman suffering from chronic PTH for 5 years post-TBI achieved full pain relief, with an associated resolution of the “iron band” sensation, significantly enhancing her quality of life. Conclusion OnaBTX-A demonstrates promise as an effective and well-tolerated treatment for chronic PTH across diverse populations. Further research is needed to refine treatment protocols, assess long-term effects, and explore its potential in complex cases, including those with persistent postconcussive symptoms or cervical dystonia.