Table 1.
Study Demographics and Outcomes of Botulinum Toxin Use in Service Members
| Year | Author | Country | Study Type | Headache Type | Botox Type | n | M:F | Age | Service Member Type | Study Site | Results | Complications |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 2015 | Yerry et al19 | United States | Retrospective chart review | Post-traumatic Headache | Onabotulinum toxin A | 64 | 63:1 | 31.3 ± 7.5 | Undefined | Womack Army Medical Center | 3 lost to follow up but 41 (64.1%) had GEC improvement | Neck pain and worsened headache in 2 patients who discontinued OTA treatment |
| 2015 | Kazerooni et al21 | United States | Case series | Chronic Migraine | Incobotulinumtoxin A | 21 | 10:11 | 40 | Undefined | Veterans Affairs San Diego Healthcare System | Significant reduction in headache days per month using OTA (19.1 vs 9.1 days; p< 0.001) and headache intensity (8.3 vs 4.1; p< 0.001) | No significant adverse effects |
| 2013 | Lin et al20 | Taiwan | Retrospective chart review | Chronic Migraine | Onabotulinum toxin A | 94 | 15:79 | 47.6 ± 13.6 | Undefined | Taipei Veterans General Hospital | Significant improvement in median migraine MIDAS at 12 weeks versus baseline (p< 0.001), responders defined as >50% improvement of MIDAS | 19.1% lateral eyebrow elevation, 5.3% neck soreness, 4.3% ptosis |
| 2019 | Diel et al26 | United States | Retrospective chart review | Chronic Migraine | Onabotulinum toxin A | 72 | 43:29 | 48 (SD 10.1) | Undefined | Miami VA Medical Center | VLSQ-8 (especially questions 2,3 and 4) and interictal photophobia NRS significantly improved following PTA (p< 0.05) | Unreported |
| 2013 | Grogan et al22 | United States | Retrospective chart review | Chronic Migraine | Rimabotulinum Toxin B | 128 | 27:101 | 19–90 (mean 42) | Undefined | San Antonio Military Medical Center | “Imploding” - and “ocular-directed” headaches were more likely to be responders to RTB (p <0.0025); patients with aura were more likely to be responders to RTB (p = 0.0007) | Transient injection site stinging (82%), dry mouth (15%), cervical muscle stiffness and tenderness (4%) |
| 2019 | Williams et al24 | United States | Retrospective chart review | Chronic Migraine, Occipital Neuralgia, TBI, neck trauma | Onabotulinum toxin A | 30 | 20:10 | Age range 27 to 55 | Veterans | Central Texas Veterans Health Care System | 41% lower probability for a headache day following OTA intervention versus pre-intervention period (p < 0.001) over 28 days | Unreported |
| 2007 | Vo et al25 | United States | Randomized Controlled Trial | Chronic Migraine | Onabotulinum toxin A | 32 | 5:27 | 44.3 ± 11.3 in OTA; 40.7 ± 4.2 in control | Undefined | Walter Reed Army Medical Center | Being in OTA versus control groups not influencing periods for frequency of headaches (p= 0.63), headache severity (p= 0.415), and headache index (p= 0.533) | No significant adverse effects |
| 2021 | Zirovich et al27 | United States | Randomized Controlled Trial | Post-traumatic Headache | Onabotulinum toxin A | 40 | 38:2 | 34.3 (SD 8.6) | Veterans | Greater Los Angeles VA System | Headaches and headache days per week in OTA group reduced by 1.6 (95% CI, 0.6 to 2.6) and 1.4 (95% CI, 0.9 to 1.9) versus control which increased by 0.3 (95% CI, −0.6 to 1.5) and 0.1 (−0.6 to 0.4) respectively, with p values 0.48 and 0.005 respectively; Pain severity in OTA group reduced by 0.06 (95% CI, 0.1 to 0.11) versus an increase of 0.04 (95% CI, −0.01 to 0.08) with p= 0.006 | Pain, forehead paresthesia, itching, sinusitis; No difference in rates between OTA and control groups, p=0.23 |
Abbreviations: GEC, global evaluation of change; OTA, onabotulinumtoxin A; MIDAS, migraine disability assessment score; VLSQ-8, visual light sensitivity questionnaire 8; NRS, numerical rating scale; RTB, rimabotulinumtoxin B.