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.