Case studyBotulinum toxin A is effective to treat tension-type headache caused by hemifacial spasm

- Tension-type headache (TTH) is higher frequently seen in hemifacial spasm (HFS) patients.
- Stress factors were associated with TTH accompanied by HFS, regardless of the existence of stiff neck and spastic muscles.
- Botulinum toxin A therapy for HFS may also be indirectly effective for improving TTH.

ObjectiveWe examined the relationship between hemifacial spasm (HFS; a form of cranio-cervical dystonia) and chronic primary headache, including tension-type headache (TTH). We also examined whether botulinum toxin A (BoNT/A) therapy for HFS ameliorates concomitant TTH.MethodsFifty-one HFS patients receiving BoNT/A therapy were recruited. Patients' characteristics (including age, gender, chronic headache history, exercise habits, stiff neck, cervical spondylolysis history), stress factors, worsening/new onset of headache associated with HFS, and dose of BoNT/A were examined. We diagnosed headache types according to The International Classification of Headache Disorders, 3rd edition, beta. Numerical Rating Scale (NRS) and Headache Impact Test-6 (HIT-6) scores for headache severity were compared between the 6-week baseline before BoNT/A therapy and 6-week follow-up after BoNT/A therapy.ResultsOf 51 patients with HFS, 17 (33.3%) reported worsening or new onset of headache (especially TTH) associated with HFS (Group-S), and 34 were not aware of headache (Group-N). Twelve patients (70.6%) in group-S reported improvement of headache after BoNT/A therapy. NRS (from 7 [5-9] to 0 [0-5], p < 0.01) and HIT-6 (from 55 [54-64] to 44 [36-52], p < 0.001) scores were significantly improved after BoNT/A therapy. Logistic regression analysis revealed significant interaction between TTH associated with HFS and the presence of stress factors (odds ratio 43.11: 2.95-629.39, p < 0.001) and history of chronic headache (odds ratio 28.53: 2.96-275.10, p < 0.001).ConclusionsPrimary headache, especially TTH, is associated with HFS. BoNT/A therapy for HFS may also be indirectly effective for treatment of TTH.