Peri-Incisional Botulinum Toxin for Chronic Postcraniotomy Headache After Traumatic Brain Injury: A Case Series

Botulinum neurotoxin (BoNT) has been used successfully to treat primary headache syndromes, but there are no published data on its use for chronic postcraniotomy headache. Botulinum neurotoxin type A (BoNT-A) (4:1 dilution) was injected at a dose of 15-50 units into peri-incisional sites of the scalp in 3 patients who had undergone craniotomy remotely for traumatic epidural hematoma. All patients reported reductions in headache lasting at least 2.5 months. Repeat injections were performed in all cases with favorable outcomes. There were no complications. Peri-incisional BoNT-A appears to be a potentially valuable tool in the chronic management of post craniotomy headache after traumatic brain injury.