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.