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To investigate the add-on efficacy of botulinum toxin A (BTA) in the treatment of medication-overuse headache (MOH), researchers randomized 179 adults with chronic migraine and MOH to receive either BTA injections (155 U) or placebo (saline, with 17.5 U of BTA in the forehead to maintain blinding), followed by ambulant withdrawal therapy for 12 weeks.
In weeks 9 through 12 after injection, the number of headache days was reduced by 26.9% in the BTA group (n=90) and by 20.5% (n=89) in the placebo group, a nonsignificant difference. All other secondary endpoints and the 1-year evaluation of MOH (still present or not) were not significantly different between groups. The authors conclude that BTA is not effective as an additional treatment for M…