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Halward Blegen, Aditya Mehta, Joseph Santamaria, Tyler Ray, Aaron Grant; Treatment of Occipital Neuralgia with low-dose Botulinum Toxin (BOTOX®) injection(s). Invest. Ophthalmol. Vis. Sci. 2019;60(9):2302.
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© ARVO (1962-2015); The Authors (2016-present)
Occipital neuralgia (ON) can cause severe headaches and impair quality of life. The literature on isolated BOTOX® treatment for ON has been sparse, with small sample sizes and large doses per injection. This retrospective study aims to compare a novel technique of targeted low dose BOTOX® injection at the greater occipital nerve (GON) or lesser occipital nerve (LON), as compared to occipital nerve block (ONB) with a mixture of lidocaine, marcaine, and triamcinolone (L/M/T). We hypothesize that BOTOX® is a viable treatment modality for ON.
This retrospective review evaluated patients treated with BOTOX® injection versus L/M/T for ON, between the years of 2013 and 2018 by a board certified neuro-ophthalmologist at our institution. Patients were injected with 5 -15 units (U) of BOTOX® or a mixture of L/M/T at up to four sites that presented with focal tenderness near the GON or LON. Patients were instructed to follow up if and when their headache symptoms returned, for repeat injection, if this treatment option was preferred by the patient.
The sample size consisted of 22 patients in the BOTOX® group and 36 patients in the L/M/T group. Average age of patients in the BOTOX® group was 42.4±16.5 years, and the majority (86.4%) was female. 95.5% of patients experienced relief of symptoms for at least 30 days status post first injection, versus 75.0% in the L/M/T group (p= 0.045). Overall, 72.7% of patients in the BOTOX® group received > 1 injection, versus 27.8% in the L/M/T group (p=0.001). Of the patients receiving > 1 injection for their headache, the average time to follow up for repeat injection was 84.8±33.5 days in the BOTOX® group, versus 65.0±36.4 in the L/M/T group (p= 0.043). 22.7% of patients’ headaches resolved, without continued care, after multiple injections in the BOTOX® group, versus 16.7% of patients in the L/M/T group.
To our best knowledge, this is the largest investigation of BOTOX® injection for ON. We demonstrate low-dose BOTOX® injection for ON is effective as compared to lidocaine/marcaine/triamcinolone. Larger, double-blinded, randomized clinical trials investigating BOTOX® versus traditional ONB and saline injection are needed to further evaluate this treatment option.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
Table 1. Results of BOTOX® injection versus occipital nerve block with a mixture of lidocaine/marcaine/triamcinolone for treatment of occipital neuralgia.
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