{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T17:22:28Z","timestamp":1791912148359,"version":"4.3.4"},"reference-count":67,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2023,2,14]],"date-time":"2023-02-14T00:00:00Z","timestamp":1676332800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Cephalalgia"],"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>A systematic and meta-analysis was conducted to examine the evidence of the effects of botulinum toxin A on chronic tension-type headache.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Cochrane, Embase, Ovid, ProQuest, PubMed, Scopus, Web-of-Science databases, and ClinicallTrials.gov registry were systematically searched for studies examining the effects of botulinum toxin A on tension-type headaches. The records were screened by two independent reviewers using pre-determined eligibility criteria. DerSimonian Liard random-effects meta-analyses were performed using the \u2018meta\u2019 package (5.2-0) in R (4.2.0). Risk of bias and quality of evidence were assessed using the Cochrane Collaboration\u2019s Tool RoB 2 and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Clinical significance was determined using pre-defined minimal clinically important differences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Eleven controlled trials were included (390 botulinum toxin A, 297 controls). Botulinum toxin A was associated with significant improvements in standardized headache intensity (\u22120.502 standard deviations [\u22120.945, \u22120.058]), headache frequency (\u22122.830 days\/month [\u22124.082, \u22121.578]), daily headache duration (\u22120.965 [\u22121.860, \u22120.069]) and the frequency of acute pain medication use (\u22122.200 days\/month [\u22123.485, \u22120.915]) vs controls. Botulinum toxin A-associated improvements exceeded minimal clinically important differences for headache intensity, frequency, and acute pain medication use. A 79% (28%, 150%) greater response rate was observed for botulinum toxin A vs controls in improving chronic tension-type headache. Treatment of eight chronic tension-type headache patients was sufficient to elicit a therapeutic response in one patient.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Corroborating the current mechanistic evidence, our meta-analysis supports the utility of botulinum toxin A for managing chronic tension-type headaches. However, due to limitations in the quality of evidence, adequately-powered high-quality controlled trials examining the effects of Botulinum toxin A on chronic tension-type headache are warranted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Registration<\/jats:title>\n                    <jats:p>Protocol preregistered in PROSPERO International Prospective Register of Systematic Reviews (CRD42020178616)<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/03331024221150231","type":"journal-article","created":{"date-parts":[[2023,2,14]],"date-time":"2023-02-14T06:49:49Z","timestamp":1676357389000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":19,"title":["The effectiveness of botulinum toxin for chronic tension-type headache prophylaxis: A systematic review and meta-analysis"],"prefix":"10.1177","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2661-062X","authenticated-orcid":false,"given":"Chathurika S","family":"Dhanasekara","sequence":"first","affiliation":[{"name":"Department of Surgery, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Payberah","sequence":"additional","affiliation":[{"name":"School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanna Y","family":"Chyu","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Texas Medical Branch at Galveston, Galveston, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chwan-Li","family":"Shen","sequence":"additional","affiliation":[{"name":"Department of Pathology, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA"},{"name":"Center of Excellence for Integrative Health, Texas Tech University Health Sciences Center, Lubbock, TX, USA"},{"name":"Center of Excellence for Translational Neuroscience and Therapeutics, Texas Tech University Health Sciences Center, Lubbock, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chanaka N","family":"Kahathuduwa","sequence":"additional","affiliation":[{"name":"Center of Excellence for Integrative Health, Texas Tech University Health Sciences Center, Lubbock, TX, USA"},{"name":"Center of Excellence for Translational Neuroscience and Therapeutics, Texas Tech University Health Sciences Center, Lubbock, TX, USA"},{"name":"Department of Psychiatry, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA"},{"name":"Department of Neurology, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2023,2,14]]},"reference":[{"key":"bibr1-03331024221150231","doi-asserted-by":"publisher","DOI":"10.1186\/s10194-022-01402-2"},{"key":"bibr2-03331024221150231","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-2982.2007.01288.x"},{"key":"bibr3-03331024221150231","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(18)30322-3"},{"key":"bibr4-03331024221150231","doi-asserted-by":"publisher","DOI":"10.1111\/head.13067"},{"key":"bibr5-03331024221150231","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(08)70062-0"},{"key":"bibr6-03331024221150231","doi-asserted-by":"publisher","DOI":"10.1016\/j.aprim.2021.102238"},{"key":"bibr7-03331024221150231","doi-asserted-by":"publisher","DOI":"10.1007\/s11910-021-01138-7"},{"key":"bibr8-03331024221150231","doi-asserted-by":"publisher","DOI":"10.1016\/S0304-3959(98)00167-5"},{"key":"bibr9-03331024221150231","doi-asserted-by":"publisher","DOI":"10.1046\/j.1526-4610.1997.3707424.x"},{"key":"bibr10-03331024221150231","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.1996.00550040113021"},{"key":"bibr11-03331024221150231","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-510X(02)00035-7"},{"key":"bibr12-03331024221150231","doi-asserted-by":"publisher","DOI":"10.1046\/j.1468-2982.2000.00070.x"},{"key":"bibr13-03331024221150231","first-page":"1","volume":"7","author":"Sait A","year":"2021","journal-title":"Tension-type headache (Primer). 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