Ömer KARADAŞ, İlker Hüseyin İPEKDAL, Ümit Hıdır ULAŞ, Yaşar KÜTÜKÇÜ, ZEKİ ODABAŞI

Perikranial hassasiyet ile ilişkili kronik gerilim tipi baş ağrısında botulinum toksin tip A tedavisi

Amaç: Kronik gerilim tipi baş ağrısının (GTBA) gelişiminden periferal ve santral nosiseptif mekanizmalar sorumludur. Kronik GTBA’nın akut tedavisinde analjezikler, koruyucu tedavisinde ise antidepresanlar kullanılmakla birlikte, yeni tedavi seçeneklerinin sunulduğu çalışmalara da ihtiyaç vardır. Çalışmamızın amacı, perikranial hassasiyet ile ilişkili kronik gerilim tipi baş ağrılı hastalarda Botulinum Nörotoksin Tip A (BoNTA) uygulamasının ağrı şiddeti ve ağrı sıklığı üzerine etkisini incelemektir. Gereç ve Yöntem: Perikranial hassasiyeti olan 14 kronik GTBA’lı hasta çalışmaya alındı. Her hastanın perikranial kaslarına toplam 50 ünite Botox® enjeksiyonu (iki taraflı olmak üzere frontal kaslara 5; temporal kaslara 5; servikal bölgede semispinalis capitis, splenius capitis ve trapezius kaslarına 5’er ünite) uygulandı. Uygulama öncesinde ve uygulama sonrası 2. ve 4. aylarda her hastanın VAS (Görsel Analog Skalası) ile ağrı şiddetleri ve bir ay içerisindeki ağrılı gün sayısı kaydedildi. Bulgular: Hastaların tedavi öncesi bir ay içindeki ağrılı gün sayısı 19.57±3.25 gün iken tedavi sonrası 2. ayda 15.28±4.37 gün, 4. ayda 15.78±3.90 gün idi. Ağrı şiddeti tedavi öncesinde 65.71±9.16 iken tedavi sonrası 2. ayda 50.71±13.56 ve 4. ayda 54.28±10.35 idi. Tedavi sonrası 2. ayda bir ay içerisindeki ağrılı gün sayısı ve ağrı şiddeti tedavi öncesine göre istatistiksel olarak anlamlı düzeyde düşmüş idi (p

Botulinum neuro-toxin aype-A in the treatment of chronic tension type headache associated with pericranial tenderness

Objectives: Both peripheral and central nociceptive mechanisms are responsible in chronic TTH. Analgegics are used in the acute treatment of chronic TTH and antidepressants are used in prophylactic treatment. However, further studies are needed to bring out new treatment options. The aim of our study is to investigate the effectiveness of Botulinum Neuro-toxin Type-A (BoNTA) in the treatment of chronic TTH associated with pericranial tenderness (PT). Methods: 14 patients with chronic TTH with PT were included in the study. 50 units Botox® injection was applied to the pericranial muscles (5 units for each muscles bilaterally: frontal, temporal, semispinalis capitis, spenius capitis and trapezius muscles) for each patient. Severity of headache was evaluated by VAS (Visual Analogue Scale) and number of days with headache per month were recorded before treatment and 2nd and 4th months after treatment. Results: Number of days with headache per month were 19.57±3.25 before treatment, 15.28±4.37 at the 2nd month after treatment and 15.78±3.90 at the 4th month after treatment. Severity of headache was 65.71±9.16 before the treatment, 50.71±13.56 at the 2nd month after treatment and 54.28±10.35 at the 4th month after treatment (p<0.05). Frequency and severity of headache before treatment were significantly decreased at the 2nd month after treatment and this significance continued at the 4th month after treatment (p<0.05). Conclusion: BoNTA treatment may be usefull in the treatment of patients with chronic TTH associated with PT.

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