Severe, intractable headache after injection with botulinum a exotoxin: report of 5 cases.

Abstract

Botulinum A exotoxin is a safe agent in common use in dermatology. Occasionally, patients receiving botulinum toxin injections report postprocedure discomfort, including headaches. Our purpose was to estimate the rate of severe headaches occurring after injection with botulinum toxin for dermatologic indications. We used prospective monitoring of botulinum toxin injection outcomes in a single-site, 3-dermatologist practice. There was in-office and telephone follow-up of patients experiencing severe headaches. Approximately 1% of patients (4/320) receiving botulinum A exotoxin injections may experience severe, debilitating headaches. These may persist at high intensity for 2 weeks to 1 month before gradually fading. Botulinum A exotoxin injection may be associated with the development of life-altering headaches. Patients should be informed of this possibility.