Safety of Onabotulinum Toxin A for the Treatment of Chronic Post-Traumatic Headache in Service Members with a History of Mild Traumatic Brain Injury (P01.076)

OBJECTIVE: To assess the safety of Onabotulinum toxin type A (Botox®) (OBA) in the preventive care of post traumatic headache (PTH). BACKGROUND: Headache is a common complication of mild traumatic brain injury (mTBI) in active duty service members. Migraine and chronic migraine type are most common. The approved use of OBA in chronic migraine (CM) led us to hypothesize that OBA might be safe and possibly effective in secondary headaches with features of CM. DESIGN/METHODS: This is a retrospective consecutive case series of patients treated with OBA for PTH in the Concussion Care Clinic at Womack Army Medical Center, Ft. Bragg, NC between 8/2008 – 8/2012. Patient demographics, prior history of headache, injury type, current headache type, time from injury to first injection, treatment techniques, number of treatments/treatment interval, side effects, reasons for discontinuation and Patient Global Evaluation of Change (PGEC) are reported. RESULTS: 67 (66 male; mean age 31.1 + 7.7) were treated, 10% with history of headache. Most common injuries: blast (46.3%), parachute jumps (14.9%) and motor vehicle accidents (11.9%). 56.7% reported more than one headache type. Headache types included: Chronic migraine (CM) (22.4%), episodic migraine (EM) (7.5%), chronic tension type (CTTH) (7.5%), Hemicrania Continua (7.5%), nummular (1.5%); mixed CTTH/CM 28/67 (41.8%); and CTTH/EM (7.5%). 74.6% had continuous headache. Mean time to first injections: 30 + 22.9 months (1 – 120); mean treatments: 3.2 + 3.8 (1 – 19). 62.3% were treated by FSFD. Reasons for discontinuation included ineffectiveness (44.8%), side effects (2.9%), or reinjury (1.5%). 22.4% were lost to follow-up of whom 73.3% reported being “much better”. Overall, 59.7% were better/much better, 4.5% were worse/much worse; 32.8% reported no change. CONCLUSIONS: OBA appears to be safe and well tolerated in active duty service members treated for PTH, warranting further studies of efficacy and consistency of effect. Disclosure: Dr. Yerry has nothing to disclose. Dr. Lewis has nothing to disclose. Dr. Finkel has recieved personal compensation for activities with Allergan as a consultant.