Efficacy of Botulinum Toxin Type A for Post-Craniotomy Headache

Authors

• Kimberly Lightfoot, University of LynchburgFollow

Specialty

Neurosurgery

Advisor

Dr. Thomas Colletti, DHSc, MPAS, PA-C

Abstract

This review evaluates the efficacy of Botulinum toxin-Type A (BoNT-A) in treating post-craniotomy headache (PCH) as an alternative treatment option. This common post-operative complication can be debilitating for patients and often presents with challenges in achieving adequate pain control. The current treatment guidelines lack a clear protocol for clinicians to approach PCH management. This clinical review explores the benefits of BoNT-A as an emerging intervention that could potentially replace traditional, less effective therapies. A comprehensive literature search, including PubMed and Google Scholar, was conducted to identify articles examining the effectiveness of BoNT-A in post-craniotomy headache. This produced five case studies (n=24) that were used to investigate the clinical question. The results showed that 96% (23/24) of patients reported improvement in PCH from baseline within the first year of treatment, with the exception of one patient who reported no response to treatment. The data produced by these case series strongly suggested that BoNT-A reduced PCH frequency and severity after the first treatment session. Among all the case studies reviewed, zero participants reported adverse drug effects. The findings from this review point to a promising direction for the future of PCH treatment. BoNT-A is a universally well-tolerated intervention that serves as an effective option for headache relief and improvement in quality of life. The less frequent, three-month dosing cycle for BoNT-A also provides an alternative for patients who struggle to adhere to daily preventative PCH medications. While these findings present positive preliminary results, larger clinical trials or randomized controlled trials are needed to further substantiate this evidence and confirm its efficacy. Furthermore, a standardized injection protocol is needed to increase the reproducibility of these positive results. This review highlights the gap in management for patients suffering from PCH, stressing the imperative for an innovative, alternative intervention for better pain control.

Recommended Citation

Lightfoot K. Efficacy of Botulinum Toxin Type A for Post-Craniotomy Headache. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2026; 8(1).