Brazilian Journal of Pain
https://brjp.org.br/article/doi/10.5935/2595-0118.20220028-en
Brazilian Journal of Pain
Review Article

Comorbidity between chronic headache and depression treated with botulinum toxin: literature review

A comorbidade entre cefaleia crônica e depressão tratada com toxina botulínica: revisão da literatura

Denis Eduardo Bertini Bo; Eduardo de Melo Carvalho Rocha

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Abstract

BACKGROUND AND OBJECTIVES: It is estimated that up to 40% of patients with migraine have at least one episode of major depression during their lifetime. On the other hand, patients with depression are twice as likely to suffer from migraine when compared to the population without the mood disorder. The comorbidity of both conditions increases the frequency of pain crises and the individual’s disability. A therapy that could act on the disorders, when simultaneous, would offer advantages through a broader and more effective action, such as botulinum toxin (BTX). Due to the lack of a clear definition on the subject, the objective of this study was to review how the concomitant treatment with BTX of the two morbidities behaves.

CONTENTS: A review of articles in English, Portuguese, and Spanish indexed in Pubmed/Medline, LILACS and Scielo databases was carried out. Of the eight articles selected, most individuals were women aged 40 to 50 years. The sample size ranged from 30 to 715 subjects. The predominance was of prospective studies. All studies found a significant reduction in pain. Six studies found a significant decrease in depression. The frequency of adverse effects ranged from 4.1% to 30%, with eyelid ptosis and headache being the most frequent.

CONCLUSION: BTX seems to be useful for the treatment of chronic headache and depression. There was a tendency to relate the improvement in depression with the decrease in pain. The specific action of the toxin in the treatment of depression was inconclusive. New studies, with high methodological rigor, as well as systematic reviews, should be carried out to reach a greater depth of comprehension of the subject and to determine the real efficacy of BTX in relieving concomitant headache and depression.

Keywords

Depression, Botulinum toxins type A, Disorder headache

Resumo

JUSTIFICATIVA E OBJETIVOS: Estima-se que até 40% dos pacientes com migrânea apresentam, pelo menos, um episódio de depressão maior ao longo da vida. Por outro lado, pacientes com depressão apresentam duas vezes mais chance de ter migrânea quando comparados à população sem transtorno de humor. A comorbidade dos dois quadros aumenta a frequência das crises de dor e a incapacidade do indivíduo. Uma terapêutica que pudesse agir nos transtornos, quando simultâneos, ofereceria vantagens, por uma ação mais ampla e eficaz, a exemplo da toxina botulínica (TXB). Por faltar ainda uma clara definição sobre o tema, o objetivo deste estudo foi revisar como se comporta o tratamento concomitante das duas morbidades com a TXB.

CONTEÚDO: Foi realizada revisão de artigos indexados nas bases de dados Pubmed/Medline, LILACS, Scielo nos idiomas inglês, português e espanhol. Dos oito artigos selecionados, a maioria dos indivíduos foram mulheres de 40 a 50 anos. O tamanho das amostras variou de 30 a 715 pacientes. A predominância foi de estudos prospectivos. Todos os estudos encontraram redução significativa da dor. Seis trabalhos encontraram diminuição significativa da depressão. A frequência dos efeitos adversos variou de 4,1% a 30%, sendo ptose palpebral e dor de cabeça os mais frequentes.

CONCLUSÃO: A TXB parece ser útil para tratamento da cefaleia crônica e depressão. Houve uma tendência a relacionar a melhora da depressão com a diminuição da dor. A ação específica da toxina no tratamento da depressão foi inconclusiva. Novos estudos, com alto rigor metodológico, assim como revisões sistemáticas, deve ser realizados para alcançar maior aprofundamento do assunto, a fim de determinar a real eficácia da TXB no alívio da cefaleia e depressão concomitantes.

Palavras-chave

Depressão, Toxina botulínica tipo A, Transtornos de enxaqueca

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Submitted date:
11/27/2021

Accepted date:
05/09/2022

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