Handb Clin Neurol. 2010;97:217-32.
Botulinum neurotoxin in the treatment of headache disorders.
Mauskop A.
Abstract
Botulinum neurotoxin (BoNT) has been in clinical use for the treatment of headaches for over 15 years. Recent double-blind placebo-controlled trials have confirmed the efficacy of BoNT type A (onabtoulinumtoxinA, Botox) in the treatment of chronic migraine.

THE EFFICACY OF BONT IN THE TREATMENT OF EPISODIC MIGRAINE HEADACHES, CLUSTER HEADACHES, AND CHRONIC TENSION-TYPE HEADACHE (TTH) HAS NOT BEEN EXAMINED IN LARGE CONTROLLED TRIALS.

Presumed mechanisms of action of BoNT in headache disorders are the reduction of afferent input induced by muscle relaxation and inhibition of the release of neurotransmitters, such as glutamate and calcitonin gene-related peptide, from peripheral sensory nerve terminals. Over 20 years of extensive clinical experience has established a remarkable safety for BoNT, particularly type A and specifically Botox or onabotulinumtoxinA, which has been used much longer and more widely than any other form or serotype of BoNT. Because BoNT is a biological product, the safety and efficacy of one BoNT formulation cannot be extrapolated to a different one, even of the same serotype.

Copyright © 2011 Elsevier B.V. All rights reserved.

PMID:20816423[PubMed]
===========
Curr Pain Headache Rep. 2009 Apr;13(2):164-7.
The role of nerve blocks and botulinum toxin injections in the management of cluster headaches.

Ailani J, Young WB.

Jefferson Headache Center, Gibbon Building, 111 South 11th Street, Suite 8130, Philadelphia, PA 19107, USA. jessica.ailani@gmail.com

Cluster headache (CH) is a primary headache syndrome that is classified with the trigeminal autonomic cephalalgias. CH treatment involves three steps: acute attack management, transitional therapy, and preventive therapy. Greater occipital nerve block has been shown to be an effective alternative bridge therapy to oral steroids in CH.

BOTULINUM TOXIN TYPE A HAS RECENTLY BEEN STUDIED AS A NEW PREVENTIVE TREATMENT FOR PATIENTS WITH CHRONIC CH, WITH LIMITED SUCCESS.

Publication Types:
Review

PMID: 19272284 [PubMed]
==========
J Neurol. 2004 Feb;251 Suppl 1:I19-30.
Botulinum toxin in the treatment of rare head and neck pain syndromes: a systematic review of the literature.

Sycha T, Kranz G, Auff E, Schnider P.

Department of Neurology, Division of Neurological Rehabilitation, University of Vienna, Austria.

[90% of this abstract has been deleted because of the technical data ref. methods of study and data analysis. --Bob Johnson]

REVIEWERS' CONCLUSIONS: There is convincing evidence for the effectiveness of BoNT in the treatment of pain associated with cervical dystonia. Due to the frequent adverse effects predominantly observed with higher doses, the trade off in risk and benefit should be carefully considered in each case. For all other rare head and neck pain syndromes we found no [randomized controlled trials for] (CLUSTER HEADACHE, chronic paroxysmal hemicrania, trigeminal neuralgia) and only a few small sized trials (cervicogenic headache, chronic neck pain, temporomandibular disorders). We were therefore unable to draw any definite conclusions.

Publication Types:
Review

PMID: 14991339 [PubMed]
=================

Overall, modest quantity of talk in the medical literature but outcome studies is not strongly positive. I'd regard it as something to try if other, standard treatments have failed.

An old neurologist of mine recommended Botox, and it didn't work for me. I had a total of three treatments over a span of a few months, and noticed that the attacks were occurring more frequently. The next neurologist I went to was of the belief that Botox can actually aggravate the cluster cycle, and would only recommend it for migraine sufferers.

The occipital nerve block described above worked great for me. I used to get injections once every two months, and would experience 6 weeks of no pain following each injection. The strength of the medication wore off after about a year of treatment, but it was great when it lasted. My insurance covered it, and I would definitely recommend looking into it for a temporary solution.

DHE (dihydroergotamine) infusions have been known to break cycles for chronic sufferers as well.

Good luck