Academic Journal
Decreased need for botulinum toxin and nerve blocks after headache surgery.
| Title: | Decreased need for botulinum toxin and nerve blocks after headache surgery. |
|---|---|
| Authors: | Mönnink GLE; Weill Cornell Medicine, Division of Plastic and Reconstructive Surgery, New York, NY, USA., DePamphilis MA; Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA., Hazewinkel MHJ; Weill Cornell Medicine, Division of Plastic and Reconstructive Surgery, New York, NY, USA., Kim AC; Weill Cornell Medicine, Division of Plastic and Reconstructive Surgery, New York, NY, USA., Vicente KA; Weill Cornell Medicine, Division of Plastic and Reconstructive Surgery, New York, NY, USA., Austen WG Jr; Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA., Gfrerer L; Weill Cornell Medicine, Division of Plastic and Reconstructive Surgery, New York, NY, USA. Electronic address: lig4013@med.cornell.edu. |
| Source: | Journal of plastic, reconstructive & aesthetic surgery : JPRAS [J Plast Reconstr Aesthet Surg] 2026 Aug; Vol. 119, pp. 297-307. Date of Electronic Publication: 2026 Jun 17. |
| Publication Type: | Journal Article; Multicenter Study |
| Language: | English |
| Journal Info: | Publisher: Elsevier Country of Publication: Netherlands NLM ID: 101264239 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1878-0539 (Electronic) Linking ISSN: 17486815 NLM ISO Abbreviation: J Plast Reconstr Aesthet Surg Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Amsterdam, The Netherlands : Elsevier, c2006- |
| MeSH Terms: | Nerve Block*/statistics & numerical data , Nerve Block*/economics , Headache*/surgery , Botulinum Toxins*/administration & dosage , Botulinum Toxins*/economics, Humans ; Female ; Male ; Middle Aged ; Adult ; Botulinum Toxins, Type A |
| Abstract: | Background: Patients with head and neck neuralgias typically exhaust conservative treatment options, including expensive botulinum toxin (BTX) and local anesthetic injections (peripheral nerve blocks; NB) before undergoing headache surgery. However, the impact of surgery on reducing injectable use and thereby treatment cost remains unclear. Methods: This multicenter study included patients with complete pre- and postoperative injectable data who underwent headache surgery at two academic centers between 2021 and 2026. Results: Eighty-four patients were included. Preoperatively, 74% (n = 62) received BTX with limited efficacy: 30% reported no relief, 46% some relief (<50%), 21% significant relief (>50%), and 3% complete relief. Relief duration was <3 months in 86%. NBs were administered to 87% (n = 73), with 35% reporting significant or complete pain relief. Among the responders, 54% experienced relief in <1 week. Paired comparison (n = 55) demonstrated that NBs provided significantly more relief than BTX (p = 0.035). NBs administered by treating surgeons significantly outperformed those from outside providers (p < 0.001). Postoperatively, BTX use decreased from 74% to 36% (p < 0.001), and NB use from 87% to 27% (p < 0.001). The projected annualized cost reduction was $365,808 in this cohort. Conclusion: Injectable treatments provide limited symptom relief for neuralgias of the head and neck. NBs were associated with greater patient-reported symptom relief compared to BTX, underscoring their role as an effective diagnostic tool. Additionally, targeted NBs provided significantly more pain relief than injections administered through universal injection protocols. Headache surgery significantly reduces injectable use, thereby reducing associated healthcare costs. (Copyright © 2026 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.) |
| Competing Interests: | Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered potential competing interests. L. Gfrerer reports board membership with BioCircuit Technologies Inc and consulting or advisory roles with Tulavi and Sientra Inc. Given the role of L. Gfrerer as Deputy Editor for JPRAS, she had no involvement in the peer review of this article and had no access to information regarding its peer review. Full responsibility for the editorial process for this article was delegated to another journal editor. W. Austen Jr. reports consulting or advisory roles with Cytrellis, Tiger Aesthetics, and DurVena. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. |
| Contributed Indexing: | Keywords: Botulinum toxin; Cost reduction; Headache surgery; Nerve blocks; Nerve decompression surgery; Neuralgia |
| Substance Nomenclature: | EC 3.4.24.69 (Botulinum Toxins) EC 3.4.24.69 (Botulinum Toxins, Type A) |
| Entry Date(s): | Date Created: 20260703 Date Completed: 20260724 Latest Revision: 20260724 |
| Update Code: | 20260725 |
| DOI: | 10.1016/j.bjps.2026.06.008 |
| PMID: | 42398178 |
| Database: | MEDLINE |
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