Botulinum Toxin Injection for Cervicogenic Headache

We report a 28-year-old woman with a 5-year history of cervicogenic headache following a whiplash injury, Her unilateral neck pain, if aggravated by exertion, would create a predictable sequence of events leading to a hemicephalgia. She proved medically refractory to usual therapies, but had a striking response to a single botulinum toxin injection in her symptomatic rapezius muscle. Repeated injections every 3 months have been required to maintain this benefit. The implications of this observation are discussed.