Shot in the dark: three patients successfully treated with onabotulinumtoxin A injections for relief of post-traumatic chronic headaches and dystonia induced by gunshot wounds

Document Type


Publication Date


Journal Title

BMJ case reports

MeSH Headings

Acetylcholine Release Inhibitors (administration & dosage); Botulinum Toxins, Type A (administration & dosage); Drug Administration Schedule; Female; Head Injuries, Penetrating (complications); Headache Disorders (etiology, therapy); Humans; Male; Middle Aged; Neck Injuries (complications); Torticollis (etiology, therapy); Treatment Outcome; Wounds, Gunshot (complications)


Three patients ranging from 49 to 61 years-old presented to our pain clinic after failing multiple treatment attempts for debilitating, chronic post-traumatic headaches, neck pain and involuntary muscle spasm following gunshot wounds to the head, neck and face. Concurrent cervical dystonia was noted in each patient on presentation. All patients were treated with onabotulinumtoxin A (ONA) injections in the head and neck. Each patient reported between 70% and 100% improvement of their headache pain, neck pain and spasm with a significant reduction in the frequency, duration and intensity of their headaches. This level of improvement has been successfully maintained in all three patients with regular ONA injections at 90-day intervals. Two patients experienced a single relapse in symptoms when scheduling conflicts caused them to miss their regularly scheduled ONA injections by several weeks. These symptoms resolved when their ONA injections resumed, suggesting that ONA is the causative agent alleviating their symptoms.