Post-traumatic cervical dystonia treated with botulinum toxin type A injections to the cranial and cervical muscles.

A male combat veteran in his late 40s presented with debilitating chronic neck pain, involuntary cervical muscle spasms, rightward head tilt and headaches occurring more than 15 days per month after cumulative cervical trauma from blast exposures and over 350 parachute jumps. He was diagnosed with post-traumatic cervical dystonia and treated with onabotulinumtoxinA injections to the procerus, bilateral corrugator, frontalis, temporalis, occipitalis, cervical paraspinal and upper and lower trapezius muscles. Ninety days after the first injection cycle he reported 85%-90% improvement in pain, spasms and headache frequency, with sustained 90% improvement across treatments. He experienced over 100 fewer headache hours and seven fewer headache days per month compared with baseline. Mild symptom recurrence during the final week of his 90-day interval led to adjustment to a 12-week schedule, resulting in improved consistency of relief. Botulinum toxin type A therapy provided substantial and consistent improvement in this case of post-traumatic cervical dystonia.