Migraine Resource Network is a comprehensive educational initiative for clinicians seeking current and emerging information on migraine headache. Our mission is to provide ongoing medical education that embodies evidence-based scientific data, current treatment strategies, and the insightful knowledge of expert faculty. Our goal is to support your ongoing dedication to optimizing treatment outcomes for your patients.

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Treatment of Headache with Botulinum Toxin Type A

Release Date: September 28, 2009
Expiration Date: September 28, 2010

Program Overview

Botulinum toxin was initially used to treat dystonia and muscle spasm. More recently, the drug has been used for cosmetic reasons and to treat patients with severe underarm and hand perspiration. Anecdotal reports of secondary analgesic response inspired its further use for the treatment of chronic pain conditions, including chronic daily headache. Although numerous clinical studies have been conducted, there remains a lack of consensus regarding evidence of botulinum toxin’s efficacy for use in headache management. Dr. Ashkenazi provides a summary of the evidence and offers practical and clinical direction on how, when, and in whom botulinum toxin may offer positive clinical outcomes for the treatment of chronic daily headache.

Target Audience

This activity is designed for physicians with an interest in the management of migraine.

Learning Objectives

After completion of this educational activity, participants will be able to:

  • Recognize need for treatment of headache and migraine as a common and debilitating disease
  • Understand the importance of preventative therapies in the management of headache and migraine
  • Explain associated risks and benefits of headache and migraine therapies

General Information

This activity is eligible for credit through September 28, 2010. After this date, this activity will expire and no further credit will be awarded.

There are no fees for participating in this activity. All participants must complete the Online Activity Evaluation. Certificates may be printed immediately after completing the online self-assessment and evaluation.

This activity is supported by an educational grant from Endo Pharmaceuticals

Faculty Biography

Abraham (Avi) Ashkenazi, MD
Neurologic Group of Bucks/Montgomery County
Neurology Consultant, Doylestown Hospital
Doylestown, Pennsylvania
Neurology Consultant, Grand View Hospital
Sellersville, Pennsylvania

Dr. Avi Ashkenazi received his medical degree from Hebrew University Hadassah Medical School, Jerusalem, Israel. He continued his postgraduate training with an internship, a residency, and a chief residency in neurology at Hadassah University Hospital. Dr. Ashkenazi completed fellowships in headache and facial pain at Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire and at Jefferson Headache Center, Thomas Jefferson University Hospital, Philadelphia. He is a member of the Neurologic Group of Bucks/Montgomery County, and a neurology consultant at Doylestown Hospital, Doylestown, Pennsylvania and Grand View Hospital, Sellersville, Pennsylvania.

Board certified by the Israel Board of Neurology, Dr. Ashkenazi is also a member the American Headache Society, the International Headache Society, and the American Academy of Neurology, where he recently received the Harold Wolff-John Graham Award for outstanding achievement in Headache and Facial Pain Research.

Dr. Ashkenazi is an ad-hoc reviewer for numerous professional journals including Cephalalgia, Headache, Journal of Neurology, The Journal of Headache and Pain, Journal of Pharmacy and Pharmacology,and European Journal of Pain. In addition, he has authored many peer-reviewed articles, books chapters, abstracts and presentations on the management of migraine and other headaches.


CME Credit
Accreditation Statement: MediCom Worldwide, Inc. is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
Designation Statement: MediCom Worldwide, Inc. designates this educational activity for a maximum of .75 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.


In accordance with the Accreditation Council for Continuing Medical Education (ACCME), ACPE and California Board of Nursing, MediCom Worldwide, Inc. requires that all program planners, faculty, and providers who are in a position to control the content of a CE activity are required to disclose any relevant financial relationships they may have or have had within the last 12 months with the commercial supporter or the manufacturer(s) of any commercial device(s) discussed in this educational activity. Accordingly, the following disclosures were made.

Faculty Disclosures

The presenting faculty reported the following: Dr. Avi Ashkenazi has disclosed that he has no significant relationships with the grantor Endo Pharmaceuticals or any other commercial company whose products and services may be related to his presentation.

Provider Disclosures

The individuals listed below from MediCom Worldwide, Inc. reported the following for this activity: Joan Meyer, executive director; Norma Jean Talley, manager, professional education; and Ruth Widmer, medical editor, have nothing to disclose.

Off-Label/Investigational Disclosures

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The opinions expressed in the educational activity are those of the faculty. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings. Further, attendees/participants should appraise the information presented critically and are encouraged to consult appropriate resources for any product or device mentioned in this program.

Dr. Ashkenazi indicated that his presentation would include the unlabeled discussion of botulinum toxin type A for the treatment of headache and pain. Botulinum toxin type A is not approved by the FDA for this use in the United States.

Dr. Ashkenazi indicated that his presentation would not include the discussion of investigational/unapproved products that have not been approved by the FDA for any use in the United States.

Conflict of Interest Resolution

To resolve identified conflicts of interest, the educational content was fully peer reviewed by members of the MediCom Content Review Committee. The resulting certified activity was found to provide educational content that is current, evidence-based, and commercially balanced.

Americans with Disabilities Act/Special Needs

MediCom Worldwide, Inc. is committed to equality of educational opportunity and does not discriminate against applicants, students, or employees on the basis of race, color, religion, sex, national origin, age, disability, veterans status, or sexual orientation.

Hardware/Software Requirements

MediCom Worldwide, Inc. requires Internet Explorer® version 7.0 or higher, or Firefox 3.0 or higher, a computer running Windows® XP, Windows® Vista, or Mac OS X, 512MB of RAM or greater, 1.5 GHZ or faster processor, and a screen resolution of 1024x768 or higher. Certain educational activities may require additional software to view. These activities will be marked with the information and/or links to the required software. That software may be Adobe® Flash® Player, Adobe® Acrobat®, Windows Media® Player or Microsoft®Silverlight™.

©2009 MediCom Worldwide, Inc., 101 Washington St., Morrisville, PA 19067.

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