Botulinum Toxin Type A for Chronic Migraine

Cephalic allodynia (CA) can be observed in 50-70% of patients with chronic migraine (CM). The aim of this trial was to assess the efficacy of botulinum toxin type A (Botx-A) in the treatment of CA associated with CM. In this placebo-controlled trial, patients were randomized either into Botx-A or 0.9% saline injections and efficacy measures were assessed every 4 weeks for 3 months. Efficacy endpoints were number of migraine episodes associated with CA, changes from baseline in visual analogical scale scores for pain (VAS) and frequency of common analgesics use for migraine. A total of 38 subjects were randomized to saline (n=18) or Botx-A (n=20). There were no significant differences in baseline between active intervention or placebo groups regarding mean age, number of headache episodes [mean 12.1 (9.22) and 17.00 (9.69) respectively; P=0.12], pain severity as measured by the VAS or frequency of analgesic use for headache episodes. Efficacy analysis showed that Botx-A injections led to an important decrease from baseline in the mean migraine episodes associated with CA after 12 weeks (5.20 versus 11.17; P=0.01). Also, VAS scores and frequency of analgesics use for headache were significantly reduced in the Botx-A group. This study suggests that Botx-A injections are superior to saline in the treatment of CA associated with CM, with mild self limited side effects.

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Botulinum toxin type A in the treatment of chronic migraine and chronic tension-type headache

Toxicon ◽

10.1016/j.toxicon.2008.04.136 ◽

2008 ◽

Vol 51 ◽

pp. 45

Author(s):

Artemenko Ada ◽

Orlova Olga

Keyword(s):

Botulinum Toxin ◽

Chronic Migraine ◽

Botulinum Toxin Type A ◽

Type A ◽

Botulinum Toxin Type ◽

Tension Type Headache ◽

Chronic Tension Type Headache ◽

Type Headache

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The use of Botulinum toxin type A for the treatment of refractory chronic migraine

10.5327/1516-3180.566 ◽

2021 ◽

Author(s):

Gabrielle Torres Oliveira Lemos ◽

Gabriel das Chagas Benevenuto ◽

Gabriela Guy Duarte ◽

Bruno Alves Pinto ◽

Ivan Magalhães Viana

Keyword(s):

Botulinum Toxin ◽

Chronic Migraine ◽

Botulinum Toxin Type A ◽

Clinical Excellence ◽

Type A ◽

Infiltration Rate ◽

Botulinum Toxin Type ◽

Control Group ◽

Pubmed Database ◽

Refractory Chronic Migraine

Background: Chronic migraine is a neurological disorder described as refractory to preventive treatments. Based on the PREEMPT study, the National Institute for Health and Clinical Excellence (NICE) and the FDA approved, in 2010, the use of Botulinum Toxin type A (BoNT/A) to treat refractory chronic migraine. Objectives: To review the effectiveness of the use of BoNT/A in the treatment of refractory migraine. Methods: Bibliographic review based on PubMed database, using the descriptors “migraine” and “botulinum toxin”. Clinical trials, meta-analyzes and randomized controlled tests, from the last five years, were defined as inclusion criteria. Results: Sanz et al., (2016) infiltrated BoNT/A in 69 patients - mean age 43 years old, 88.4% women, mean infiltration rate was 2,0. The reduction of headache days and pain intensity was 48.5% and 20.5%, respectively, both statistically significant (p <0.006). Ion et al., (2018) intervened 61 patients - mean age 50 years old, 87% women, mean infiltration of 3.5. 73% showed a reduction greater than 50% for the frequency of migraine episodes, 48% for headache days and 48% for drug use. Dodick et al., (2019) applied BoNT/A in 688 patients - 696 received placebo. The severity and frequency of pain showed a statistically significant reduction (p < 0.001) after the first week of treatment in relation to the control group. Conclusions: The use of BoNT/A to treat refractory chronic migraine proves to be effective, although there is need for studies with larger samples to ensure its effectiveness.

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A Critical Review of Botulinum Toxin Type A in the Prophylactic Treatment of Chronic Migraine in Adults

Aesthetic Surgery Journal ◽

10.1093/asj/sjy224 ◽

2018 ◽

Vol 39 (8) ◽

pp. 898-907

Author(s):

Hanieh Mimeh ◽

Anna Maria Fenech Magrin ◽

Simon Myers ◽

Ali M Ghanem

Keyword(s):

Botulinum Toxin ◽

Chronic Migraine ◽

Prophylactic Treatment ◽

Financial Burden ◽

Botulinum Toxin Type A ◽

Type A ◽

Botulinum Toxin Type ◽

World Health ◽

Evidence Based ◽

Increased Risk

Abstract Background Migraine is a severe, disabling condition, ranked by World Health Organization as the sixth highest cause of disability worldwide. It greatly affects patients’ quality of life, functionality, and physical and mental health. The financial burden of migraine on the UK economy is conservatively estimated at £3.42 billion per year. Objectives The authors sought to perform an evidence-based literature review of the safety and efficacy of botulinum toxin type A (onaBoNTA) in the prophylactic treatment of adult patients suffering with chronic migraine (CM) compared to placebo. After the best evidence is identified, it will be utilized to formulate a protocol for doctors managing CM in their aesthetic clinic. Methods A comprehensive search of the current literature on the topic was performed by H.M. using Pubmed MEDLINE electronic database on March 1, 2018. All articles up to and inclusive of this date were included. Articles were limited to human studies and those in the English language. In vitro and animal studies were excluded. Results A total of 260 articles were identified. Of these, the excellent-quality, high-strength (level 1A) trials were short-listed to answer the research question. Conclusions There is high-quality, level 1A evidence to support onaBoNTA treatment in adults with CM is well tolerated and considered safe. However, it is associated with increased risk of adverse events and still some uncertainty exists associated with the degree onaBoNTA improves outcome measures compared to placebo. These data have been used to formulate The London Aesthetic Migraine Protocol (LAMP) to provide safe, evidence-based guidance for appropriately trained and experienced aesthetic practitioners to manage CM in their aesthetic clinics. Level of Evidence: 1

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A Proposal for Botulinum Toxin Type A Injection Into the Temporal Region in Chronic Migraine Headache

Toxins ◽

10.3390/toxins12040214 ◽

2020 ◽

Vol 12 (4) ◽

pp. 214 ◽

Cited By ~ 1

Author(s):

Young-gun Kim ◽

Jung-Hee Bae ◽

Hyeyun Kim ◽

Shuu-Jiun Wang ◽

Seong Taek Kim

Keyword(s):

Botulinum Toxin ◽

Chronic Migraine ◽

Botulinum Toxin Type A ◽

Superficial Temporal Artery ◽

Type A ◽

Temporal Artery ◽

Botulinum Toxin Type ◽

Superficial Layer ◽

Sensory Nerves ◽

Temporal Region

Botulinum toxin type-A (BTX-A) injection for treating chronic migraine (CM) has developed into a new technique covering distinct injection points in the head and neck regions. The postulated analgesic mechanism implies that the injection should be administered to sensory nerves rather than to muscles. This study aimed to determine the topographical site of the auriculotemporal nerve (ATN) and to propose the effective injection points for treating CM. ATNs were investigated on 36 sides of 25 Korean cadavers. The anatomical structures of the ATN were investigated focusing on the temporal region. A right-angle ruler was positioned based on two clearly identifiable orthogonal reference lines based on the canthus and tragus as landmarks, and photographs were taken. The ATN appeared superficially in the anterosuperior region of the tragus. The nerve is located deeper than the superficial temporal artery. And it runs between the artery and the superficial temporal vein. In the superficial layer, it is divided into anterior and posterior divisions. The anterior division runs in a superior direction, while the posterior division runs in front of the ear and the several branches are distributed to the skin. We suggest that the optimal BTX-A injection points for CM are in the temporal region. The first point is about 2 cm anterior and 3 cm superior to two orthogonal reference lines defined based on the tragus and canthus, and the second point is about 4 cm superior to the first point. The third and fourth points are recommended about 2 cm superior to the first point, but respectively 1 cm anterior and posterior to it.

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