Rationale for use of onabotulinum toxin A (BOTOX) in chronic migraine

Barbanti, Piero; Egeo, Gabriella; Fofi, Luisa; Aurilia, Cinzia; Piroso, S.

doi:10.1007/s10072-015-2195-0

Cited by 23 publications

(23 citation statements)

References 39 publications

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“…Although the efficacy of low dose found in the pilot study in China agrees with some previous studies [ 12 , 36 ], it is at odds with the current literature. More recent studies of the Phase III Research Evaluating Migraine Prophylaxis Therapy (PREEMPT) have demonstrated and recommended 155–195 U dose of BoNTA for migraine therapy [ 37 , 38 ]. Considering the inadequacy of this single study, PREEMPT paradigm for injection dose of BoNTA will be used in future protocol of migraine treatment.…”

Section: Resultsmentioning

confidence: 99%

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Acupoint Injection of Onabotulinumtoxin A for Migraines

Hou

Xie

Kong

et al. 2015

Toxins

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Onabotulinumtoxin A (BoNTA) has been reported to be effective in the therapy for migraines. Acupuncture has been used worldwide for the treatment of migraine attacks. Injection of a small amount of drug at acupuncture points is an innovation as compared to traditional acupuncture. The purpose of this study was to evaluate and compare the effectiveness of fixed (muscle)-site and acupoint-site injections of BoNTA for migraine therapy in a randomized, double-blinded, placebo-controlled clinical trial extending over four months. Subjects with both episodic and chronic migraines respectively received a placebo (n = 19) or BoNTA (2.5 U each site, 25 U per subject) injection at fixed-sites (n = 41) including occipitofrontalis, corrugator supercilii, temporalis and trapeziue, or at acupoint-sites (n = 42) including Yintang (EX-HN3), Taiyang (EX-HN5), Baihui (GV20), Shuaigu (GB8), Fengchi (GB20) and Tianzhu (BL10). The variations between baseline and BoNTA post-injection for four months were calculated monthly as outcome measures. BoNTA injections at fixed-sites and acupoint-sites significantly reduced the migraine attack frequency, intensity, duration and associated symptoms for four months compared with placebo (p < 0.01). The efficacy of BoNTA for migraines in the acupoint-site group (93% improvement) was more significant than that in the fixed-site group (85% improvement) (p < 0.01). BoNTA administration for migraines is effective, and at acupoint-sites shows more efficacy than at fixed-sites. Further blinded studies are necessary to establish the efficacy of a low dose toxin (25 U) introduced with this methodology in chronic and episodic migraines.

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Section: Resultsmentioning

confidence: 99%

“…The majority of controlled studies with BoNTA report failure of this form of treatment in episodic migraine [ 20 , 37 , 47 , 48 ]. Controlled studies using our methodology and dose are necessary to see if our positive results can be independently replicated.…”

Section: Resultsmentioning

confidence: 99%

Acupoint Injection of Onabotulinumtoxin A for Migraines

Hou

Xie

Kong

et al. 2015

Toxins

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“…The rationale for administering these interventions is that effecting a decrease of afferent nociceptive information in the cranio-cervical region (i.e. a peripheral mechanism) will lead to a decrease of peripheral sensitization or sensitization of the trigemino-cervical nucleus caudalis [ 12 , 13 ]. Therefore, providing clinicians who administer such interventions with reference PPT values in the cranio-cervical region may assist them in their evaluation of PPT values.…”

Section: Reviewmentioning

confidence: 99%

Pressure pain thresholds over the cranio-cervical region in headache: a systematic review and meta-analysis

2018

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BackgroundSensitivity of tissues can be measured by algometry. Decreased pressure pain thresholds over the cranio-cervical area are supposed to reflect signs of sensitization of the trigemino-cervical nucleus caudalis. A systematic review was conducted to assess the current scientific literature describing pressure pain threshold (PPT) values over the cranio-cervical region in patients with migraine, tension-type headache (TTH), and cervicogenic headache (CeH). A literature search was executed in three databases. The search strategy included the following keywords: migraine, TTH, CeH, PPT and algometry. A total of 624 papers was identified of which relevant papers were subsequently assessed for methodological quality. Twenty-two selected papers were assessed by two independent reviewers and the majority of studies scored low risk of bias on the selected items. Mean PPT values of several sites measured in the cranio-cervical region in patients with migraine, chronic TTH and CeH scored lower values compared to controls. The trapezius muscle (midpoint between vertebrae C7 and acromion) was the most frequently targeted site and showed significantly lower PPT values in adults with migraine (pooled standardized mean difference kPa: 1.26 [95%CI -1.71, −0.81]) and chronic TTH (pooled standardized mean difference kPa: -2.00 [95%CI -2.93, −1.08]). Most studies found no association between PPT values and headache characteristics such as frequency, duration or intensity. Further standardization of PPT measurement in the cranio-cervical region is recommended.Electronic supplementary materialThe online version of this article (10.1186/s10194-018-0833-7) contains supplementary material, which is available to authorized users.

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“…25–27 The technique is based off the theory introduced by works from our neurology colleagues that BOTOX works directly on the nerves to decrease migraine pain 28,29 rather than an indirect effect by acting on the muscle alone. This technique has taken the initial Guyuron method 15 of BOTOX injection and added to it additional injection sites based on newer data regarding migraine etiology and nerve anatomy, 12–14,30 and the experience of the migraine BOTOX injection practice of the senior author, 20 to form the first comprehensive, nerve-specific treatment for migraines.…”

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confidence: 99%