Smuts Johan A, Schultz Donovan, Barnard Adri
Department of Neurology and Neurophysiology, University of Pretoria, South Africa.
Headache. 2004 Sep;44(8):801-5. doi: 10.1111/j.1526-4610.2004.04148.x.
The main objective of this study is to determine whether change in migraine frequency is correlated with a denervation pattern of the corrugator muscle after local botulinum toxin type A injections.
Recent studies suggest botulinum toxin type A is effective in preventing migraine. Relaxation of the corrugator muscle may be one of multiple targets of botulinum toxin type A in relieving migraine pain.
The pretreatment amplitude of the compound muscle action potential (CMAP) was obtained in 10 patients with a migraine frequency of two to six attacks per month following stimulation of the temporal branch of the facial nerve. Patients were subsequently injected with 20 units of botulinum toxin type A at predefined sites in the procerus and corrugator muscles. CMAP was obtained on days 7, 30, 60, and 90 after injection. Migraine frequency, as reported in headache diaries, was compared with the amplitudes obtained.
A 50% decrease in CMAP was demonstrated in the total group by day 7. Maximal decline of CMAP was observed by day 30, and was sustained at day 60. Migraine frequency declined by 50% or more in 7 of 10 patients by day 60. Migraine response to botulinum toxin type A treatment did not correlate with the denervation pattern.
Relaxation of the corrugator muscles is not solely responsible for the pain relief in migraine patients treated with botulinum toxin type A.
本研究的主要目的是确定偏头痛发作频率的变化是否与局部注射A型肉毒杆菌毒素后皱眉肌的去神经模式相关。
最近的研究表明，A型肉毒杆菌毒素在预防偏头痛方面有效。皱眉肌的松弛可能是A型肉毒杆菌毒素缓解偏头痛疼痛的多个靶点之一。
对10例每月偏头痛发作2至6次的患者，在刺激面神经颞支后获取复合肌肉动作电位（CMAP）的预处理幅度。随后，在降眉间肌和皱眉肌的预定义部位给患者注射20单位A型肉毒杆菌毒素。在注射后第7天、30天、60天和90天获取CMAP。将头痛日记中记录的偏头痛发作频率与所获得的幅度进行比较。
到第7天，全组CMAP下降了50%。到第30天观察到CMAP最大程度下降，并在第60天维持。到第60天，10例患者中有7例偏头痛发作频率下降了50%或更多。偏头痛对A型肉毒杆菌毒素治疗的反应与去神经模式无关。
皱眉肌的松弛并非接受A型肉毒杆菌毒素治疗的偏头痛患者疼痛缓解的唯一原因。
