Department of Otorhinolaryngology, Head and Neck Surgery, Central Military Hospital Utrecht, Utrecht, The Netherlands.
J Neural Transm (Vienna). 2011 Nov;118(11):1571-4. doi: 10.1007/s00702-011-0654-1. Epub 2011 May 20.
Chronic daily headache (CDH) located in the frontal region is a common problem. We have previously described the positive results that were achieved with botulinum toxin (BTX) injections in the musculus corrugator supercilii (MCS) for this disorder. Nowadays, we offer transection of this muscle to patients following a minimum of two BTX injections, provided these injections result in a significant reduction of pain. This procedure is based on the assumption that the pathophysiological mechanism in some of these patients suffering from CDH is a neural entrapment of the supratrochlear nerve in the corrugator muscle. To assess the effect of transection, we have evaluated all the consecutive patients (n = 10) so far. Treatment was successful in nine of these patients. Prior to the treatment, the mean pain score in the 9 successfully treated patients was 8.1 (range 6-9), after transection this had been reduced to 0.8 (range 0-3). All of these successfully treated patients ceased their daily use of pain relief medication for their frontally localised headaches. Moreover, they stated that they would definitely undergo surgery, if they were to find themselves in the same situation again. Therefore, we conclude that transection of the MCS is an efficient and successful procedure for a carefully selected group of patients suffering from CDH in the frontal region. Most of all we intend to popularise this pathophysiological concept based on the distinct possibility that some headaches might be due to neural entrapment.
慢性每日头痛（CDH）位于额区，是一种常见的问题。我们之前曾描述过肉毒杆菌毒素（BTX）注射到皱眉肌（MCS）对这种疾病的积极效果。如今，我们为那些已经接受过至少两次 BTX 注射且疼痛明显减轻的患者提供这种肌肉横断术。该手术基于这样一种假设，即对于一些患有 CDH 的患者，其病理生理机制是滑车上神经在皱眉肌中被神经卡压。为了评估横断术的效果，我们评估了迄今为止所有连续的患者（n=10）。在这些患者中，有 9 人治疗成功。在治疗之前，9 名治疗成功的患者的平均疼痛评分为 8.1（6-9 分），横断术后降至 0.8（0-3 分）。所有这些治疗成功的患者都停止了他们每日使用的针对额部局灶性头痛的止痛药。此外，他们表示，如果再次出现同样的情况，他们肯定会接受手术。因此，我们得出结论，对于精心挑选的患有额部 CDH 的患者群体，MCS 横断术是一种有效且成功的手术。最重要的是，我们旨在普及这种基于神经卡压可能是某些头痛原因的病理生理学概念。
