Amirlak Bardia, Sanniec Kyle, Pezeshk Ronnie, Chung Michael
Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Tex.
Plast Reconstr Surg Glob Open. 2016 Dec 27;4(12):e1194. doi: 10.1097/GOX.0000000000001194. eCollection 2016 Dec.
Migraine headaches are a debilitating disease that causes significant socioeconomic problems. One of the speculated etiologies of the generation of migraines is peripheral nerve irritation at different trigger points. The use of Onabotulinum toxin A (BOTOX), although initially a novel approach, has now been determined to be a valid treatment for chronic headaches and migraines as described in the Phase III Research Evaluating Migraine Prophylaxis Therapy trials that prompted the approval by the Food and Drug Administration for treatment of chronic migraines. The injection paradigm established by this trial was one of a broad injection pattern across large muscle groups that did not always correspond to the anatomical locations of nerves. The senior author developed the Anatomical Regional Targeted BOTOX injection paradigm as an alternative to the current injection model. This technique targets both the anatomical location of nerves known to have causal effects with migraines and the region where the pain localizes, to provide relief across a wide distribution of the peripheral nerve. This article serves as a guide to the Anatomical Regional Targeted injection technique, which, to our knowledge, is the first comprehensive BOTOX injection paradigm described in the literature for treatment of migraines that targets nerves and nerve areas rather than purely muscle groups. This technique is based on the most up-to-date anatomical and scientific studies and large-volume migraine surgery experience.
偏头痛是一种使人衰弱的疾病，会引发重大的社会经济问题。偏头痛产生的推测病因之一是不同触发点的周围神经刺激。A型肉毒毒素（保妥适）的使用，尽管最初是一种新颖的方法，但现在已被确定为慢性头痛和偏头痛的有效治疗方法，如在评估偏头痛预防疗法的III期研究试验中所述，该试验促使美国食品药品监督管理局批准其用于治疗慢性偏头痛。该试验建立的注射模式是在大肌肉群上广泛注射的模式之一，并不总是与神经的解剖位置相对应。资深作者开发了解剖区域靶向保妥适注射模式，作为当前注射模型的替代方法。该技术既针对已知与偏头痛有因果关系的神经解剖位置，也针对疼痛定位区域，以在周围神经的广泛分布范围内提供缓解。本文作为解剖区域靶向注射技术的指南，据我们所知，这是文献中描述的第一种用于治疗偏头痛的全面保妥适注射模式，该模式针对神经和神经区域而非单纯的肌肉群。这项技术基于最新的解剖学和科学研究以及大量的偏头痛手术经验。
