Mayo Clinic School of Medicine, Rochester, MN, USA.
Department of Neurology, Mayo Clinic Rochester, Rochester, MN, USA.
Headache. 2018 Jul;58(7):973-985. doi: 10.1111/head.13317. Epub 2018 May 15.
OnabotulinumtoxinA has been demonstrated to be effective for the preventive treatment of headache in individuals with chronic migraine and has been approved and recommended for this patient population. While the therapeutic effect of onabotulinumtoxinA on migraine headache is well documented, there is limited information on the effect of onabotulinumtoxinA on migraine aura.
Given the prolonged and often debilitating nature of aura in patients with hemiplegic migraine, our group sought to examine the effect of onabotulinumtoxinA on aura frequency and severity in this specific subset of migraine patients.
All clinical notes from July 1, 1994 to December 1, 2017 at our institution were retrospectively reviewed to identify patients diagnosed with hemiplegic migraine who received at least one set of onabotulinumtoxinA injections. Thirty-four patients were identified; and of those, 23 were excluded due to incomplete documentation regarding aura symptoms at follow-up visits. The clinical notes of the remaining 11 patients (4 with familial hemiplegic migraine [FHM] and 7 with sporadic hemiplegic migraine [SHM]) were reviewed, and the frequency and description of their headaches and aura before and after receiving onabotulinumtoxinA were recorded.
Nine of the 11 patients in our series noted a decrease in the frequency, severity, and/or duration of their aura after receiving onabotulinumtoxinA. Of the 2 non-responders, one was FHM and one was SHM. Of the 9 that noticed improved aura symptoms, 6 described a "wearing off" effect of onabotulinumtoxinA around week 9 or 10 of the 12-week cycle, with subsequent improvement after the next round.
For 9 of 11 patients with hemiplegic migraine, onabotulinumtoxinA was helpful not only in reducing the frequency and severity of headaches but also in reducing the frequency and severity of the aura. In this manuscript, we speculate on potential pathophysiologic mechanisms that could have contributed to this effect.
肉毒杆菌毒素 A 已被证明可有效预防慢性偏头痛患者的头痛发作，已被批准并推荐用于此类患者人群。虽然肉毒杆菌毒素 A 治疗偏头痛头痛的疗效已有充分记录，但关于肉毒杆菌毒素 A 对偏头痛先兆的影响的信息有限。
鉴于偏瘫性偏头痛患者的先兆持续时间长且常常使人虚弱，我们的研究小组试图研究肉毒杆菌毒素 A 对该特定偏头痛患者亚组的先兆频率和严重程度的影响。
回顾了 1994 年 7 月 1 日至 2017 年 12 月 1 日在我院的所有临床记录，以确定接受至少一组肉毒杆菌毒素 A 注射的偏瘫性偏头痛患者。确定了 34 例患者；其中，由于在随访期间有关先兆症状的记录不完整，有 23 例被排除在外。回顾了其余 11 例患者（4 例家族性偏瘫性偏头痛[FHM]和 7 例散发性偏瘫性偏头痛[SHM]）的临床记录，并记录了他们在接受肉毒杆菌毒素 A 前后头痛和先兆的频率和描述。
在我们的研究系列中，有 9 例患者注意到在接受肉毒杆菌毒素 A 后，其先兆的频率、严重程度和/或持续时间降低。在 2 例无反应者中，1 例为 FHM，1 例为 SHM。在注意到先兆症状改善的 9 例患者中，有 6 例描述了肉毒杆菌毒素 A 在 12 周周期的第 9 或第 10 周左右出现“失效”效应，随后在下一轮治疗后有所改善。
对于 11 例偏瘫性偏头痛患者中的 9 例，肉毒杆菌毒素 A 不仅有助于减少头痛的频率和严重程度，而且有助于减少先兆的频率和严重程度。在本文中，我们推测了可能促成这种效果的潜在病理生理机制。
