Hacettepe University Medical School, Department of Physical and Rehabilitation Medicine, Ankara, Turkey.
Gaziler Training and Research Hospital, Department of Physical and Rehabilitation Medicine, Ankara, Turkey.
Toxicon. 2019 Oct 25;172:19-22. doi: 10.1016/j.toxicon.2019.10.239. Epub 2019 Oct 23.
The treatment of chronic migraine headache is quite challenging and new alternatives are still being explored for its management. Onabotulinum toxin A (BoNT-A) applied into extracranial muscles has been shown to inhibit the release of acetylcholine and local nociceptive peptides at the sensory nerve endings. As the highest concentration of extracranial pain fibers are located at/nearby the sutures, extracranial applications of BoTN-A are suggested to be performed to sutures rather than into the head and neck muscles in the treatment of chronic migraine. Moreover, in an animal study, BoTN-A is found to be more effective for decreasing the chemosensitivity of meningeal nociceptors when the total dose is injected along the sutures in comparison to being divided into sutures and cranial muscles. Of note, since BoNT-A injections performed with the blind/nontargeted technique have lower effectivity and several complications (muscle weakness, ptosis, facial paresis, etc.), the use of ultrasound guidance for targeting the cranial sutures is definitely expected to provide technical ease, better pain relief and toxin tolerance in chronic migraine.
慢性偏头痛头痛的治疗极具挑战性，目前仍在探索新的替代方法来进行管理。肉毒杆菌毒素 A（BoNT-A）作用于颅外肌肉，可抑制感觉神经末梢处乙酰胆碱和局部伤害性肽的释放。由于颅外疼痛纤维的最高浓度位于/邻近缝线处，因此建议将 BoTN-A 颅外应用于缝线处，而不是将其注射到头颈肌肉中，以治疗慢性偏头痛。此外，在一项动物研究中，与将总剂量分为缝线和颅外肌肉相比，BoTN-A 沿着缝线注射时，降低脑膜伤害感受器化学敏感性的效果更显著。需要注意的是，由于盲目/非靶向技术的 BoNT-A 注射效果较差，且存在多种并发症（肌无力、上睑下垂、面瘫等），因此使用超声引导来靶向颅缝，可明显提高技术的便利性、更好地缓解疼痛和提高慢性偏头痛患者对毒素的耐受性。
