Refractory Chronic Migraine Therapy with Botulinum Toxin A
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Once diagnosis of a migraine is made (including imaging studies to rule out secondary headaches, criterion E of ICHD 1.1 or 1.2), no further diagnostic workup is needed before initiating a treatment with Botox. However, for Botox treatment of migraine, a diagnosis of “chronic migraine” (CM) is required according to the PREEMPT protocols. The most reliable tool is a patient headache diary in which the headache days can be distinguished between days with migraine and days with non-migraine headaches. Neurological exam may reveal tender points in those pericranial muscles that may receive additional dosages according to the “follow the pain” paradigm (temporalis, occipitalis, and trapezius muscles). Oral anticoagulation needs to be asked although full anticoagulation is not an absolute contraindication.
KeywordsBotulinum Toxin Chronic Migraine Diagnostic Workup Trapezius Muscle Episodic Migraine
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