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Refractory Chronic Migraine Therapy with Botulinum Toxin A

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Case-Based Diagnosis and Management of Headache Disorders

Part of the book series: Headache ((HEAD))

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Abstract

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.

General introductory note: For reasons of simplicity, the term “Botox” is used in this chapter instead of onabotulinumtoxinA.

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Authors and Affiliations

  1. Kopfwehzentrum Hirslanden Zürich – Headache Center, Forchstrasse 424, Zollikon, 8702, Switzerland

    Reto Agosti

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  1. Reto Agosti
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Correspondence to Reto Agosti .

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Editors and Affiliations

  1. Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey

    Aksel Siva

  2. Headache Medical Center Seilerstaette Linz, Hospital Sisters of Charity, Linz, Austria

    Christian Lampl

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Agosti, R. (2015). Refractory Chronic Migraine Therapy with Botulinum Toxin A. In: Siva, A., Lampl, C. (eds) Case-Based Diagnosis and Management of Headache Disorders. Headache. Springer, Cham. https://doi.org/10.1007/978-3-319-06886-2_6

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  • DOI: https://doi.org/10.1007/978-3-319-06886-2_6

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-06885-5

  • Online ISBN: 978-3-319-06886-2

  • eBook Packages: MedicineMedicine (R0)

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