A proposal of injection points of botulinum toxin into temporal region for chronic migraine

ABSTRACT

Botulinum toxin (BoNT) injections have been used not only in the field of cosmetic surgery such as forehead and eye wrinkle treatment but also in the treatment of chronic migraine, dystonia, spasticity, temporomandibular disorders (TMD). BoNT injections are the only approved therapies to date for prophylactic treatment of chronic migraine patients. Unlike the previously known paralysis of motor neurons, the mechanism of action for migraine is to block the release of non-cholinergic neurotransmitters such as substance P, CGRP, and glutamate, which are associated with peripheral sensitization and neurogenic inflammation in the sensory nerve, it is hypothesized that the signal is blocked. This review focuses on the analgesic effects of BoNT and suggests the direction for the development of injection methods for chronic migraine patients.