BOTULINUM TOXIN A (BTA) has a strong safety profile and proven efficiency for both acute as well as prophylactic treatment of migraine headache.
Dr Binder, while experimenting with clinical treatment of facial wrinkles with BTA in 1998, found out the positive effect of BTA on migraine symptoms. Ever since, the role of BTA in medicine and plastic surgery has widely spread.
Injection protocol:
- Fixed-site and fixed-dose injection approach. It uses injections on 31 fixed sites in fixed doses in corrugator, procerus, frontalis, occipitalis, cervical paraspinal and trapezius muscles.
- The ” follow the pain approach”. Sites and doses are not fixed but they depend on the patient’s symptom scope, pain location and sensitivity. It gives additional eight injection sites: two at the temporalis, two at occipitalis and four at trapezius.
PREEMPT technique is considered to be a standard one for injection at 39 sites with the maximum of 195 units every 12 weeks.
Mechanism of functioning:
BTA has probably got a number of function mechanisms. The most probable is the one at the neuromuscular junction point. Disrupted release of acetylcholine causes a temporary muscle paralyses.
BTA reduces the pain (analgesic effect).
Theory of retrograde transmission – thus central effect of BTA!
Botulinum toxin is a product of anaerobic bacteria Clostridium botulinum. Seven antigenic variations of serotypes of botulinum toxin have been identified, but only serotypes A and B are used for medical treatments.
There are various formulations of serotype A, for instance onabotulinum toxin A (Botox), abobotulinum toxin A (Dysport) and incobotulinumtoxin A (Xeomin).
For migraine treatment only Botox is used – and not the other two formulations, as they are proven to be inefficient.