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November 2010

Botulinum Toxin Type A Headache Treatment and Entrapment of the Supratrochlear Nerve

Author Affiliations

Author Affiliations: Department of Dermatology, Saint Louis University School of Medicine, St Louis, Missouri.


Copyright 2010 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2010

Arch Dermatol. 2010;146(11):1310-1311. doi:10.1001/archdermatol.2010.312

In response to the article “Predicting Migraine Responsiveness to Botulinum Toxin Type A Injections”1 in the February issue of the Archives, we offer our thoughts on the possible pathophysiologic mechanism of botulinum toxin type A (BTX) treatment in some patients with headache.1 We agree that a selective group of patients with headache might benefit from treatment with BTX. In our opinion, the underlying headache mechanism is entrapment of the supratrochlear nerve in the corrugator muscle. Therefore, decreased muscle contractility following BTX injection would lead to pain reduction.2,3 This mechanism is particularly relevant when patients with migraine exhibit hypertrophy of the corrugator muscle.4

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