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| Botulinum Toxin Injection Therapy for Migraines |
| A number of studies, both controlled and open-label, have demonstrated efficacy of botulinum toxin for various types of headache including migraine, cluster and chronic daily headaches |
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Dr Andrew H Evans
Flemington Neurology
Flemington Neurology
Suite 105
55 Flemington Road
North Melbourne, Victoria 3051
admin@flemingtonneurology.com
t: 03 9348 9381 f: 03 9329 1473
55 Flemington Road
North Melbourne, Victoria 3051
admin@flemingtonneurology.com
t: 03 9348 9381 f: 03 9329 1473
One of the theories proposed involves a reduction of "muscular hyperactivity"
Patients with cervical dystonia have less pain after botulinum toxin treatment, a mechanism of decreased contractility of the
musculature seems valid as an explanation for pain relief. The prevention of acetylcholine release from the presynaptic
terminal would lead to a relaxation in the muscle
"Normalization of excessive muscle spindle activity"
In muscle, active regions of spontaneous EMG activity correspond to an excessive release of acetylcholine at the
neuromuscular junction leading to abnormally excessive end plate activity. Botulinum toxin inhibits transmission at gamma
motor neurons in the muscle spindle, which may lead to a decrease in muscle overactivity. This results in decreased spindle
activity and less sensory information traveling from the 1a afferents from the muscle to the CNS
"Neurogenic inflammation"
Another interesting mechanism of action involves its possible entry into the CNS leading to pain modulation. Pain of migraine
may be secondary to neurogenic inflammation of dural and meningeal vessels. Botulinum toxin has been found to inhibit
release of substance P from trigeminal nerve endings, along with activating expression of substance P in the raphe nuclei
thereby decreasing pain
Botulinum toxin may also reduce parasympathetic outflow. In cluster patients, involvement of the trigemino-cervical complex
and the pterygopalatine ganglion are integral in the autonomic symptoms and vasomotor control. Botulinum toxin may block
the parasympathetic outflow loop leading to analgesia
Patients with cervical dystonia have less pain after botulinum toxin treatment, a mechanism of decreased contractility of the
musculature seems valid as an explanation for pain relief. The prevention of acetylcholine release from the presynaptic
terminal would lead to a relaxation in the muscle
"Normalization of excessive muscle spindle activity"
In muscle, active regions of spontaneous EMG activity correspond to an excessive release of acetylcholine at the
neuromuscular junction leading to abnormally excessive end plate activity. Botulinum toxin inhibits transmission at gamma
motor neurons in the muscle spindle, which may lead to a decrease in muscle overactivity. This results in decreased spindle
activity and less sensory information traveling from the 1a afferents from the muscle to the CNS
"Neurogenic inflammation"
Another interesting mechanism of action involves its possible entry into the CNS leading to pain modulation. Pain of migraine
may be secondary to neurogenic inflammation of dural and meningeal vessels. Botulinum toxin has been found to inhibit
release of substance P from trigeminal nerve endings, along with activating expression of substance P in the raphe nuclei
thereby decreasing pain
Botulinum toxin may also reduce parasympathetic outflow. In cluster patients, involvement of the trigemino-cervical complex
and the pterygopalatine ganglion are integral in the autonomic symptoms and vasomotor control. Botulinum toxin may block
the parasympathetic outflow loop leading to analgesia
Mechanism of Action for headaches:
For headache disorders, different theories have arisen
explaining the proposed efficacy of botulinum toxin,
according to the known pathophysiology of pain transmission
For headache disorders, different theories have arisen
explaining the proposed efficacy of botulinum toxin,
according to the known pathophysiology of pain transmission
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 | General Neurology |
| Botulinum toxin injection treatments |
| Dystonia and hyperhydrosis |
| Migraine and headaches |
| Nerve conduction studies and Electrodiagnostic services |
| Multidisciplinary care for the management of complex movement | |
| disorders cases including: |
| assessment for deep brain stimulation procedures for treatment of Parkinson's | |
| disease, tremor, dystonia and dystonic motor tics |
| assessment for apomorphine infusion treatment for Parkinson's disease | |