Treatment of Myofascial Pain and Dysfunction With Onabotulinumtoxin A in Patients with Chronic Migraine Encephalalgia
Migraine headaches are a recurrent neurological disorder with a high prevalence globally. A subgroup of migraine patients suffer from chronic migraines defined as migraine frequency greater than 15 episodes in a month1. Of this group of chronic migraine headache sufferers some patients have the co morbidity of myofascial pain and dysfunction (MPD) and TMD. Our retrospective study looked at the effect of reducing MPD symptoms when treating chronic migraine encephalalgia (CME) without aura.
Our chart review returned 35 patients who had a diagnosis of myofascial pain and dysfunction and a concurrent diagnosis of CME without aura. These CME patients were treated with 100 units of Onabotulinumtoxin A at 20 trigger points over the front-temporal parietal area. The trigger injections where dosed at 5 units per each site. The injection interval for this therapy was repeated every 12 weeks. The inclusion criteria for this study were: (1) diagnosis of myofascial pain with dysfunction, (2) diagnosis of chronic migraines encephalalgia and (3) trigger point injections of 100 units of Onabotulinumtoxin A with greater than 1 treatment.
An Institution Review application was granted for a retrospective analysis of charts and interviews completed on each patient. To determine the effectiveness of Onabotulinumtoxin A in reducing MPD and treating and preventing CME we used a visual analog scale to determine the subjective intensity of the craniofacial myalgia which encompasses both MPD and CME. Prior to treatment with Onabotulinumtoxin A per our protocol (please see evaluators protocol). At a minimum of 12 weeks following the second treatment patients were then given the same visual analog scale to subjectively describe the intensity of their relapsing craniofacial myalgia, in addition data was collected regarding frequency and duration of craniofacial myalgia prior to and after therapy of 20 trigger point injection a 5 units per site with Onabotulinumtoxin A coupled with the number of treatments needed to see an effect of therapy from the first 12 week interval.
Our retrospective chart review population included n=26 patients. Of those patients 26 were female and none (0) were male. Nine (9) Patients were excluded due to limited treatment number (1). The average age of patients treated was (40). The average frequency of CME per month with associated MPD prior to treatment was 18.385 and the frequency of post injection of MPD with CME per month was 6.256. The Visual analog scale average score prior to treatment was 8.6154 and following treatment the average score was 3.769. Finally the average number of treatments needed to effect a change was 1.462.
In conclusion CME with MPD has been shown to have a significant effect on the decreased quality of life and overall productivity of these affected individuals especially when you consider that the average age to range from 24 – 44 years old 2. While many treatments are available for episodic migraines, few therapies exist for treatment of CME and associated MPD. Our study showed that Onabotulinumtoxin A is effective in reducing CME frequency and duration while also reducing the symptoms of MPD.
References:
1. Oleson J, Bousser MG, Diener HC, et al. New appendix criteria open for a broader concept of chronic migraine. Cephalalgia 2006; 26: 742-6
2. Stang PE, Osterhaus JT. Impact of migraine in the United States: data from the National Health Interview Survey. Headache. 1993;33(1):29–35. doi: 10.1111/j.1526-4610.1993.hed3301029.x