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KEY FACTS
Terminology
Preprocedure
Procedure
Post Procedure
TERMINOLOGY
Abbreviations
- Electromyography (EMG)
- Temporomandibular joint (TMJ)
- Botulinum neurotoxin (BoNT)
Definitions
- PREEMPT study: Phase III research evaluating migraine prophylaxis therapy
- Combination of 2 largest placebo-controlled clinical trials of chronic migraine population that evaluated efficacy and safety of onabotulinumtoxinA
- Scalp block targets following 6 nerves
- Supraorbital and supratrochlear nerves originate from ophthalmic division (V1) of trigeminal nerve and innervate forehead and upper eyelids
- Auriculotemporal nerve is trigeminal branch of mandibular division (V3) and innervates anterior and superior areas of ears
- Zygomaticotemporal nerve originates from maxillary division (V2) of trigeminal nerve and innervates lateral to outer cantus of eyes
- Greater occipital nerves originate from dorsal ramus of C2 and innervate posterior scalp medial to occipital artery
- Lesser occipital nerves originate from ventral rami of C2 and C3 and innervate scalp behind ear
- Botulinum toxin type A (BoNT-A): Commercial forms are marketed under following brand names
- Botox (onabotulinumtoxinA)
- Original BoNT-A product approved by FDA
- Dysport (abobotulinumtoxinA)
- Botox and Dysport differ in purification procedure; Dysport is reported to exhibit greater spread, and dose ratios between Dysport and Botox is commonly estimated to be 3:1
- Xeomin (incobotulinumtoxinA)
- Xeomin:Botox ratio is reported to be near 1:1, without any significant differences in safety and efficacy; by stripping BoNT-A of complexing proteins, Xeomin is hypothesized to carry reduced risk of sensitization or antibody formation, which have yet to be validated in literature
- Botox (onabotulinumtoxinA)
- Botulinum toxin type B (BoNT-B)
- Myobloc (rimabotulinumtoxinB)
- This is only BoNT-B commercially available in USA, indicated only for treatment of cervical dystonia in adults
- Compared to BoNT-A, it shows more rapid onset and greater diffusion but shorter duration of actions and more painful injections
- Conversion from Botox to Myobloc is reported to be in range of 1:50-100
- Myobloc (rimabotulinumtoxinB)
- Note: There is no established conversion method for equivalent dosing among different BoNT products
- Each unit injection from one product is not interchangeable with other preparations
- They offer different safety and efficacy characteristics, and, thus, interventionalist must be familiar with selected product prior to their use
- PREEMPT study: Phase III research evaluating migraine prophylaxis therapy
PREPROCEDURE
Indications
Contraindications
Getting Started
PROCEDURE
Procedure Steps
POST PROCEDURE
Expected Outcome
OUTCOMES
Complications
Selected References
- FDA website. Botox prescribing information. https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/125274s112lbl.pdf. Published 2018. Reviewed July 2019. Accessed July 2019.
- Vikelis M et al: Sustained onabotulinumtoxinA therapeutic benefits in patients with chronic migraine over 3 years of treatment. J Headache Pain. 19(1):87, 2018
- Awan KH: The therapeutic usage of botulinum toxin (Botox) in non-cosmetic head and neck conditions - an evidence based review. Saudi Pharm J. 25(1):18-24, 2017
- Janis JE et al: Targeted peripheral nerve-directed onabotulinumtoxin A injection for effective long-term therapy for migraine headache. Plast Reconstr Surg Glob Open. 5(3):e1270, 2017
- Pihut M et al: The efficiency of botulinum toxin type A for the treatment of masseter muscle pain in patients with temporomandibular joint dysfunction and tension-type headache. J Headache Pain. 17:29, 2016
- Scaglione F: Conversion ratio between Botox®, Dysport®, and Xeomin® in clinical practice. Toxins (Basel). 8(3), 2016
- Mor N et al: Temporomandibular myofacial pain treated with botulinum toxin injection. Toxins (Basel). 7(8):2791-800, 2015
- Bebawy JF et al: A modified technique for auriculotemporal nerve blockade when performing selective scalp nerve block for craniotomy. J Neurosurg Anesthesiol. 26(3):271-2, 2014
- McNicholas E et al: Transient facial nerve palsy after auriculotemporal nerve block in awake craniotomy patients. A A Case Rep. 2(4):40-3, 2014
- Guilfoyle MR et al: Regional scalp block for postcraniotomy analgesia: a systematic review and meta-analysis. Anesth Analg. 116(5):1093-102, 2013
- Aurora SK et al: OnabotulinumtoxinA for treatment of chronic migraine: pooled analyses of the 56-week PREEMPT clinical program. Headache. 51(9):1358-73, 2011
- Amsterdam, James et al: Regional Anesthesia of the Head and Neck. Roberts, Hedges. Clinical Procedures in Emergency Medicine. 5th ed. Philadelphia: Saunders Elsevier. 510-2, 2010
- Aurora SK et al: OnabotulinumtoxinA for treatment of chronic migraine: results from the double-blind, randomized, placebo-controlled phase of the PREEMPT 1 trial. Cephalalgia. 30(7):793-803, 2010
- Diener HC et al: OnabotulinumtoxinA for treatment of chronic migraine: results from the double-blind, randomized, placebo-controlled phase of the PREEMPT 2 trial. Cephalalgia. 30(7):804-14, 2010
- Osborn I et al: "Scalp block" during craniotomy: a classic technique revisited. J Neurosurg Anesthesiol. 22(3):187-94, 2010
- Loukas M et al: Identification of greater occipital nerve landmarks for the treatment of occipital neuralgia. Folia Morphol (Warsz). 65(4):337-42, 2006
- Chikhani L et al: [Bruxism, temporo-mandibular dysfunction and botulinum toxin.] Ann Readapt Med Phys. 46(6):333-7, 2003
- Gain P et al: [Facial anesthetic blocks in the treatment of acute pain during ophthalmic zoster.] J Fr Ophtalmol. 26(1):7-14, 2003
- Dimitriou V et al: Blockade of branches of the ophthalmic nerve in the management of acute attack of migraine. Middle East J Anaesthesiol. 16(5):499-504, 2002
Related Anatomy
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Related Differential Diagnoses
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References
Tables
Tables
KEY FACTS
Terminology
Preprocedure
Procedure
Post Procedure
TERMINOLOGY
Abbreviations
- Electromyography (EMG)
- Temporomandibular joint (TMJ)
- Botulinum neurotoxin (BoNT)
Definitions
- PREEMPT study: Phase III research evaluating migraine prophylaxis therapy
- Combination of 2 largest placebo-controlled clinical trials of chronic migraine population that evaluated efficacy and safety of onabotulinumtoxinA
- Scalp block targets following 6 nerves
- Supraorbital and supratrochlear nerves originate from ophthalmic division (V1) of trigeminal nerve and innervate forehead and upper eyelids
- Auriculotemporal nerve is trigeminal branch of mandibular division (V3) and innervates anterior and superior areas of ears
- Zygomaticotemporal nerve originates from maxillary division (V2) of trigeminal nerve and innervates lateral to outer cantus of eyes
- Greater occipital nerves originate from dorsal ramus of C2 and innervate posterior scalp medial to occipital artery
- Lesser occipital nerves originate from ventral rami of C2 and C3 and innervate scalp behind ear
- Botulinum toxin type A (BoNT-A): Commercial forms are marketed under following brand names
- Botox (onabotulinumtoxinA)
- Original BoNT-A product approved by FDA
- Dysport (abobotulinumtoxinA)
- Botox and Dysport differ in purification procedure; Dysport is reported to exhibit greater spread, and dose ratios between Dysport and Botox is commonly estimated to be 3:1
- Xeomin (incobotulinumtoxinA)
- Xeomin:Botox ratio is reported to be near 1:1, without any significant differences in safety and efficacy; by stripping BoNT-A of complexing proteins, Xeomin is hypothesized to carry reduced risk of sensitization or antibody formation, which have yet to be validated in literature
- Botox (onabotulinumtoxinA)
- Botulinum toxin type B (BoNT-B)
- Myobloc (rimabotulinumtoxinB)
- This is only BoNT-B commercially available in USA, indicated only for treatment of cervical dystonia in adults
- Compared to BoNT-A, it shows more rapid onset and greater diffusion but shorter duration of actions and more painful injections
- Conversion from Botox to Myobloc is reported to be in range of 1:50-100
- Myobloc (rimabotulinumtoxinB)
- Note: There is no established conversion method for equivalent dosing among different BoNT products
- Each unit injection from one product is not interchangeable with other preparations
- They offer different safety and efficacy characteristics, and, thus, interventionalist must be familiar with selected product prior to their use
- PREEMPT study: Phase III research evaluating migraine prophylaxis therapy
PREPROCEDURE
Indications
Contraindications
Getting Started
PROCEDURE
Procedure Steps
POST PROCEDURE
Expected Outcome
OUTCOMES
Complications
Selected References
- FDA website. Botox prescribing information. https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/125274s112lbl.pdf. Published 2018. Reviewed July 2019. Accessed July 2019.
- Vikelis M et al: Sustained onabotulinumtoxinA therapeutic benefits in patients with chronic migraine over 3 years of treatment. J Headache Pain. 19(1):87, 2018
- Awan KH: The therapeutic usage of botulinum toxin (Botox) in non-cosmetic head and neck conditions - an evidence based review. Saudi Pharm J. 25(1):18-24, 2017
- Janis JE et al: Targeted peripheral nerve-directed onabotulinumtoxin A injection for effective long-term therapy for migraine headache. Plast Reconstr Surg Glob Open. 5(3):e1270, 2017
- Pihut M et al: The efficiency of botulinum toxin type A for the treatment of masseter muscle pain in patients with temporomandibular joint dysfunction and tension-type headache. J Headache Pain. 17:29, 2016
- Scaglione F: Conversion ratio between Botox®, Dysport®, and Xeomin® in clinical practice. Toxins (Basel). 8(3), 2016
- Mor N et al: Temporomandibular myofacial pain treated with botulinum toxin injection. Toxins (Basel). 7(8):2791-800, 2015
- Bebawy JF et al: A modified technique for auriculotemporal nerve blockade when performing selective scalp nerve block for craniotomy. J Neurosurg Anesthesiol. 26(3):271-2, 2014
- McNicholas E et al: Transient facial nerve palsy after auriculotemporal nerve block in awake craniotomy patients. A A Case Rep. 2(4):40-3, 2014
- Guilfoyle MR et al: Regional scalp block for postcraniotomy analgesia: a systematic review and meta-analysis. Anesth Analg. 116(5):1093-102, 2013
- Aurora SK et al: OnabotulinumtoxinA for treatment of chronic migraine: pooled analyses of the 56-week PREEMPT clinical program. Headache. 51(9):1358-73, 2011
- Amsterdam, James et al: Regional Anesthesia of the Head and Neck. Roberts, Hedges. Clinical Procedures in Emergency Medicine. 5th ed. Philadelphia: Saunders Elsevier. 510-2, 2010
- Aurora SK et al: OnabotulinumtoxinA for treatment of chronic migraine: results from the double-blind, randomized, placebo-controlled phase of the PREEMPT 1 trial. Cephalalgia. 30(7):793-803, 2010
- Diener HC et al: OnabotulinumtoxinA for treatment of chronic migraine: results from the double-blind, randomized, placebo-controlled phase of the PREEMPT 2 trial. Cephalalgia. 30(7):804-14, 2010
- Osborn I et al: "Scalp block" during craniotomy: a classic technique revisited. J Neurosurg Anesthesiol. 22(3):187-94, 2010
- Loukas M et al: Identification of greater occipital nerve landmarks for the treatment of occipital neuralgia. Folia Morphol (Warsz). 65(4):337-42, 2006
- Chikhani L et al: [Bruxism, temporo-mandibular dysfunction and botulinum toxin.] Ann Readapt Med Phys. 46(6):333-7, 2003
- Gain P et al: [Facial anesthetic blocks in the treatment of acute pain during ophthalmic zoster.] J Fr Ophtalmol. 26(1):7-14, 2003
- Dimitriou V et al: Blockade of branches of the ophthalmic nerve in the management of acute attack of migraine. Middle East J Anaesthesiol. 16(5):499-504, 2002
