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A Proposal for Botulinum Toxin Type A Injection Into the Temporal Region in Chronic Migraine Headache

 Young-Gun Kim  ;  Jung-Hee Bae  ;  Hyeyun Kim  ;  Shuu-Jiun Wang  ;  Seong Taek Kim 
 TOXINS, Vol.12(4) : 214, 2020-03 
Journal Title
Issue Date
Botulinum toxin injection ; auriculotemporal nerve ; chronic migraine
Botulinum toxin type-A (BTX-A) injection for treating chronic migraine (CM) has developed into a new technique covering distinct injection points in the head and neck regions. The postulated analgesic mechanism implies that the injection should be administered to sensory nerves rather than to muscles. This study aimed to determine the topographical site of the auriculotemporal nerve (ATN) and to propose the effective injection points for treating CM. ATNs were investigated on 36 sides of 25 Korean cadavers. The anatomical structures of the ATN were investigated focusing on the temporal region. A right-angle ruler was positioned based on two clearly identifiable orthogonal reference lines based on the canthus and tragus as landmarks, and photographs were taken. The ATN appeared superficially in the anterosuperior region of the tragus. The nerve is located deeper than the superficial temporal artery. And it runs between the artery and the superficial temporal vein. In the superficial layer, it is divided into anterior and posterior divisions. The anterior division runs in a superior direction, while the posterior division runs in front of the ear and the several branches are distributed to the skin. We suggest that the optimal BTX-A injection points for CM are in the temporal region. The first point is about 2 cm anterior and 3 cm superior to two orthogonal reference lines defined based on the tragus and canthus, and the second point is about 4 cm superior to the first point. The third and fourth points are recommended about 2 cm superior to the first point, but respectively 1 cm anterior and posterior to it.
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2. College of Dentistry (치과대학) > Dept. of Oral Biology (구강생물학교실) > 1. Journal Papers
2. College of Dentistry (치과대학) > Dept. of Orofacial Pain and Oral Medicine (구강내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Seong Taek(김성택)
Kim, Young Gun(김영건)
Bae, Jung Hee(배정희)
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