Botulinum toxin type A for chronic neurovascular and myofascial facial pain: a comprehensive case report

This article reports on a female patient with chronic orofacial pain, followed up for 12 years. She described her pain as throbbing with intermittent pain attacks, and frequently accompanied by symptoms such as photophobia, phonophobia, and nausea. This was associated with myofascial pain of masticatory muscles, which were very painful on palpation. The patient was diagnosed with a complex pain profile that included chronic facial migraine, chronic masticatory myofascial pain, nonspecific neuropathic components, and generalized facial hypersensitivity. Despite the diversity of pharmacologic treatments, clinical benefit was limited and transient, with many medications discontinued due to adverse effects or lack of efficacy. The successful use of botulinum toxin type A (BoNT-A; Dysport) in treating this patient is presented. Planned administration of BoNT-A into anatomically and symptomatically defined trigger zones produced significant and sustained relief of migraine symptoms, followed up for 2 years. However, mild residual myofascial discomfort persisted. BoNT-A administration has the advantage of providing periodic rather than daily prophylactic treatment, the latter utilized by the present conventional method.