open access publication

Article, 2024

Pericranial Muscle Stiffness, Pain Thresholds, and Tenderness during a Treatment Cycle of OnabotulinumtoxinA for Chronic Migraine Prevention

Diagnostics, ISSN 2075-4418, Volume 14, 3, Page 330, 10.3390/diagnostics14030330

Contributors

Dalby, Sebastian Worsaae [1] Hvedstrup, Jeppe 0000-0002-4342-6226 [1] Carlsen, Louise Ninett 0000-0003-3634-7287 [1] Ashina, Sait 0000-0003-3973-6640 [2] [3] [4] Bendtsen, Lars 0000-0002-4810-4998 [1] [4] Schytz, Henrik Winther 0000-0002-6262-2986 (Corresponding author) [1] [4]

Affiliations

  1. [1] Rigshospitalet
    2. [NORA names: Capital Region of Denmark; Hospital; Denmark; Europe, EU; Nordic; OECD];
  2. [2] Beth Israel Deaconess Medical Center
    3. [NORA names: United States; America, North; OECD];
  3. [3] Harvard University
    4. [NORA names: United States; America, North; OECD];
  4. [4] University of Copenhagen
    5. [NORA names: KU University of Copenhagen; University; Denmark; Europe, EU; Nordic; OECD]

Abstract

BACKGROUND: Treatment with OnabotulinumtoxinA (BoNT-A) is effective as a preventive treatment for chronic migraine (CM). Preclinical studies suggest that the mechanism of action of BoNT-A in migraine is based on blocking unmyelinated C fibers. We aimed to investigate whether the muscle-relaxing effect of BoNT-A is associated with the preventive mechanism in patients with chronic migraine by measuring the stiffness, pain thresholds, and tenderness of the BoNT-A-applied muscles. METHODS: A total of 22 patients with CM who were already in BoNT-A treatment participated in this longitudinal prospective study. Pericranial muscle stiffness was measured using ultrasound shear wave elastography, which measures the speed of shear waves propagating through the muscle. Pressure pain thresholds (PPT) were obtained via algometry, and muscle tenderness was measured via manual palpation. Measurements were made before BoNT-A injections and six weeks after the treatment. The measurements were performed while the muscles were maximally relaxed. The patients also completed daily diaries on headache and neck pain. RESULTS: No change was observed in muscle stiffness (p = 0.737) or pericranial muscle tenderness (p = 0.400). The PPT over the trapezius muscles increased from 250 kPa before treatment to 304 kPa six weeks after treatment (p = 0.027). No change was observed on the temporalis muscles (p = 0.200) nor the non-dominant index finger (p = 0.067). BoNT-A decreased neck pain (p = 0.008) and headache (p = 0.007). CONCLUSIONS: The findings suggest that BoNT-A leads to the desensitization of cutaneous and muscle nociceptors in the head and neck regions, whereas muscle relaxation might not be an important part of the anti-migraine effect.

Keywords

Before treatment, BoNT-A, BoNT-A injection, BoNT-A treatment, C-fibers, action of BoNT-A, algometry, anti-migraine effect, changes, chronic migraine, chronic migraine prevention, chronically, daily diaries, desensitization, diary, effect, effect of BoNT-A, elastography, findings, finger, head, head and neck region, headache, index finger, injection, kPa, longitudinal prospective study, manual palpation, measurements, mechanism, migraine, migraine prevention, muscle, muscle nociceptors, muscle relaxation, muscle stiffness, muscle tenderness, muscle-relaxant effects, neck, neck pain, neck region, no change, nociceptors, non-dominant index finger, onabotulinumtoxinA, pain, pain threshold, palpation, patients, pericranial muscle tenderness, preclinical studies, pressure, pressure pain threshold, prevention, prevention mechanism, preventive treatment, prospective study, region, relaxation, shear wave elastography, shear waves, speed, speed of shear waves, stiffness, study, temporalis muscle, tenderness, threshold, trapezius, trapezius muscle, treatment, treatment cycles, ultrasound, ultrasound shear wave elastography, unmyelinated C-fibers, wave, wave elastography, weeks

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