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Text
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URL Address
<a href="http://doi.org/10.1097/AAP.0000000000000818" target="_blank" rel="noreferrer noopener">http://doi.org/10.1097/AAP.0000000000000818</a>
Pages
869–874
Issue
8
Volume
43
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Anatomical Look Into OnabotulinumtoxinA Injection for Chronic Migraine Headache.
Publisher
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Regional anesthesia and pain medicine
Date
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2018
2018-11
Subject
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80 and over; 80 and Over; Adolescence; Adolescent; Adult; Aged; Anatomic Landmarks/anatomy & histology/*diagnostic imaging; Body Regions; Body Regions – Anatomy and Histology; Botulinum Toxins; Botulinum Toxins – Administration and Dosage; Chronic Disease; Female; Human; Humans; Male; Middle Age; Middle Aged; Migraine; Migraine – Drug Therapy; Migraine Disorders/*diagnostic imaging/*drug therapy; Neck Muscles; Neck Muscles – Anatomy and Histology; Neck Muscles – Drug Effects; Neck Muscles/anatomy & histology/*diagnostic imaging/drug effects; Pilot Projects; Pilot Studies; Random Allocation; Random Assignment; Tomography; Type A/*administration & dosage; X-Ray Computed – Methods; X-Ray Computed/methods; Young Adult
Creator
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Wu-Fienberg Yuewei; Ansari Hossein; Zardouz Shawn; Narouze Samer; Blaha Taryn; Swanson Marco; Totonchi Ali
Description
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BACKGROUND AND OBJECTIVES: While existing studies about onabotulinumtoxinA for chronic migraines have focused on injection location and appropriate dosing, little consideration has been given to patient body habitus and its potential impact on efficacy. We hypothesized that with increasing patient body mass index (BMI) there would be more subcutaneous fat separating targeted muscle groups from the skin surface, such that standard 0.5-inch needles used in existing protocols may not allow intramuscular injection. This may have implications for treatment planning. METHODS: Anatomically normal computed tomography scans of the head, neck, and face were randomly selected. Subjects were stratified into 4 groups based on BMI, with 30 patients in each group. Four standardized locations were chosen to obtain measurements from the skin surface to the underlying muscle fascia, including (1) frontalis, (2) temporalis, (3) semispinalis capitis, and (4) trapezius. RESULTS: Median depth for the temporalis was 12.65 mm (Q1 = 9.32 mm, Q3 = 15.08 mm) for the BMI greater than 35 kg/m group. Median depth for the semispinalis capitis was 13.77 mm (Q1 = 10.3 mm, Q3 = 15.7 mm) for the BMI 30 to 35 kg/m group, and 14.75 mm (Q1 = 11.00, Q3 = 17.00 mm) for the BMI greater than 35 kg/m group. Median depth for the trapezius was 13.95 mm (Q1 = 10.18 mm, Q3 = 19.00 mm) for the BMI greater than 35 kg/m group. These medians exceeded the length of the standard 0.5-inch (12.-mm) needle used in existing protocols. CONCLUSIONS: Our study demonstrates that with increasing BMI there is a greater distance between the skin surface and the muscle fascia of muscles that are targeted for injection in standard chronic migraine botulinum toxin injection protocols. Because of this, patient body habitus may be an important factor in injection technique.
Identifier
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<a href="http://doi.org/10.1097/AAP.0000000000000818" target="_blank" rel="noreferrer noopener">10.1097/AAP.0000000000000818</a>
Rights
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Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
2018
80 and over
Adolescence
Adolescent
Adult
Aged
Anatomic Landmarks/anatomy & histology/*diagnostic imaging
Ansari Hossein
Blaha Taryn
Body Regions
Body Regions – Anatomy and Histology
Botulinum Toxins
Botulinum Toxins – Administration and Dosage
Chronic Disease
Female
Human
Humans
Male
Middle Age
Middle Aged
Migraine
Migraine – Drug Therapy
Migraine Disorders/*diagnostic imaging/*drug therapy
Narouze Samer
Neck Muscles
Neck Muscles – Anatomy and Histology
Neck Muscles – Drug Effects
Neck Muscles/anatomy & histology/*diagnostic imaging/drug effects
Pilot Projects
Pilot Studies
Random Allocation
Random Assignment
Regional anesthesia and pain medicine
Swanson Marco
Tomography
Totonchi Ali
Type A/*administration & dosage
Wu-Fienberg Yuewei
X-Ray Computed – Methods
X-Ray Computed/methods
Young Adult
Zardouz Shawn