Anatomical Look Into OnabotulinumtoxinA Injection for Chronic Migraine Headache.

Anatomical Look Into OnabotulinumtoxinA Injection for Chronic Migraine Headache.

Wu-Fienberg Yuewei; Ansari Hossein; Zardouz Shawn; Narouze Samer; Blaha Taryn; Swanson Marco; Totonchi Ali

Regional anesthesia and pain medicine

2018

2018-11

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.

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

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