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Correspondence |

Botulinum Toxin Type A Headache Treatment and Entrapment of the Supratrochlear Nerve

Steven J. F. Saers, MD; J. Alexander de Ru, MD, PhD
Arch Dermatol. 2010;146(11):1310-1311. doi:10.1001/archdermatol.2010.312.
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In response to the article “Predicting Migraine Responsiveness to Botulinum Toxin Type A Injections”1 in the February issue of the Archives, we offer our thoughts on the possible pathophysiologic mechanism of botulinum toxin type A (BTX) treatment in some patients with headache.1 We agree that a selective group of patients with headache might benefit from treatment with BTX. In our opinion, the underlying headache mechanism is entrapment of the supratrochlear nerve in the corrugator muscle. Therefore, decreased muscle contractility following BTX injection would lead to pain reduction.2,3 This mechanism is particularly relevant when patients with migraine exhibit hypertrophy of the corrugator muscle.4

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