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Injection technique of the upper face with onabotulinumtoxinA in chronic migraine.

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Title: Injection technique of the upper face with onabotulinumtoxinA in chronic migraine.
Authors: Boczarska‐Jedynak, Magdalena, Blumenfeld, Andrew M.
Source: Headache: The Journal of Head & Face Pain. Jul2023, Vol. 63 Issue 7, p849-860. 12p.
Subjects: Skeletal muscle physiology, Migraine prevention, Prevention of chronic diseases, Migraine diagnosis, Botulinum toxin, Frontal lobe, Injections, Muscle relaxants, Dermatologic nursing, Migraine, Face, Treatment effectiveness, Plastic surgery nursing, Documentation, Antibiotic prophylaxis, Photography, Facial muscles
Abstract: Background: The objective is to review the technique of onabotulinumtoxinA injection treatment in the glabellar and frontal regions using the PREEMPT (Phase III REsearch Evaluating Migraine Prophylaxis Therapy) paradigm, with review of the aesthetic issues related to the procedure. OnabotulinumtoxinA is an effective medication for the prevention of chronic migraine. The PREEMPT injection paradigm has been validated in randomized clinical trials and real‐world settings. This treatment includes injections in the forehead and glabella area. In addition, for aesthetic uses, glabella onabotulinumtoxinA injections are done in similar muscles specifically the procerus, corrugator supercilii, and frontalis muscles. Often patients who have been injected with onabotulinumtoxinA for chronic migraine have concerns about their appearance and will ask if they can see an aesthetic injector to improve this. This is a difficult issue as onabotulinumtoxinA should be injected with an interval of 10–12 weeks to avoid development of antibodies against onabotulinumtoxinA, so all injections (migraine and aesthetic) should ideally be done close together; however, if an aesthetic injection is done on the same day as a PREEMPT injection, the effect of the PREEMPT injection will not yet be visible as it takes time for onabotulinumtoxinA effects to be seen. Thus, there is a risk of a potential overdose in a particular area if aesthetic injections are done without input from the PREEMPT injector. Methods: This is a narrative review supported by photographic documentation showing the technique of onabotulinumtoxinA injection of the upper face, considering anatomical differences between patients, and combining the needs in neurology and aesthetic medicine fields. Results: Practitioners treating chronic migraine often modify some of the principles of the PREEMPT paradigm. Many practitioners are unsure about injections in the glabellar and frontal areas. The authors present a technique for using the PREEMPT protocol and adapting this to the individual patient's anatomy to prevent an unsightly appearance or ptosis. In addition, sites are provided where an aesthetic injector could inject to improve the patient's appearance without overlapping with the PREEMPT injection sites. Conclusion: Adherence to the PREEMPT injection protocol provides an evidence‐based approach to achieving clinical benefit for patients with chronic migraine. Aesthetic elements of the treatment of the glabella and forehead require additional attention. The authors provide practical considerations and recommendations regarding this. [ABSTRACT FROM AUTHOR]
Copyright of Headache: The Journal of Head & Face Pain is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Label: Title
  Group: Ti
  Data: Injection technique of the upper face with onabotulinumtoxinA in chronic migraine.
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  Data: <searchLink fieldCode="AR" term="%22Boczarska‐Jedynak%2C+Magdalena%22">Boczarska‐Jedynak, Magdalena</searchLink><br /><searchLink fieldCode="AR" term="%22Blumenfeld%2C+Andrew+M%2E%22">Blumenfeld, Andrew M.</searchLink>
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  Data: <searchLink fieldCode="JN" term="%22Headache%3A+The+Journal+of+Head+%26+Face+Pain%22">Headache: The Journal of Head & Face Pain</searchLink>. Jul2023, Vol. 63 Issue 7, p849-860. 12p.
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  Data: <searchLink fieldCode="DE" term="%22Skeletal+muscle+physiology%22">Skeletal muscle physiology</searchLink><br /><searchLink fieldCode="DE" term="%22Migraine+prevention%22">Migraine prevention</searchLink><br /><searchLink fieldCode="DE" term="%22Prevention+of+chronic+diseases%22">Prevention of chronic diseases</searchLink><br /><searchLink fieldCode="DE" term="%22Migraine+diagnosis%22">Migraine diagnosis</searchLink><br /><searchLink fieldCode="DE" term="%22Botulinum+toxin%22">Botulinum toxin</searchLink><br /><searchLink fieldCode="DE" term="%22Frontal+lobe%22">Frontal lobe</searchLink><br /><searchLink fieldCode="DE" term="%22Injections%22">Injections</searchLink><br /><searchLink fieldCode="DE" term="%22Muscle+relaxants%22">Muscle relaxants</searchLink><br /><searchLink fieldCode="DE" term="%22Dermatologic+nursing%22">Dermatologic nursing</searchLink><br /><searchLink fieldCode="DE" term="%22Migraine%22">Migraine</searchLink><br /><searchLink fieldCode="DE" term="%22Face%22">Face</searchLink><br /><searchLink fieldCode="DE" term="%22Treatment+effectiveness%22">Treatment effectiveness</searchLink><br /><searchLink fieldCode="DE" term="%22Plastic+surgery+nursing%22">Plastic surgery nursing</searchLink><br /><searchLink fieldCode="DE" term="%22Documentation%22">Documentation</searchLink><br /><searchLink fieldCode="DE" term="%22Antibiotic+prophylaxis%22">Antibiotic prophylaxis</searchLink><br /><searchLink fieldCode="DE" term="%22Photography%22">Photography</searchLink><br /><searchLink fieldCode="DE" term="%22Facial+muscles%22">Facial muscles</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Background: The objective is to review the technique of onabotulinumtoxinA injection treatment in the glabellar and frontal regions using the PREEMPT (Phase III REsearch Evaluating Migraine Prophylaxis Therapy) paradigm, with review of the aesthetic issues related to the procedure. OnabotulinumtoxinA is an effective medication for the prevention of chronic migraine. The PREEMPT injection paradigm has been validated in randomized clinical trials and real‐world settings. This treatment includes injections in the forehead and glabella area. In addition, for aesthetic uses, glabella onabotulinumtoxinA injections are done in similar muscles specifically the procerus, corrugator supercilii, and frontalis muscles. Often patients who have been injected with onabotulinumtoxinA for chronic migraine have concerns about their appearance and will ask if they can see an aesthetic injector to improve this. This is a difficult issue as onabotulinumtoxinA should be injected with an interval of 10–12 weeks to avoid development of antibodies against onabotulinumtoxinA, so all injections (migraine and aesthetic) should ideally be done close together; however, if an aesthetic injection is done on the same day as a PREEMPT injection, the effect of the PREEMPT injection will not yet be visible as it takes time for onabotulinumtoxinA effects to be seen. Thus, there is a risk of a potential overdose in a particular area if aesthetic injections are done without input from the PREEMPT injector. Methods: This is a narrative review supported by photographic documentation showing the technique of onabotulinumtoxinA injection of the upper face, considering anatomical differences between patients, and combining the needs in neurology and aesthetic medicine fields. Results: Practitioners treating chronic migraine often modify some of the principles of the PREEMPT paradigm. Many practitioners are unsure about injections in the glabellar and frontal areas. The authors present a technique for using the PREEMPT protocol and adapting this to the individual patient's anatomy to prevent an unsightly appearance or ptosis. In addition, sites are provided where an aesthetic injector could inject to improve the patient's appearance without overlapping with the PREEMPT injection sites. Conclusion: Adherence to the PREEMPT injection protocol provides an evidence‐based approach to achieving clinical benefit for patients with chronic migraine. Aesthetic elements of the treatment of the glabella and forehead require additional attention. The authors provide practical considerations and recommendations regarding this. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
  Label:
  Group: Ab
  Data: <i>Copyright of Headache: The Journal of Head & Face Pain is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=pbh&AN=164935930
RecordInfo BibRecord:
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    Identifiers:
      – Type: doi
        Value: 10.1111/head.14588
    Languages:
      – Code: eng
        Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 12
        StartPage: 849
    Subjects:
      – SubjectFull: Skeletal muscle physiology
        Type: general
      – SubjectFull: Migraine prevention
        Type: general
      – SubjectFull: Prevention of chronic diseases
        Type: general
      – SubjectFull: Migraine diagnosis
        Type: general
      – SubjectFull: Botulinum toxin
        Type: general
      – SubjectFull: Frontal lobe
        Type: general
      – SubjectFull: Injections
        Type: general
      – SubjectFull: Muscle relaxants
        Type: general
      – SubjectFull: Dermatologic nursing
        Type: general
      – SubjectFull: Migraine
        Type: general
      – SubjectFull: Face
        Type: general
      – SubjectFull: Treatment effectiveness
        Type: general
      – SubjectFull: Plastic surgery nursing
        Type: general
      – SubjectFull: Documentation
        Type: general
      – SubjectFull: Antibiotic prophylaxis
        Type: general
      – SubjectFull: Photography
        Type: general
      – SubjectFull: Facial muscles
        Type: general
    Titles:
      – TitleFull: Injection technique of the upper face with onabotulinumtoxinA in chronic migraine.
        Type: main
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            NameFull: Boczarska‐Jedynak, Magdalena
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            NameFull: Blumenfeld, Andrew M.
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            – D: 01
              M: 07
              Text: Jul2023
              Type: published
              Y: 2023
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            – TitleFull: Headache: The Journal of Head & Face Pain
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