**Author details**

Michael Chung, Xingchen Li, Kyle Sanniec and Bardia Amirlak\*

\*Address all correspondence to: Bardia.Amirlak@UTSouthwestern.edu

UT Southwestern Department of Plastic Surgery, Dallas, Texas, USA

## **References**

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[2] Pascual, J., Colas, R., and Castillo, J., Epidemiology of chronic daily headache. Current Pain and Headache Reports, 2001. **5**(6): pp. 529–36.

**6. Conclusion**

140 Current Perspectives on Less-known Aspects of Headache

**Author details**

**References**

OnabotulinumtoxinA injection is an effective strategy to treat chronic migraine. At 56 weeks, the percentage of patients in the PREEMPT trials that received at least 50% reduction in headache days was 68%, significantly better than the reduction seen in patients who received placebo [48]. In addition to being effective, BTX-A has also been shown to cause very minimal adverse effects. Some commonly seen complications include neck pain/weakness, eyelid ptosis, and injection site pain. There have been no reported deaths among migraine BTX-A studies, and only 1.4–3.8% of patients discontinued treatment due to adverse effects [9, 10, 16, 17, 24]. BTX-A injection is an effective and well-tolerated treatment option for chronic migraine patients who have previously failed a number of traditional medications. It is most effective in patients who suffer from a higher frequency of headache days, such as those seen in chronic migraines. Additionally, it is well known that chronic migraine patients often suffer from medication overuse. In a subanalysis of PREEMPT trial results, BTX-A demonstrated significant effectiveness in reducing frequency of headache days even in patients who are designated with medication overuse [49]. Sometimes, patients may not respond from the first injection interval. It has been shown even among patients that fail to respond initially, a meaningful proportion of patients responded in the second and third treatment cycles [50]. ART injection on the other hand is a newer, expanded, and more refined version of the targeted injection based on recent neurology data and theories suggesting that BTX-A is more effective if deposited closer to nerves. Although available studies are less robust, preliminary

While onabotulinumtoxinA injection has been shown to be both safe and effective among a broad group of patients, demonstrating versatile and robust efficacy, research is ongoing to develop the best and most efficient ways to deliver this treatment. Knowledge of potential culprit nerves and the accurate understanding of surrounding tissue anatomy are essential to

[1] Headache Classification, C., et al., New appendix criteria open for a broader concept of

clinical results show less complications than PREEMPT.

maximize efficacy and efficiency in chronic migraine pain management.

Michael Chung, Xingchen Li, Kyle Sanniec and Bardia Amirlak\*

chronic migraine*.* Cephalalgia, 2006. **26**(6): pp. 742–6.

\*Address all correspondence to: Bardia.Amirlak@UTSouthwestern.edu UT Southwestern Department of Plastic Surgery, Dallas, Texas, USA


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[16] Mathew, N.T., et al., Botulinum toxin type A (BOTOX) for the prophylactic treatment of chronic daily headache: A randomized, double-blind, placebo-controlled trial.

[17] Silberstein, S.D., et al., Botulinum toxin type A for the prophylactic treatment of chronic daily headache: A randomized, double-blind, placebo-controlled trial. Mayo Clinic

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[25] Burstein, R., et al., Selective inhibition of meningeal nociceptors by botulinum neurotoxin type A: Therapeutic implications for migraine and other pains. Cephalalgia, 2014.

[26] Zhang, X., et al., Extracranial injections of botulinum neurotoxin type A inhibit intracranial meningeal nociceptors' responses to stimulation of TRPV1 and TRPA1 channels: Are we getting closer to solving this puzzle? Cephalalgia, 2016. **36**(9): pp. 875–86.

[27] Durham, P.L. and Cady, R., Insights into the mechanism of onabotulinumtoxinA in

[28] Aurora, S.K., et al., Botulinum toxin type a prophylactic treatment of episodic migraine: A randomized, double-blind, placebo-controlled exploratory study. Headache, 2007.

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#### **Acupuncture as a Therapy for Headache Acupuncture as a Therapy for Headache**

Sumire Chiku and Yasushi Shibata Sumire Chiku and Yasushi Shibata

Additional information is available at the end of the chapter Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/65012

#### **Abstract**

[44] Zhang, X., et al., Activation of central trigeminovascular neurons by cortical spreading

[45] Guyuron, B., et al., Five-year outcome of surgical treatment of migraine headaches.

[46] Guyuron, B., et al., A placebo-controlled surgical trial of the treatment of migraine head-

[47] Lee, M., et al., An anatomical study of the lesser occipital nerve and its potential compression points: Implications for surgical treatment of migraine headaches. Plastic and

[48] Aurora, S.K., et al., OnabotulinumtoxinA for treatment of chronic migraine: pooled analyses of the 56-week PREEMPT clinical program. Headache, 2011. **51**(9): pp. 1358–73.

[49] Silberstein, S.D., et al., OnabotulinumtoxinA for treatment of chronic migraine: PREEMPT 24-week pooled subgroup analysis of patients who had acute headache medication overuse at baseline. Journal of the Neurological Sciences, 2013. **331**(1–2):

[50] Silberstein, S.D., et al., Per cent of patients with chronic migraine who responded per onabotulinumtoxinA treatment cycle: PREEMPT. Journal of Neurology, Neurosurgery,

depression. Annals of Neurology, 2011. **69**(5): pp. 855–65.

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pp. 48–56.

aches. Plastic and Reconstructive Surgery, 2009. **124**(2): pp. 461–8.

Acupuncture has been used to treat various diseases, and there are many reports from various countries around the world as a therapy for headaches. Acupuncture has been used to relieve tension‐type headaches and prevent migraine attacks. In patients with migraine without aura, the number of headache attacks and analgesic use among patients who received acupuncture was significantly decreased compared to those who were treated with flunarizine. However, few articles have classified headaches in detail and examined the effectiveness of acupuncture. Thus, there is no clear evidence of the types of headache for which acupuncture is effective or whether acupuncture should be performed in the attack phase or intermittent phase. Functional MRI (fMRI) is a form of objective imaging study. Recently, a study was performed to investigate brain dysfunction in patients with migraine and chronic tension‐type headache. In the study of the pain‐induced activation of fMRI, migraine patients demonstrated specific brain activation in the interictal period compared to controls. We hypothesize that acupunc‐ ture affects not only peripheral circulation, but also central nervous function. However, few scientific studies have investigated the effects of acupuncture for headache by assessing cerebral function.

**Keywords:** headache, acupuncture, acupoint, tension‐type headache, migraine
