Evaluation Of The Efficacy Of Botulinum Toxin Type A In The Treatment Of Migraine

Background:Migraine is a headache that manifests as a unilateral beating headache with recurrent,moderate to severe pain.Typical migraine attacks generally continued for 4 to 72 hours.Prior to the attack can be accompanied by visile,esthetic.cinetic and other precursors.ln recent years,the transformation of migraine to chronic migraine shows an increasing trend,and the latest survey shows that about 2 to 3%of accidental migraine transforms into chronic migraine every year.Migraine,as an important disability disease,not only influences the quality of life of the personal,but also has a different degree of burden on the family and society.Because of the complexity of the pathogenesis of migraine,the existing research is not clear about its pathogenesis.Based on existing basic and clinical studies,there are many kinds of drugs used in the period of headache attack and prevention.However,due to drug resistance,headache combined with other diseases and individual differences,resulting in poor drug efficacy.In recent years,the FDA approved BoNT-A as a preventive drug for chronic migraine.Foreign clinical studies also confirmed that the headache symptoms improved significantly after BoNT-A injection and the safety factor was higher.Although a large number of studies have confirmed that botulinum toxin has analgesic effect,its specific analgesic mechanism is still unclear,and is being continuously explored in recent years.Animal models established abroad found that BoNT-A can down-regulate the expression of TRVP1 channel,inhibit the release of noxious factors such as Calcitonin gene-related peptide(CGRP).glutamic acid,substance P.and inhibit neurogenic inflammation,thereby inhibiting peripheral sensitization of noxious nerve fibers,reducing the transmission of pain signals,and playing an analgesic role.In addition,blood tests on chronic migraine patients who received BoNT-A also found that CGRP levels were associated with improved headache in patients.However,there has not been a domestic study report on the efficacy of BoNT-A in the treatment of headache by human blood indicator testing.Objective:To evaluate the clinical efficacy,safety and potential mechanism of BoNT-A in the treatment of headaches by observing the changes of blood CGRP levels and pain scores before and after injection of BoNT-A,and to further guide the treatment of chronic migraine.Methods:From June 2017 to December 2018,patients with chronic migraine were collected from the Department of Neurology,People undefineds Hospital of Liaoning Provincial and military area command general hospital,who were prepared to be injected with BoNT-A for the treatment of chronic migraine.On the basis of nclusive criteria and exclusive Criteria.80 patients with chronic migraine were chosen as the experimental group.In accordance with BoNT-A injection before and after injection into the control group and experimental group,among which 23 were males and 57 were females.Visual analogue score of migraine patients before and after injection of BoNT-A(Visual Analogue Scale/Score,for short VAS),was used to observe the degree of headache relief and calculate the relief percentage of headache score 1 month after botulinum toxin injection.The complete relief(headache degree improved to 100%),marked improvement(headache degree improved to 50%-99%),effective(headache degree improved to 20%-49%)and ineffective(headache degree improved to 20%-49%).Mitigation of headache was less than 20%.Complete remission,marked effect and effective treatment are considered to be clinically effective,while invalid and aggravated cases are classified as clinically invalid.In addition,2 ml venous blood was drawn from elbow vein within 72 hours before injection and one month after injection,respectively,Enzyme-linked immunosorbent assay(ELISA)was used to determine the concentration of CGRP in serum.Data analysis adopting spss22.0 software.Results:Except for 2 patients,the symptoms of cephalea did not alleviate after treatment.The headache degree and headache time of other patients were improved in varying degrees.The efficacious proportion of cephalea treatment was 2%.One month after treatment,the concentration of CGRP in migraine patients was significantly lower than that before treatment(P<0.01).The VAS score of patients with migraine 1 month after treatment was obviously under than that of patients with migraine prior treatment(p<0.01).Conclusion:BoNT-A has a significant effect on the improvement of chronic migraine with and without aura,and can effectively reduce the intensity and frequency of headache.The study also found that BoNT-A can effectively reduce serum CGRP levels in patients with chronic migraine with or without aura,indirectly confirming that CGRP plays an important role in the analgesic effect of BoNT-A,indicating that the change of CGRP concentration is related to the treatment of migraine with BoNT-A.