title: A proposal to prevent the "Mephisto sign" side effect of botulinum toxin type A injection in chronic migraine.
abstract: Botulinum toxin type A (BoNT-A) has been reported as an effective treatment for chronic migraine. When BoNT-A is injected on the frontalis muscle for chronic migraine, an unexpected clinical side effect called the "Mephisto sign" may occur. The aim of this article is to propose a method to eliminate or prevent the Mephisto sign side effect. A 25-year-old female patient visited the hospital and was diagnosed with chronic migraine. A total of 155 U of BoNT-A was injected into 31 sites. 2-weeks later, and the patient developed the Mephisto sign. An additional 2-U dose was administered bilaterally to the lateral-most point of the frontalis muscles, and the eyebrow morphology returned to normal within 2-3 weeks. We propose that the development of the Mephisto sign may be prevented with an additional BoNT-A injection of 2-4 U bilaterally to the lateral most point of the frontalis muscles during the primary injection process.
authors.affiliation: Department of Orofacial Pain and Oral Medicine, College of Dentistry, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea. k8756050@hotmail.com.
authors.forename: Eunae S
authors.initials: ES
authors.lastname: Cho
authors.forename: Jae Young
authors.initials: JY
authors.lastname: Hwang
authors.forename: Seong Taek
authors.initials: ST
authors.lastname: Kim
mesh_terms: D000328:Adult; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007267:Injections; D008881:Migraine Disorders / Q000188:drug therapy*
chemical_list: D019274:Botulinum Toxins, Type A
keywords: Migraine disorders; botulinum toxin type A; eyebrows