title: Herpes zoster ophthalmicus following onabotulinumtoxinA administration for chronic migraine: a case report and literature review.
abstract: BACKGROUND
  There is a growing body of literature documenting local herpes zoster outbreak following procedures. The mechanism underlying these outbreaks remains elusive. We present a case of zoster following onabotulinumtoxinA (BTX) for migraine and a literature review.
  
  
  METHODS
  Chart and literature review.
  
  
  METHODS
  A 72-year-old woman with chronic migraine received BTX injections for 3 years without incident. She had a history of thoracic zoster with subsequent post-herpetic neuralgia. In August 2013, 48 hours after receiving BTX injections, she developed a painful rash in the right V1 distribution consistent with herpes zoster ophthalmicus. One week later the rash had resolved without treatment.
  
  
  METHODS
  We identified 65 (including 2 from Juel-Jenson) cases of zoster reactivation following minor procedures. These cases tend to be in young patients without specific risk factors. Outbreaks characteristically occur at the level of exposure to local trauma.
  
  
  CONCLUSIONS
  Our review suggests that local trauma, regardless of the nature of stimuli, may be sufficient for zoster reactivation. We hypothesize that the stressors in these reported cases exert a local epigenetic influence on viral transcription, allowing for viral reactivation.
  
  
  CONCLUSIONS
  Zoster is a potential complication of BTX administration for chronic migraine in adults. Physician awareness can reduce the significant morbidity associated with this disease.
authors.affiliation: University of Kentucky, Department of Neurology, KY, USA.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Gadient
authors.affiliation: University of Kentucky, Department of Neurology, KY, USA.
authors.forename: Jonathan H
authors.initials: JH
authors.lastname: Smith
authors.affiliation: University of Kentucky, Department of Neurology, KY, USA stephen.ryan@uky.edu.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Ryan
mesh_terms: D000368:Aged; D019274:Botulinum Toxins, Type A / Q000009:adverse effects*; D005260:Female; D006563:Herpes Zoster Ophthalmicus / Q000209:etiology*; D014645:Herpesvirus 3, Human / Q000502:physiology; D006801:Humans; D008881:Migraine Disorders / Q000517:prevention & control*; D009465:Neuromuscular Agents / Q000009:adverse effects*; D014775:Virus Activation / Q000502:physiology
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A
keywords: Migraine; botox; herpes; onabotulinumtoxinA; shingles; zoster