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A型肉毒毒素(Botulinum toxin A,BTX-A)是肉毒杆菌产生的一种神经毒素,已广泛用于肌肉过度活动性疾病和美容外科领域。近年来用于预防偏头痛的研究越来越多,多数研究已证实颅周注射BTX-A可有效地减少偏头痛发作频率、减轻发作时头痛的严重程度、缩短头痛发作的持续时间、减少急性发作口服药物的使用,但也有研究发现注射BTXA对偏头痛没有明显的疗效。同时,有研究发现外爆性偏头痛(exploding headache)对BTX-A的疗效欠佳,而内爆性偏头痛(implodingheadache)和眼病性偏头痛(ocular headache)对BTX-A的疗效显著,因此偏头痛的性质可能会影响BTX-A的疗效,BTX-A预防偏头痛的常用剂量是25~100U,但注射剂量与疗效之间有无剂量-疗效关系、最佳的注射剂量尚未达成一致。BTX-A预防偏头痛的注射位点常采用固定点注射法、压痛点注射法、固定点和压痛点相结合法及针灸穴位点注射法,但最佳的注射位点尚未达成一致。本文就BTXA在预防偏头痛的疗效、注射位点、预防机制等方面研究进行综述分析。
Botulinum toxin A (BTX-A) is a neurotoxin produced by Clostridium botulinum and is widely used in the fields of muscle hypermotility diseases and cosmetic surgery. In recent years, there are more and more studies on the prevention of migraine. Most studies have demonstrated that intracranial injection of BTX-A can effectively reduce the frequency of migraine attacks, reduce the severity of headache during the attack, shorten the duration of headache attacks and reduce acute However, some studies have found that injection of BTXA has no obvious effect on migraine. In the meantime, studies have found that exploding headache is not effective against BTX-A, whereas imploding headache and ocular headache have a significant effect on BTX-A The nature of migraine may affect the efficacy of BTX-A. The usual dose of BTX-A for prevention of migraine is 25-100 U. However, there is no dose-response relationship between injection dose and efficacy, and the optimal injection dose has not been agreed. BTX-A injection site for the prevention of migraine often fixed point injection method, tender point injection method, fixed point and tenderness point combination method and acupuncture point injection, but the best injection site has not yet reached an agreement. In this paper, BTXA in the prevention of migraine efficacy, injection sites, prevention mechanisms and other aspects of the study reviewed.