Diagnostic targeted Botox injections have high positive predictive value for migraine trigger site localization, according to a study published in the May issue of Plastic and Reconstructive Surgery.
Hassan ElHawary, M.D., from the McGill University Health Centre in Montreal, and colleagues examined the diagnostic capacity of Botox in a sensitivity analysis performed on 40 patients receiving Botox for migraine trigger site localization followed by surgical decompression of affected peripheral nerves.
The researchers found that patients with successful Botox injections (defined as ≥50 percent improvement in Migraine Headache Index scores after injection) had significantly higher average reductions in migraine intensity, frequency, and Migraine Headache Index postsurgical deactivation. Use of Botox injection as a diagnostic modality for migraine headaches had sensitivity and specificity of 56.7 and 80.0 percent, respectively, in a sensitivity analysis. The positive and negative predictive values were 89.5 and 38.1 percent, respectively.
“Our study supports the value of preoperative Botox injections as a reliable diagnostic tool for identifying patients who will respond to migraine surgery, with a positive predictive value of nearly 90 percent,” coauthor Jeffrey E. Janis, M.D., of The Ohio State University Wexner Medical Center in Columbus, said in a statement. “We recommend the routine use of diagnostic Botox injections as well as nerve blocks with the goal of confirming trigger sites and identifying patients who are more likely to benefit from migraine surgery.”
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