Yonsei Med J.  2013 Nov;54(6):1542-1544. 10.3349/ymj.2013.54.6.1542.

A Proposal to Prevent the "Mephisto Sign" Side Effect of Botulinum Toxin Type A Injection in Chronic Migraine

• Cho ES
• Hwang JY
• Kim ST

• KMID: 1798156
• DOI: http://doi.org/10.3349/ymj.2013.54.6.1542

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.

Keyword

Migraine disorders; botulinum toxin type A; eyebrows

MeSH Terms

Adult
Botulinum Toxins, Type A/administration & dosage/*adverse effects
Female
Humans
Injections
Migraine Disorders/*drug therapy
Botulinum Toxins, Type A

Figure

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  Fig. 1 (A) Before BoNT-A injection, (B) 2 weeks after BoNT-A injection. BoNT-A, botulinum toxin type A.

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  Fig. 2 Proposed injection points of BoNT-A on the frontalis muscle in chronic migraine, with additional injection points marked in red. BoNT-A, botulinum toxin type A.

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