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We present the case of an 8\u2010year\u2010old girl with CHARGE syndrome, associated right\u2010sided facial palsy, and chronic severe migraines, that were intractable to medical treatment. At age 6, onabotulinum toxin A was used to weaken the contralateral non\u2010paralyzed side of her face to address her stigmatizing asymmetry. Onabotulinum toxin A chemodenervation was performed on the left lower lip depressors to relax the muscles and improve left lower lip position. Coincidentally, it was noted that with these treatments, migraine symptoms resolved. As the chemodenervation subsided over the next 3\u20134\u00a0months, the severe migraines returned. Continued treatment with onabotulinum toxin A injections every 3\u00a0months has resulted in ongoing improvements in facial symmetry and migraine control. Onabotulinum toxin A is a well\u2010known treatment of chronic migraine. Injections are usually directed to the occipitalis, frontalis, and corrugator muscles. The literature has no reports of injections to the lower lip depressors as a useful therapy for migraine, making the results from this case unique.<\/jats:p>","DOI":"10.1002\/ajmg.a.62340","type":"journal-article","created":{"date-parts":[[2021,5,18]],"date-time":"2021-05-18T13:10:47Z","timestamp":1621343447000},"page":"2514-2518","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["A case of migraine treatment in a patient with a clinical diagnosis of <scp>CHARGE<\/scp> syndrome using onabotulinum toxin A"],"prefix":"10.1002","volume":"185","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2142-9477","authenticated-orcid":false,"given":"Julia B.","family":"Morrison","sequence":"first","affiliation":[{"name":"Faculty of Medicine Dalhousie University  Halifax Nova Scotia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5745-4474","authenticated-orcid":false,"given":"Bradley M.","family":"Fisher","sequence":"additional","affiliation":[{"name":"Faculty of Dentistry University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Arra","sequence":"additional","affiliation":[{"name":"Department of Pediatrics IWK Health  Halifax Nova Scotia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Bezuhly","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Dalhousie University  Halifax Nova Scotia Canada"},{"name":"Division of Plastic and Reconstructive Surgery Department of Pediatrics, IWK Health  Halifax Nova Scotia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kim","family":"Blake","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Dalhousie University  Halifax Nova Scotia Canada"},{"name":"Department of Pediatrics IWK Health  Halifax Nova Scotia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,5,18]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/cne.21460"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000001330"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/bdra.20330"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10072-015-2195-0"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1177\/000992289803700302"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajmg.a.32179"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1101\/gad.301887.117"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(17)30435-0"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpra.2017.01.005"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1038\/ncomms14758"},{"key":"e_1_2_8_12_1","volume-title":"CHARGE Syndrome (first ed., genetic syndromes and communication disorders)","author":"Hartshorne T.","year":"2011"},{"key":"e_1_2_8_13_1","first-page":"169","volume-title":"CHARGE syndrome","author":"Hartshorne T. 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