{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T18:19:29Z","timestamp":1791569969801,"version":"4.3.4"},"reference-count":33,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>Nerve decompression surgery is an effective treatment modality for patients who experience migraines. Botulinum toxin type A (Botox) injections have been traditionally used as a method to identify trigger sites; however, there is a paucity in data regarding its diagnostic efficacy. The goal of this study was to assess the diagnostic capacity of Botox in successfully identifying migraine trigger sites and predicting surgical success.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>A sensitivity analysis was performed on all patients receiving Botox for migraine trigger site localization followed by a surgical decompression of affected peripheral nerves. Positive and negative predictive values were calculated.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>A total of 40 patients met our inclusion criteria and underwent targeted diagnostic Botox injection followed by a peripheral nerve deactivation surgery with at least 3 months\u2019 follow-up. Patients with successful Botox injections (defined as at least 50% improvement in Migraine Headache Index scores after injection) had significantly higher average reduction in migraine intensity (56.7% versus 25.8%; <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.020), frequency (78.1% versus 46.8%; <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.018), and Migraine Headache Index (89.7% versus 49.2%; <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.016) postsurgical deactivation. Sensitivity analysis shows that the use of Botox injection as a diagnostic modality for migraine headaches has a sensitivity of 56.7% and a specificity of 80.0%. The positive predictive value is 89.5% and the negative predictive value is 38.1%.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>Diagnostic targeted Botox injections have a very high positive predictive value. It is therefore a useful diagnostic modality that can help identify migraine trigger sites and improve preoperative patient selection.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CLINICAL QUESTION\/LEVEL OF EVIDENCE:<\/jats:title>\n            <jats:p>Diagnostic, II.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/prs.0000000000010806","type":"journal-article","created":{"date-parts":[[2023,6,7]],"date-time":"2023-06-07T16:02:35Z","timestamp":1686153755000},"page":"1133-1140","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":10,"title":["The Positive and Negative Predictive Value of Targeted Diagnostic Botox Injection in Nerve Decompression Migraine Surgery"],"prefix":"10.1097","volume":"153","author":[{"given":"Hassan","family":"ElHawary","sequence":"first","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, McGill University Health Centre"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaitlin","family":"Kavanagh","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Ohio State University, Wexner Medical Center."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey E.","family":"Janis","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Ohio State University, Wexner Medical Center."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2023,6,6]]},"reference":[{"key":"R1-20250501","doi-asserted-by":"crossref","first-page":"954","DOI":"10.1016\/S1474-4422(18)30322-3","article-title":"Global, regional, and national burden of migraine and tension-type headache, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016.","volume":"17","year":"2018","journal-title":"Lancet Neurol"},{"issue":"Suppl 1","key":"R2-20250501","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1007\/s10072-013-1363-3","article-title":"Is migraine a disorder of the central nervous system?","volume":"34","author":"Panerai","year":"2013","journal-title":"Neurol Sci"},{"key":"R3-20250501","doi-asserted-by":"crossref","first-page":"1752","DOI":"10.1097\/01.PRS.0000161679.26890.EE","article-title":"The lesser and third occipital nerves and migraine headaches.","volume":"115","author":"Dash","year":"2005","journal-title":"Plast Reconstr Surg"},{"key":"R4-20250501","doi-asserted-by":"crossref","first-page":"1227","DOI":"10.1097\/PRS.0b013e31826d9c8d","article-title":"The anatomical morphology of the supraorbital notch: clinical relevance to the surgical treatment of migraine headaches.","volume":"130","author":"Fallucco","year":"2012","journal-title":"Plast Reconstr Surg"},{"key":"R5-20250501","doi-asserted-by":"crossref","first-page":"e795","DOI":"10.1097\/GOX.0000000000000802","article-title":"Supraorbital rim syndrome: definition, surgical treatment, and outcomes for frontal headache.","volume":"4","author":"Hagan","year":"2016","journal-title":"Plast Reconstr Surg Glob Open"},{"key":"R6-20250501","doi-asserted-by":"crossref","first-page":"1647","DOI":"10.1097\/01.prs.0000282725.61640.e1","article-title":"Anatomy of the corrugator supercilii muscle: part I. 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