A Proposal to Prevent the "Mephisto Sign" Side Effect of Botulinum Toxin Type A Injection in Chronic Migraine
A 25-year-old female patient visited the hospital due to frequent headaches, and was diagnosed with chronic migraine. There was no specific medical history. She did not effectively respond to various types of pharmacotherapy, and BoNT-A injection was indicated. BoNT-A injections were performed as described above, so that a total of 155 U was injected into 31 sites. At the follow-up appointment 2 weeks later, the patient reported a change in eyebrow morphology, showing the Mephisto sign. An additional BoNT-A dose of 2 U each was administered to the lateral-most point of the frontalis muscle bilaterally. However, the morphology of eyebrow became normalized within 2-3 weeks after this additional injection.