TITLE:
A Case of Pelvic Migraine
AUTHORS:
Conor O’Brien
KEYWORDS:
Pudendal Neuropathy, Vaginal Birth, Pelvic Pain, Migraine, Pelvic Migraine, Botulinum Toxin Injection, Pelvic Floor Neurophysiology
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.5 No.11,
September
29,
2015
ABSTRACT: A 62-year-old woman presented with an 8-year history of chronic
persisting pelvic pain. She described constant throbbing, stabbing vaginal
pain. A pelvic floor neurophysiological assessment of the pudendal nerve was
performed by performing a needle EMG to the left and right external anal
sphincter assessing for insertional activity and recruitment pattern. A
quantitative assessment of the motor unit action potentials [MUAPs] was also
performed. Tests confirmed a left pudendal neuropathy with chronic denervation
in the left external anal sphincter, with reasonable muscle function, with a recruitment
pattern of 65% - 70% of normal. The CAR showed an elevated sensory threshold
with a normal distal latency. All other conventional pudendal nerve treatments
including oral antiepileptic medication, neuromodulation and pudendal nerve
blocking injections had failed, and the patient was exacerbated by the
persisting pain and discomfort. In this case, 30 international units (iu) of
botulinum toxin type A in 10 divided doses of 3 iu were injected along the
nerve. Four days later the patient reported a significant improvement in the
pain symptoms. She was reviewed 3 weeks later and for the first time in 8 years
had made the 70 mile journey to the clinic as a passenger in her husband’s car.
This case highlights a new therapeutic option of botulinum toxin type A
injection, along the nerve length, for this common painful condition. It seems
to have clinical veracity as unlike other therapeutic option the affect lasts
for 3 or 4 months.