Increasing relief with repeated botulinum neurotoxin A injections in a rare case of hemi facial spasm with contralateral trigeminal autonomic orofacial pain and occipital neuralgia: A case report

Ipsilateral hemi facial spasm, trigeminal autonomic orofacial pain and occipital neuralgia may occur due to close proximity of V and VII nerves in pons and inter-neuronal interconnections of trigeminocervical complex. In this report, we describe management of a patient with long standing untreated left hemi facial spasm of ten years with contralateral trigeminal autonomic orofacial pain and occipital neuralgia present for last five years. Repeated intramuscular injections of Botulinum neurotoxin A were given for hemi facial spasm which completely resolved the twitches for 5-8 months with decreased baseline twitches noted before next cycle of injections. Addition of Botulinum neurotoxin A in nerve block injections for occipital neuralgia resulted in prolonged relief of five months and decreased baseline pain scores. Addition of Botulinum neurotoxin A to nerve block injections for trigeminal autonomic orofacial pain decreased autonomic features and baseline pain scores.