Botulinum toxin as a novel therapeutic approach for auriculotemporal neuralgia

Objectives/Background: Auriculotemporal neuralgia is a rare headache disorder. Anesthetic nerve blockade seems to be effective in most cases; however, literature is scarce about the management of refractory cases. Methods: Case report. Results: We report a 44-year-old woman with migraine without aura presented with moderate-to-severe right temporoparietal headache. The pain was refractory to multiple pharmacological strategies, including intravenous analgesia. A more throughout examination lead to the diagnosis of auriculotemporal neuralgia and anesthetic nerve blocks were performed. Due to early pain recrudescence, botulinum toxin (BoNT) was tried with better and longstanding pain control. Conclusion: BoNT may be a useful treatment option in refractory auriculotemporal neuralgia. The best approach is yet to be established; however, the "follow-the-pain" protocol may be a reasonable option.