A proposal to prevent the "Mephisto Sign" side effect of botulinum toxin type a injection in chronic migraine

Eunae S. Cho, Jae Young Hwang, Seong Taek Kim

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11 Citations (Scopus)


Botulinum toxin type A (BoNT-A) has been reported as an effective treatment for chronic migraine. When BoNT-A is injected on the frontalis muscle for chronic migraine, an unexpected clinical side effect called the "Mephisto sign" may occur. The aim of this article is to propose a method to eliminate or prevent the Mephisto sign side effect. A 25-year-old female patient visited the hospital and was diagnosed with chronic migraine. A total of 155 U of BoNT-A was injected into 31 sites. 2-weeks later, and the patient developed the Mephisto sign. An additional 2-U dose was administered bilaterally to the lateral-most point of the frontalis muscles, and the eyebrow morphology returned to normal within 2-3 weeks. We propose that the development of the Mephisto sign may be prevented with an additional BoNT-A injection of 2-4 U bilaterally to the lateral most point of the frontalis muscles during the primary injection process.

Original languageEnglish
Pages (from-to)1542-1544
Number of pages3
JournalYonsei medical journal
Issue number6
Publication statusPublished - 2013

All Science Journal Classification (ASJC) codes

  • Medicine(all)

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