OJOG  Vol.5 No.11 , September 2015
A Case of Pelvic Migraine
Author(s) Conor O’Brien
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.

Cite this paper
O’Brien, C. (2015) A Case of Pelvic Migraine. Open Journal of Obstetrics and Gynecology, 5, 672-675. doi: 10.4236/ojog.2015.511095.
[1]   O’Brien, C., O’Herlihy, C. and O’Connell, P.R. (2004) Pudendal Neuropathy Is Best Determined by Full Neurophysiologic Assessment. American Journal of Obstetrics & Gynecology, 191, 1836.

[2]   O’Brien, C. (2012) Levator Ani Syndrome—British Society of Clinical Neurophysiology. Joint Meeting with the Italian Society of Neurophysiology, Queens Square, September 2012.

[3]   Berhman, R.A., Tucker, T. and Guyuron, B. (2003) Single Site Botulinum Toxin Type—A Injection for Elimination of Migraine Trigger Points. Headache, 43, 1085-1089.

[4]   Schaefer, S.M., Gottschalk, C.H. and Jabbari, B. (2015) Treatment of Chronic Migraine with Focus on Botulinum Neurotoxins. Toxins, 7, 2615-2628.

[5]   Benson, J.T. and Griffis, K. (2005) Pudendal Neuralgia, a Severe Pain Syndrome. American Journal of Obstetrics & Gynecology, 192, 1663-1668.

[6]   Fitzpatrick, M., O’Brien, C., O’Connell, P.R. and O’Herlihy, C. (2003) Patterns of Abnormal Pudendal Nerve Conduction Associated with Postpartum Faecal Incontinence. American Journal of Obstetrics & Gynecology, 189, 730-735.

[7]   Hruby, S., Ebmer, J. and Dellon, L. (2005) Anatomy of Pudendal Nerve at Urogenital Diaphragm—New Critical Site for Nerve Entrapment. Urology, 66, 9949-9952.

[8]   Asplund, C. and Brkdul, T. (2007) Weiss BDI Genitourinary Problems in Bicyclists. Current Sports Medicine Reports, 6, 333-339.

[9]   Wise, D. and Anderson, R.U. (2014) A Headache in the Pelvis. 6th Edition, Cataloging-in Publication Data, USA.