Botulinum toxin type A for chronic neurovascular and myofascial facial pain: a comprehensive case report.

This article focuses on the use of botulinum toxin type A (BoNT-A; Dysport) in treating a female patient with chronic, treatment-resistant orofacial pain characterized by overlapping neurovascular (chronic facial migraine), myofascial, and neuropathic components. Over a 12-year period, conventional pharmacologic and interventional therapies provided limited and transient relief, whereas targeted BoNT-A injections into symptom-specific facial and masticatory regions resulted in significant and sustained reduction of migraine symptoms and partial improvement of myofascial pain, with pain levels decreasing from a visual analog scale (VAS) of 4–10 to approximately 2. The case highlights BoNT-A's dual peripheral and central neuromodulatory mechanisms, favorable safety profile, and advantages over daily systemic medications, supporting its role as a viable therapeutic option in complex orofacial pain syndromes unresponsive to standard treatments. Further research is recommended to optimize dosing protocols and validate long-term outcomes in larger populations.