Botulinum Toxin: Treatment for Refractory Chronic Migraine and Red Ear Syndrome

Objectives: The objective of this case report is to discuss botulinum toxin as a treatment for Red Ear Syndrome (RES) and refractory chronic migraine, as well as provide a brief overview of possible RES etiologies. Background: Because RES presents with several conditions, its pathophysiology and treatment options are difficult to define. Given their similar clinical presentations, RES may be an auricular subtype of erythromelalgia. Additionally, RES presents consistently with chronic migraine. Botulinum toxin has been proven an effective medication for erythromelalgia and refractory migraine, and it may be just as useful for RES. Results: This paper reports one case of a patient who presented with chronic migraine with aura and unilateral RES. This patient failed several treatment options, and the most recent regimen only reduced the intensity of migraine attacks. With the addition of botulinum toxin, both chronic migraine and RES symptoms were mitigated. Conclusion: While a definitive treatment for RES has not been determined, a promising option for patients with concomitant chronic migraine may be botulinum toxin.