Abstract
Botulinum toxin type A has been used in the treatment of chronic migraine for over a decade and has become established as a well-tolerated option for the preventive therapy of chronic migraine. Ongoing research is gradually shedding light on its mechanism of action in migraine prevention. Given that its mechanism of action is quite different from that of the new monoclonal antibodies directed against calcitonin gene-related peptide (CGRP) or its receptor, it is unlikely to be displaced to any major extent by them. Both will likely remain as important tools for patients with chronic migraine and the clinicians assisting them. New types of botulinum toxin selective for sensory pain neurons may well be discovered or produced by recombinant DNA techniques in the coming decade, and this may greatly enhance its therapeutic usefulness. This review summarizes the evolution of botulinum toxin use in headache management over the past several decades and its role in the preventive treatment of chronic migraine and other headache disorders.
Highlights
After the approval of onabotulinumtoxinA (OBTA) for prophylaxis of chronic migraine in 2010 in the USA, and in 2011 in Canada, it became a mainstream therapy for chronic migraine
OBTA remains a mainstay of chronic migraine treatment, but with the advent of the calcitonin gene-related peptide (CGRP)-related monoclonal antibodies in the USA and Canada in 2018, the practice milieu shifted considerably
OBTA is administered in the scalp and migraine pain is thought to come from the meninges, but research has gradually uncovered the mechanisms likely involved
Summary
After the approval of onabotulinumtoxinA (OBTA) for prophylaxis of chronic migraine in 2010 in the USA, and in 2011 in Canada, it became a mainstream therapy for chronic migraine. It was clearly as effective if not more effective than any other migraine preventive medication available at the time and proved to be well tolerated. OBTA remains a mainstay of chronic migraine treatment, but with the advent of the calcitonin gene-related peptide (CGRP)-related monoclonal antibodies in the USA and Canada in 2018, the practice milieu shifted considerably. The place of OBTA in migraine prevention in the future remains to be determined
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
