Botulinum Toxin Type A for Chronic Migraine
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Chronic migraine (CM) is the leading cause of chronic daily headache, a common and debilitating headache syndrome. The management of CM patients is challenging, with only limited benefit from available oral preventive medications. Botulinum neurotoxin (BoNT) has been used extensively to treat disorders associated with increased muscle tone. More recent scientific data support an analgesic effect of the toxin. The pharmacokinetic and pharmacodynamic profiles of BoNT make it an appealing candidate for migraine prevention. Results from older clinical trials on the efficacy of the toxin in CM were inconclusive. However, recent trials using more stringent inclusion criteria have shown positive results, supporting the use of the toxin in some patients with this disorder. This review summarizes the scientific data on the analgesic properties of BoNT, as well as the clinical data on the efficacy of the toxin in treating CM.
KeywordsBotulinum toxin Chronic migraine
Dr. Ashkenazi received honoraria from MediCom Worldwide for writing commentaries on various topics in headache for its website http://www.migraineresourcenetwork.com.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.The International Classification of Headache Disorders: 2nd edition. Cephalalgia 2004, 24(Suppl 1):9–160.Google Scholar
- 6.Ashkenazi A, Levin M, Dodick DW: Peripheral procedures: nerve blocks, peripheral neurostimulation and botulinum neurotoxin injections. In Wolff’s Headache and Other Head Pain. Edited by Silberstein SD, Lipton RB, Dodick DW. New York: Oxford University Press; 2007:767–792.Google Scholar
- 15.Oshinsky ML: Botulinum toxins and migraine: how does it work. Practical Neurol 2004, 4:S10–S13.Google Scholar
- 16.•• Antonucci F, Rossi C, Gianfranceschi L, et al.: Long-distance retrograde effects of botulinum neurotoxin A. J Neurosci 2008, 28:3689–3696. This very interesting study showed a transfer of active BoNT-A through axonal transport and transcytosis to sensory synapses.Google Scholar
- 19.• Ranoux D, Attal N, Morain F, Bouhassira D: Botulinum toxin type A induces direct analgesic effects in chronic neuropathic pain. Ann Neurol 2008, 64:274–283. This important, well-designed study showed an analgesic effect of BoNT-A in patients with neuropathic pain.Google Scholar
- 20.• Yuan RY, Sheu JJ, Yu JM, et al.: Botulinum toxin for diabetic neuropathic pain: a randomized double-blind crossover trial. Neurology 2009, 72:1473–1478. This is another well-designed study that showed efficacy of BoNT-A in treating painful diabetic neuropathy.Google Scholar
- 28.Jakubowski M, McAllister PJ, Bajwa ZH, et al.: Exploding vs. imploding headache in migraine prophylaxis with Botulinum Toxin A. Pain 2006, 125:286–295.Google Scholar