Migraine and Other Primary Headaches

  • Bahman Jabbari


Primary headaches consist of migraine, tension-type headaches, and trigeminal autonomic cephalalgias (e.g., cluster headache). Migraine and tension-type headaches are common and, in chronic form, are major causes of disability. Prospective double-blind and placebo-controlled studies have confirmed the efficacy of onabotulinumtoxinA (onaA) in chronic migraine (class A evidence). Follow-up of patients in PREEMPT studies with five cycles of onaA injections (over 56 weeks) attests to the tolerability and safety of this drug in chronic migraine and demonstrates progressive improvement of patient’s quality of life. In clinical practice, patients treated with onaA for more than 2 years describe their experience as very gratifying (attached videotapes). Studies using onaA in management of episodic migraine and chronic daily headaches have shown disappointing results and no evidence of efficacy. Investigations using botulinum neurotoxins (BoNTs) in management of tension-type headache have also provided negative results, but the results are confounded by selection of low-dose, suboptimal technique and selection of rigid primary outcome criteria. No blinded studies with BoNTs are available for trigeminal autonomic cephalalgias.


Episodic migraine Chronic migraine Tension headache Chronic daily headache Autonomic neuralgias Cluster headache Botulinum toxin Botulinum neurotoxin OnabotulinumtoxinA OnaA 

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Bahman Jabbari
    • 1
  1. 1.Botulinum Toxin Treatment ProgramYale School of MedicineNew HavenUSA

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