IMR Press / JIN / Volume 21 / Issue 5 / DOI: 10.31083/j.jin2105141
Open Access Review
Chronic Migraine: A Narrative Review on the Use of Botulinum Toxin with Clinical Indications and Future Directions
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1 GCA-Centro Spoke AO Cannizzaro, Catania, IRCCS Centro Neurolesi Bonino-Pulejo, 98124 Messina, Italy
2 Stroke Unit, AOU Policlinico Universitario, 98125 Messina, Italy
3 Neurorehabilitation Unit, IRCCS Centro Neurolesi “Bonino Pulejo”, 98124 Messina, Italy
*Correspondence: roccos.calabro@irccsme.it (Rocco Salvatore Calabrò)
Academic Editor: Parisa Gazerani
J. Integr. Neurosci. 2022, 21(5), 141; https://doi.org/10.31083/j.jin2105141
Submitted: 9 May 2022 | Revised: 19 June 2022 | Accepted: 21 June 2022 | Published: 10 August 2022
(This article belongs to the Special Issue Migraine: from Bench to Clinical Practice)
Copyright: © 2022 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.
Abstract

Chronic migraine belongs to the “chronic long-duration headaches”, and it is associated to high burden and significant economic impact. Treatment for both episodic (EM) and chronic migraine (CM) is based on the management of acute attacks and their prevention. For moderate/severe attacks, pharmacological therapies are triptans, dihydroergotamine nasal sprays or injections or neuroleptics, non-steroidal anti-inflammatory drugs, and corticosteroids. Chronic migraine belongs to the “chronic long-duration headaches”, and it is associated to high burden and significant economic impact. Treatment for both episodic (EM) and chronic migraine (CM) is based on the management of acute attacks and their prevention. For moderate/severe attacks, pharmacological therapies are triptans, dihydroergotamine nasal sprays or injections or neuroleptics, non-steroidal anti-inflammatory drugs, and corticosteroids. The pathophysiology of CM is characterized by an abnormal activation of the trigemino-vascular system in the meninges causing a neurogenic inflammation, which explains the use of anti-inflammatory during attacks. It seems that the objective of the preventive therapy with the botulin toxin OnaBoNT-A consists in interrupting the release of CGRP and other neuropeptides as well as the activation of C-fiber nociceptor and of the nearby A-delta fibers. The protocol for migraine treatment with OnaBoNT-A injections consists of 31–39 pericranial injection sites involving seven muscle groups bilaterally in specific areas of the head and neck, with a total dose of between 155 and 195 units, every three months. The severe adverse events reported with high doses of botulin toxin for spasticity, have not been reported for CM treated with OnabotA at the labeled dose. The established improvement with onabotulinumtoxinA treatment in CM patients had a positive impact not only in reduction monthly headache days but also in improving quality of life, with reduction in both healthcare resource utilisation (HRU) and work impairment. Aim of this review was to give an overview on the use of BoNT-A in patients with CM, giving practical advices on the clinical indications.

Keywords
chronic migraine
onabotulinum toxin A
botulin toxin
calcitonin gene-related peptide (CGRP) pathway
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