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Critical analysis of the use of onabotulinumtoxinA (botulinum toxin type A) in migraine

Authors Robertson C, Garza I

Received 23 September 2011

Accepted for publication 18 October 2011

Published 13 January 2012 Volume 2012:8 Pages 35—48


Review by Single-blind

Peer reviewer comments 2

Carrie E Robertson, Ivan Garza
Department of Neurology, Mayo Clinic, Rochester, MN, USA

Abstract: OnabotulinumtoxinA, a neurotoxin, has been studied in numerous trials as a novel preventive therapy for migraine headache. The data would support that it may be effective at reducing headache days in patients suffering from chronic migraine (≥15 headache days/month, with eight or more of those migraine headache days). The mechanism by which onabotulinumtoxinA exerts its effects on migraine is not yet understood. It is known to inhibit acetylcholine release at the neuromuscular junction, but this probably does not explain the observed antinociceptive properties noted in preclinical and clinical trials. This review will discuss the known mechanisms of action of botulinum toxin type A, and will review the available randomized, placebo-controlled trials that have looked at its efficacy as a migraine preventative. We also describe the onabotulinumtoxinA injection sites used at our institution.

Keywords: botulinum toxin, prophylaxis, onabotulinumtoxinA, mechanism, migraine, prevention

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