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The Use of Botulinum Toxin in the Management of Headache Disorders

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Botulinum Toxin Therapy

Part of the book series: Handbook of Experimental Pharmacology ((HEP,volume 263))

Abstract

Tremendous progress has been made in the past decades for the treatment of headache disorders. Chronic migraine is the most disabling type of headache and requires the use of acute and preventive medications, many of which are associated with adverse events that limit patient adherence. Botulinum toxin (BoNT) serotype A, a neurotoxin derived from certain strains of Clostridium, disrupts neuropeptide secretion and receptor translocation related to trigeminal nociception, thereby preventing pain sensitization through peripheral and possibly central mechanisms. Ever since the first randomized controlled trial on onabotulinumtoxinA (onabotA) for migraine was published two decades ago, onabotA has been the only BoNT formulation approved for use in the prevention of chronic migraine. Superior tolerability and efficacy have been demonstrated on multiple migraine endpoints in many controlled trials and real-life studies. OnabotA is a safe and efficacious treatment for chronic migraine and possibly high-frequency episodic migraine. Further research is still needed to understand its mechanism of action to fully develop its therapeutic potential.

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Change history

  • 15 December 2020

    The authors noticed that unfortunately in the chapter, in Section 9 on the second paragraph lines 1 and 3, 2 numbers were replaced by 2 citations. The injection protocols commonly used are (GBD 2016 DALYs Hale Collaborators 2017) the fixed-site approach, which uses fixed, symmetrical injection sites and a range of predetermined doses (GBD 2016 Disease and Injury Incidence and Prevalence Collaborators 2017); the follow-the-pain approach, which often employs … .. The sentence should read as ‘The injection protocols commonly used are: (1) the fixed-site approach, which uses fixed, symmetrical injection sites and a range of predetermined doses; (2) the follow-the-pain approach, which often employs… .

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Acknowledgments

Disclosure: Dr. Yuan received honoraria from Supernus Pharmaceuticals, Inc. Dr. Silberstein is a consultant and/or advisory panel member for and has receives honoraria from Alder (Lundbeck) Biopharmaceuticals; Allergan, Inc.; Amgen; Biohaven; Cefaly; Curelator; eNeura Inc.; electroCore Medical, LLC; Impel NeuroPharma; Medscape, LLC; Novartis; Ipsen Biopharmaceuticals; Eli Lilly, MedscapevLLC; Satsuma; Supernus Pharmaceuticals, Inc.; Teva Pharmaceuticals and Trigemina, Inc. No funding was received for this manuscript.

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  1. Jefferson Headache Center, Thomas Jefferson University, Philadelphia, PA, USA

    Hsiangkuo Yuan & Stephen D. Silberstein

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  1. Hsiangkuo Yuan
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Correspondence to Stephen D. Silberstein .

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    Scott M. Whitcup

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    Mark Hallett

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Yuan, H., Silberstein, S.D. (2020). The Use of Botulinum Toxin in the Management of Headache Disorders. In: Whitcup, S.M., Hallett, M. (eds) Botulinum Toxin Therapy. Handbook of Experimental Pharmacology, vol 263. Springer, Cham. https://doi.org/10.1007/164_2020_365

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