The Use of Botulinum Toxin in the Management of Headache Disorders

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


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.


Botulinum toxin Calcitonin gene-related peptide Migraine 



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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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Jefferson Headache CenterThomas Jefferson UniversityPhiladelphiaUSA

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