Botulinum toxin (BoNT) in headache disorders

Headache disorders, including migraine and chronic migraine (headaches ≥15 days/month and a link to migraine) are common debilitating conditions that profoundly impact quality of life. There are 7 BoNT serotypes (A, B, C1, D, E, F, and G). Botulinum toxin type A (BoNTA) has been the most widely studied serotype for therapeutic purposes. Several randomized, double-blind, placebo-controlled studies support the efficacy of BoNT for the treatment of chronic migraine. More recently, the PREEMPT clinical program confirmed OnabotulinumtoxinA as an effective, safe, and well-tolerated headache prophylactic treatment for adults with chronic migraine. The PATS program suggested that OnabotulinumtoxinA is a safe treatment and is efficacious for the prevention of high frequency episodic migraine. Further research is needed to understand the mechanism of action of BoNT in headache, further establish its safety and efficacy for these indications, and fully develop its therapeutic potential.