OnabotulinumtoxinA in Migraine and Other Headaches: Review and Update

• Published in: Current treatment options in neurology Vol. 21; no. 4; p. 21
• Main Authors: Lenaerts, Marc E., Green, Tiffany H.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-04-2019
• Subjects: Critical Care Medicine; Diabetes; Family Medicine; General Practice; Headache (JR Couch; Intensive; Internal Medicine; Medicine; Medicine & Public Health; Neurology; Ophthalmology; Section Editor; Topical Collection on Headache; OnabotulinumtoxinA; Headache; Cluster headache; Trigeminal neuralgia; Migraine
• ISSN: 1092-8480; 1534-3138
• DOI: 10.1007/s11940-019-0561-6

Purpose of the review
The role of onabotulinumtoxinA in headache management was serendipitously found over a decade ago and approved for chronic migraine in 2010 based on pivotal studies. The purpose of this review is to highlight the impact on headache and other health parameters which is critically reviewed, as well as the putative mechanisms of action.
Recent findings
OnabotulinumtoxinA is effective in migraine, not only headache frequency and pain intensity but also other health parameters including quality of life. Tolerability is high and benefit/cost analysis is favorable. It should be considered off-label in refractory trigeminal neuralgia and post-herpetic neuralgia but further research in these areas. Ongoing investigation of onabotulinumtoxinA in cluster headache is too preliminary for recommendation of use but promising. Recent and future developments in other headache disorders are discussed.
Summary
OnabotulinumtoxinA has been approved for migraine almost a decade ago and been proven beneficial not only on headache parameters but other health outcomes. Its role as adjuvant is being studied and emerging in other headache syndromes.