Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Jun 29;10(13):2898.
doi: 10.3390/jcm10132898.

OnabotulinumtoxinA in Migraine: A Review of the Literature and Factors Associated with Efficacy

Jason C Ray  1   2   3 , Elspeth J Hutton  1   3 , Manjit Matharu  4   5
Affiliations
Review

OnabotulinumtoxinA in Migraine: A Review of the Literature and Factors Associated with Efficacy

Jason C Ray et al. J Clin Med. .

Abstract

The efficacy of onabotulinumtoxinA (OnaB-A) as a preventative treatment for chronic migraine, emerging fortuitously from clinical observation is now supported by class one evidence and over two decades of real-world clinical data. There is still limited ability to predict a clinically meaningful response to OnaB-A for individual patients, however. This review summarises briefly the proposed mechanism of OnaB-A in chronic migraine, the literature of predictors of clinical response, and recent developments in the field.

Keywords: botulinum toxin; migraine; predictors of efficacy.

PubMed Disclaimer

Conflict of interest statement

J.C.R. has received compensation from the Pharmaceutical Society of Australia, sponsored by Viatris for educational material. E.J.H. has served on advisory boards for Sanofi-Genzyme, Novartis, Teva, Eli Lilly, Allergan, Lundbeck, been involved in clinical trials sponsored by Novartis, Teva, Xalud, Daewong and Novotech, and has received payment for educational presenta-tions from Allergan, Teva, Eli Lilly and Novartis. M.M. has served on advisory boards for Allergan, Autonomic Technologies Inc, Eli Lilly Novartis, Pfizer, Salvia and TEVA; has received payment for educational presen-tations from Allergan, electroCore, Eli Lilly, Novartis and TEVA; has received grants from Abbott, Medtronic and electroCore; and has a patent on system and method for diagnosing and treating headaches (WO2018051103A1, issued).

Figures

Figure 1
Figure 1
The PREEMPT protocol for injection of onabotulinumtoxinA (stylised)—green dots represent injection sites [12].
Figure 2
Figure 2
Mechanism of action of botulinum toxin [12]. (a) Normal synaptic transmission; arriving active channel opens voltage-gated calcium channels, allowing influx of calcium. Calcium allows synaptic vesicle docking via SNARE proteins, neurotransmitter release, and activation of post-synaptic potential. (b) Neuronal uptake of onabotulinumtoxinA, internalisation of botulinum toxin via synaptic vesicle, and cleavage of SNAP-25 protein causing inhibition of neurotransmitter release.
See this image and copyright information in PMC

References

    1. GBD 2016 Headache Collaborators Global, regional, and national burden of migraine and tension-type headache, 1990–2016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2018;17:954–976. doi: 10.1016/S1474-4422(18)30322-3. - DOI - PMC - PubMed
    1. The International Classification of Headache Disorders 3rd edition. [(accessed on 12 August 2019)]; Available online: https://ichd-3.org/
    1. Buse D.C., Greisman J.D., Baigi K., Lipton R.B. Migraine progression: A Systematic Review. Headache. 2019;59:306–338. doi: 10.1111/head.13459. - DOI - PubMed
    1. Horowitz B.Z. Botulinum toxin. Crit. Care Clin. 2005;21:825–839, viii. doi: 10.1016/j.ccc.2005.06.008. - DOI - PubMed
    1. Whitcup S.M. The History of Botulinum Toxins in Medicine: A Thousand Year Journey. Handb. Exp. Pharmacol. 2021;263:3–10. - PubMed

LinkOut - more resources