title: Rationale for use of onabotulinum toxin A (BOTOX) in chronic migraine.
abstract: Chronic migraine is a severely disabling headache evolving from episodic migraine as a result of different transforming factors and characterized by atypical pain modulation and peripheral and central sensitization. Discovered by serendipity, onabotulinum toxin A (BoNT-A) represents the only drug specifically approved for CM prophylaxis. According to the dominant opinion, BoNT-A acts peripherally, impairing the exocytosis of neuropeptide and neurotransmitter and the delivery of receptors and ion channels on the cell surface of peripheral trigeminal endings, thereby indirectly reducing central sensitization. However, it is not excluded that BoNT-A has also a central antinociceptive action, probably associated with an enhanced opioidergic and GABA-ergic transmission. This review discusses the rationale for use of BoNT-A in CM including its mechanisms of action and molecular targets and provides suggestions for a more tailored BoNT-A prophylaxis in patients with CM.
authors.affiliation: Headache and Pain Unit, Department of Neurological, Motor and Sensorial Sciences, IRCCS San Raffaele Pisana, Via della Pisana 235, 00163, Rome, Italy, piero.barbanti@sanraffaele.it.
authors.forename: P
authors.initials: P
authors.lastname: Barbanti
authors.forename: G
authors.initials: G
authors.lastname: Egeo
authors.forename: L
authors.initials: L
authors.lastname: Fofi
authors.forename: C
authors.initials: C
authors.lastname: Aurilia
authors.forename: S
authors.initials: S
authors.lastname: Piroso
mesh_terms: D065087:Acetylcholine Release Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D019274:Botulinum Toxins, Type A / Q000494:pharmacology / Q000627:therapeutic use*; D002908:Chronic Disease; D006801:Humans; D008881:Migraine Disorders / Q000188:drug therapy*
chemical_list: D065087:Acetylcholine Release Inhibitors; D019274:Botulinum Toxins, Type A