Insights from 25 years of onabotulinumtoxinA in migraine - mechanisms and management.

Patricia Pozo-Rosich, Alicia Alpuente, Stephen D Silberstein, Rami Burstein

Nature reviews. Neurology 2024 Sep

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OnabotulinumtoxinA (BTX-A) was first linked to beneficial effects in migraine 25 years ago and was approved by the FDA for preventive treatment of chronic migraine in 2010. The treatment has since had a major impact on the well-being of people with chronic migraine. The clinical development programme for BTX-A and research since its approval have provided insights into the neuromodulatory sensory effect of BTX-A, how it can control chronic migraine despite its peripheral action, and the underlying biology of migraine as a disease. In this Review, we consider the impact that BTX-A has had on the management of chronic migraine and on the research field. We discuss the insights provided by clinical research, encompassing the clinical trials and subsequent real-world evidence, and the mechanistic insights provided by preclinical and translational research. We also provide an overview of future directions of research in the field BTX-A in migraine and the clinical translation of this research. © 2024. Springer Nature Limited.

Citation

Patricia Pozo-Rosich, Alicia Alpuente, Stephen D Silberstein, Rami Burstein. Insights from 25 years of onabotulinumtoxinA in migraine - mechanisms and management. Nature reviews. Neurology. 2024 Sep;20(9):555-568