OnabotulinumtoxinA in the treatment of migraine headache

Recent trials have demonstrated that onabotulinumtoxinA is a safe and effective treatment for the prevention of chronic migraine headaches. Although the exact effect of the toxin on the pathophysiology of migraine is not clear, several in vivo and in vitro models have shown that onabotulinumtoxinA inhibits the release of neurotransmitters and neuropeptides involved in pain-signaling pathways with resulting attenuation of both peripheral and central sensitization in migraine. Limited systemic adverse effects and physician-administered treatments that eliminate concerns for patient compliance have made onabotulinumtoxinA an appealing alternative to oral prophylactic medications for migraine. This article is designed to provide an overview of current research into the mechanism of action of onabotulinumtoxinA in the pathophysiology of pain conditions including migraine, as well the current literature supporting its efficacy in migraine treatment.