OnabotulinumtoxinA as a Treatment for Chronic Migraine

OnabotulinumtoxinA is a protein produced by a bacterium (Clostridium botulinum) that in high doses can cause diffuse muscular paralysis, inability to breathe, and death. Injected into specific muscles in tiny doses, however, onabotA has been demonstrated to be effective in treating various types of involuntary muscle contraction safely and effectively. OnabotA also is used for cosmetic purposes, relaxing facial muscles and so smoothing out facial wrinkles.

While evaluating onabotA administered for disorders involving muscle contraction, investigators discovered that the pain experienced by patients with those disorders tended to improve even before any meaningful reduction in muscle contraction occurred. In addition, patients with migraine who were receiving onabotA for cosmetic purposes frequently reported a significant improvement in their headaches following the injections. Those observations subsequently led to a series of clinical research studies designed to assess the value of onabotA therapy for headache prevention. To make a long story short, the results from those studies suggested that onabotA does not appear to be effective in treating tension-type headache or patients with infrequent migraine attacks. The PREEMPT study, however, demonstrated onabotA to be both safe and effective for the treatment of chronic migraine.

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