The Application of Botulinum Toxin in the Prophylactic Treatment of Migraine

Introduction: Migraine is a common disorder that affects about 2% of the general population, with a prevalence of 7% in men, 24% in women and 4% in children. Migraine is the fourth most disabling condition among women and the seventh most disabling worldwide. It is characterized by paroxysmal, throbbing headaches, often unilateral, accompanied by hypersensitivity to noise, light, nausea and vomiting. Migraine is divided into episodic and chronic, with chronic meaning headache for at least 15 days a month for more than 3 months, with 8 migraine days. Treatment includes non-pharmacological and pharmacological methods, but often ineffective and fraught with side effects. Chronic migraine can lead to significant disability.

Material and methods: The purpose of this article is to discuss the treatment of migraine with botulinum toxin. Information was collected from the English-language databases Google Scholar, Scopus and PubMed.

Results :Onabotulinum toxin A, approved for the treatment of migraine, works by blocking acetylcholine release at the synapse level, leading to reversible flaccid paralysis and blocking neurotransmitters such as CGRP. Injection sites include peri-cranial and neck muscles, allowing the toxin to be transported to the meninges and trigeminal ganglion. In recent years, injections near the cranial sutures have been preferred. BTX-A therapy has shown efficacy in reducing the frequency and severity of migraine pain, with fewer side effects compared to topiramate. Side effects, such as hematoma or ptosis, are rare and their frequency decreases with subsequent sessions. The cost of migraine treatment is high, but botulinum toxin reduces headache days and is cost-effective.