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DEBATE: Is botulinum toxin type-A an effective and safe treatment for chronic migraine? YES SEE also CON View and COMMENTARY

Headache: What causes post traumatic headache - Will CRGP antagonists be effective?

October 30, 2010


Congress:The 4th World Congress on Controversies in Neurology (CONy)
Presenter:A. Mauskop

Despite the number of available prophylactic treatments for primary headache disorders, many patients do not respond to therapy or cannot tolerate treatment. Many drugs have been studied for the prophylactic treatment of episodic migraine with four being approved by the FDA, but far fewer treatments have been systematically studied for the treatment of CDH or CM. Several PBO-controlled trials and extensive open-label studies have suggested efficacy, safety, and tolerability of BoNTA in the treatment of various headache disorders, particularly in patients with CDH or CM and, to a lesser extent in patients with episodic migraine. Clinical experience in the treatment of headaches with the Dysport® and MYOBLOC® is limited. Due to differences in formulation and actions, the various BoNTs are not interchangeable and both efficacy and safety profiles may differ. Thus, the current data set provides information on the efficacy and safety of BOTOX® while further studies are warranted to establish the clinical profiles of other formulations in the treatment of headaches. BoNT represents a unique and remarkably safe form of treatment for headache sufferers. It is currently approved for the treatment of chronic migraines in the UK and is expected to be approved by the end of 2010 in the US.
BoNTA injections are usually given at 3-month intervals, therefore obviating the common problem of compliance with daily medications. It appears from current data that BoNTA may be an effective prophylactic treatment for headache disorders, especially migraine and CDH. Additional controlled trials may help define the most appropriate patient populations for successful treatment and the optimal doses and regimens.
Recent studies suggest that improved formulations of botulinum toxin with faster onset of action and longer duration of effect may become available in the future through protein engineering