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Botulinum toxin type A reduces headache frequency, severity, and acute medication use in chronic migraine, but shows lower efficacy than topiramate and selected CGRP monoclonal antibodies.
Tackling chronic migraine remains a significant clinical hurdle, with therapeutic strategies heavily focused on symptom prevention and reducing disease burden. While botulinum toxin type A (BoNT-A) has long served as an established prophylactic option, evolving pharmacotherapeutic options have prompted a reassessment of its comparative efficacy and safety profile within modern clinical practice.
To clarify these clinical parameters, a rigorous umbrella review issued in "Toxins" synthesized quantitative evidence from high-quality systematic reviews and meta-analyses published up to August 2024. Following PRISMA guidelines and registered in PROSPERO, the authors analyzed 14 high-quality systematic reviews to explore primary clinical outcomes, including monthly headache frequency, headache severity, and acute medication consumption.
BoNT-A achieved remarkable superiority over placebo across all primary endpoints, successfully decreasing headache frequency, attenuating pain severity, and lowering reliance on acute rescue medications. However, in comparative evaluations, BoNT-A exhibited lower overall efficacy when evaluated alongside topiramate as well as calcitonin gene-related peptide (CGRP) monoclonal antibodies, specifically galcanezumab and fremanezumab.
From a safety and tolerability standpoint, BoNT-A illustrated a favorable overall profile. Although mild-to-moderate adverse events were reported frequently, the therapy was well-tolerated by patients, exhibiting superior tolerability compared to topiramate and safety outcomes comparable to calcitonin gene-related peptide (CGRP) monoclonal antibodies.
In conclusion, current evidence supports a moderate level of efficacy for BoNT-A as a preventive regimen for chronic migraine. The authors emphasize that future long-term prospective studies and direct head-to-head trials are fundamental to fully define its comparative role alongside emerging biologic therapies.
Toxins (Basel)
Botulinum Toxin Type A for the Prevention of Migraines: An Umbrella Review of Systematic Reviews
Goli Chamani et al.
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