Clinical data and experience to date have demonstrated that
BoNT-A is an effective and well-tolerated
therapy for the prevention of
migraine and other
headache disorders. It has a long duration of action that may last over 4 months with no systemic or serious AEs. Several issues remain to be defined, however, including dosing, location, and number of
injections; optimal dilution of
BoNT-A; specific
headache types that respond best to
BoNT-A; and long-term efficacy and safety. Data from ongoing well-designed trials that include a larger patient population investigating these issues may confirm a role for
BoNT-A as a first-line agent for
migraine prevention.
Neurotoxin therapy is part of a broader
headache management approach. Because the injection techniques for
headache are unique and vary depending on the
primary headache disorder being treated and the location and pattern of
pain referral, the use of
BoNT-A for
headache is not simply an extension of its use for cosmesis. The use of
BoNT-A in the overall management of
primary headache disorders should be reserved for medical practitioners who not only have experience with
BoNT-A injections, but possess the expertise in the diagnosis and management of complex
headache disorders. Educating patients and addressing
headache triggers and optimizing acute treatment improve the outcome of any preventive program.