Neurológia pre prax 3/2026

Botulinum toxin in the treatment of headache

Onabotulinumtoxin A (OnaBoNT/A) is a neurotoxin with a complex mechanism of action that influences not only neuromuscular transmission but also the modulation of neurotransmitters and neuropeptides, which play a key role in the pathophysiology of primary and certain secondary headache disorders. Currently, OnaBoNT/A is considered an effective and safe prophylactic therapy for chronic migraine and has been approved for this indication by both American and European regulatory authorities. It also represents a promising treatment option for other types of headaches, including trigeminal autonomic cephalalgias and trigeminal neuralgia. Further expansion of its therapeutic indications can be expected in the future. However, to establish its efficacy in headache disorders beyond migraine, large-scale, rigorously designed randomized clinical trials with long-term follow-up will be required.

Keywords: onabotulinumtoxin A, chronic migraine, CGRP, tension-type headache, trigeminal autonomic cephalalgias, trigeminal neuralgia