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Some 14% of global prevalence, based on high-income country populations, suffers from migraine. Chronic migraine is very disabling, being characterized by at least 15 headache days per month of which at least 8 days present the features of migraine. Onabotulinumtoxin A, targeting the machinery for exocytosis of neurotransmitters and neuropeptides, has been approved for use in chronic migraine since 2010. This systematic review and meta-analysis appraises the safety of onabotulinumtoxin A treatment for chronic migraine and the occurrence of treatment-related adverse events (TRAEs) in randomized, clinical studies in comparison with placebo or other comparators and preventative treatments according to the most updated Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 recommendations. The search retrieved 888 total records. Nine studies are included and seven were eligible for meta-analysis. The present study demonstrates that toxin produces more TRAEs than placebo, but less than oral topiramate, supporting the safety of onabotulinumtoxin A, and highlights the heterogeneity of the studies present in the literature (I = 96%; < 0.00001). This points to the need for further, adequately powered, randomized clinical trials assessing the safety of onabotulinumtoxin A in combination with the newest treatment options.
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http://dx.doi.org/10.3390/toxins15050332 | DOI Listing |
Cephalalgia
August 2025
Department of Neurology, NeuroClinic Norway, Lillestrom, Norway.
BackgroundThe discovery of calcitonin gene-related peptide (CGRP) as a key player in migraine pathophysiology has revolutionized the approach to preventive treatment. Atogepant, an oral small-molecule CGRP receptor antagonist, has shown promising efficacy in randomized controlled trials (RCTs) for both episodic and chronic migraine. However, real-world evidence, particularly in individuals with chronic migraine and multiple preventive treatment failures, remains limited.
View Article and Find Full Text PDFToxins (Basel)
April 2025
Digital and Predictive Medicine, Pharmacology and Clinical Metabolic Toxicology-Headache Center and Drug Abuse-Laboratory of Clinical Pharmacology and Pharmacogenomics, AOU Policlinico Di Modena, 41124 Modena, Italy.
Onabotulinumtoxin-A (onabotA) is a neurotoxin widely used for several indications, including chronic migraine (CM) preventive treatment, due to its well-demonstrated efficacy, tolerability, and safety. However, onabotA safety during pregnancy and breastfeeding remains unclear, as these populations are typically excluded from clinical trials. The action of onabotA starts locally at the injection sites, modulating the pain pathway with minimal systemic absorption, which theoretically minimizes risks to the fetus or breastfeeding infant.
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March 2025
Dr Philip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
Botulinum toxin (BoNT) is well-recognized throughout dermatology for its cosmetic indications and growing therapeutic value. Recent studies have trialed BoNT in the treatment of hair and scalp disorders, many of which lack long-term effective treatments and significantly impact quality of life. In this review, we summarize the current clinical literature on this topic to comprehensively evaluate the efficacy, safety, and clinical value of BoNT in treating hair and scalp conditions.
View Article and Find Full Text PDFToxins (Basel)
January 2025
Division of Dermatology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
Introduction: Enlarged facial pores are a common cosmetic concern caused by excessive sebum production, visible hair shafts, and a reduction in skin elasticity, leading to a decrease in skin quality and overall appearance. Various treatment modalities have been explored to address this issue. This study focuses on the efficacy and safety of combining Onabotulinumtoxin A (OnaBoNT-A) and hyaluronic acid filler (HA filler) to target enlarged facial pores in Asians.
View Article and Find Full Text PDFJ Pediatr Urol
February 2025
Department of Urology, Atrium Health Wake Forest Baptist, Winston Salem, NC, 27101, USA. Electronic address:
Introduction: While not entirely understood, nocturnal enuresis (NE) has been considered pathophysiologically distinct from other non-neurogenic voiding disorders. We believe that a significant component of the pathology is due to bladder overactivity. Intravesical Onabotulinumtoxin A (OBTA) injections are utilized in overactive bladder management.
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