Headache in migraine does not respond well to medical treatment, but botulinum toxin A (BoNT/A) proves to be beneficial in pain management, according to the findings of a narrative review published in the journal Cureus. The review also found that migraine is often accompanied by psychiatric illnesses, including major depressive disorder, anxiety disorders, and bipolar disorders.
Migraine is a neurologic headache caused by high excitability of the central nervous system (CNS), which is one of the most debilitating health complaints worldwide. Patients with migraine experience its effects at home, the workplace, and in social settings, which can lead to poor quality of life.
The most common type of migraine is accompanied by aura (39.5%). This type of migraine manifests with symptoms of light sensitivity, altered vision, dizziness, and/or buzzing in the ears. For migraine without aura, some patients report additional symptoms of anxiety, depression, and/or fatigue and nonaura migraine can continue for up to 72 hours.
Evidence suggests that migraine and psychiatric illness have a bidirectional relationship. The correlation hypothesis posits that anxiety in adolescence begins a process that leads to migraine and depression later in life.
As living with migraine can have wide-reaching consequences, affecting daily life and mental health, receiving effective treatment is of upmost importance.
For more than 15 years, BoNT/A has been used to treat chronic migraine headaches. The neurotoxin BoNT/A is produced by Clostridium botulinum which acts by paralyzing muscles and decreasing the production of acetylcholine. The neurotoxin also inhibits nociceptive mediator production, which suggests it decreases the nociceptive input to the CNS. Its effects on the CNS are not immediately apparent, as it does not cross the blood-brain barrier.
A study found that BoNT/A associated with a 57% reduction in use of pain medication for acute headache and in general, BoNT/A decreases the prevalence and severity of headaches. Due to its efficacy, the US Food and Drug Administration (FDA) approved BoNT/A for the treatment of chronic migraine in 2010.
Additional study is needed to evaluate BoNT/A use for hemiplegic migraine as well as other uses in the headache and pain management setting.
Migraine is an incapacitating disorder that is often associated with psychiatric comorbidities, including anxiety, depression, panic, bipolar, and sleep disorders, the review authors acknowledged.
“The recent advancement in treating migraine and the associated neuropathic pain with botulinum toxin has come up, benefiting a large population of sufferers. Still, the full potential of this toxin is undiscovered and needs more research,” they concluded.
Dhengare AS, Fulmali DG. The development of psychiatric illness and chemoprophylaxis of botulinum toxin in migraine: A narrative review. Cureus. Published online December 27, 2022. doi:10.7759/cureus.32998