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Updated: Feb 16, 2026

Modeling Neural Immune Signaling of Episodic and Chronic Migraine Using Spreading Depression In Vitro
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Modeling Neural Immune Signaling of Episodic and Chronic Migraine Using Spreading Depression In Vitro

Published on: June 13, 2011

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Optimizing the long-term management of chronic migraine with onabotulinumtoxinA in real life

Cristina Tassorelli1,2, Gioacchino Tedeschi3, P Sarchielli4

  • 1a Headache Science Center , National Neurological Institute C. Mondino , Pavia , Italy.

Expert Review of Neurotherapeutics
|December 28, 2017
PubMed
Abstract

Insights

OnabotulinumtoxinA (OBT-A) is a key treatment for chronic migraine. This review synthesizes evidence on its long-term effectiveness and practical management strategies for optimal patient outcomes.

Area of Science:

  • Neurology
  • Pharmacology

Background:

  • Chronic migraine management presents significant challenges.
  • OnabotulinumtoxinA (OBT-A) is the sole licensed medication for chronic migraine prevention, widely used in clinical settings.
  • Data on the long-term efficacy and application of OBT-A is limited.

Purpose of the Study:

  • To provide an updated review of the latest evidence on the long-term use of OBT-A in chronic migraine.
  • To analyze critical issues in OBT-A decision-making based on literature and clinical practice.
  • To propose a treatment algorithm for daily clinical adoption.

Main Methods:

  • Combination of data from controlled trials and real-world studies on OBT-A's long-term use.
  • Inclusion of information from a survey of Italian headache centers.
  • Incorporation of authors' clinical experience.

Main Results:

  • Identified six key areas relevant to chronic migraine patients: defining responders, managing responders, optimal prophylaxis timing, OBT-A's role in prevention, medication overuse management, and patient education.
  • Analysis of literature and routine practice highlights critical decision-making issues.
  • A proposed treatment algorithm aims to guide daily clinical practice.

Conclusions:

  • This review offers current evidence on long-term OBT-A use in chronic migraine.
  • It addresses practical challenges and provides a framework for optimizing OBT-A therapy.
  • The proposed algorithm supports informed clinical decision-making for chronic migraine management.
Keywords:
Botoxchronic migraineheadachemigraine prophylaxisonabotulinumtoxinA

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