Chronic migraine treatment: from OnabotulinumtoxinA onwards

ABSTRACT

Introduction: WHO ranks migraine as the 6th highest cause of disability worldwide when considered alone, and the 3rd highest when medication overuse headache (MOH) is included. Migraine is an episodic disorder but in its natural course, its frequency could progressively increase and evolve to a chronic form. More than 50% of chronic migraine patients show acute pain medications overuse which is linked to the development of MOH.

Areas covered: Our goal is to review the existing data on OnabotulinoumtoxinA and CGRP-targeting drugs such as anti-CGRP monoclonal antibodies, one of the most promising migraine drugs under development. The research of bibliographic databases has included only published peer-reviewed articles from indexed journals.

Expert commentary: To date, real-life studies are supporting OnabotulinumtoxinA in the treatment of chronic migraine. Additionally, anti-CGRP mAbs showed good efficacy and safety in recent RCTs and may soon contribute to improve the quality of life of patients suffering with migraine.

KEYWORDS:

• migraine
• OnabotulinumtoxinA
• CGRP
• monoclonal antibodies
• migraine prophylaxis

Declaration of interest

A Negro has received travel grants and participated on the advisory boards of Allergan, Electrocore and Medtronic. MA Giamberardino received research funding from Epitech Group, honoraria for participation in advisory board meeting from Bayer, and participation in conferences from IBSA Institute Biochimique and Helsinn Healthcare, and Royalties from IASP Press. P Martelletti received travel grants, honoraria, consultancy and participated on the advisory boards of Allergan, Bayer, Medtronic, Mylan and Teva. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.