Botulinum Toxin Type A Therapy in Migraine: Preclinical and Clinical Trials

Abstract

BackgroundBotulinum toxin type A (BTX-A) has been reported to be effective for the therapy for migraine. The purpose of this study was to investigate the effect of BTX-A on the immunoreactive levels of calcitonin gene-related peptide (CGRP) and substance P (SP) in the jugular plasma and medulla oblongata of migraine in rats induced by nitroglycerin (NTG), and then to evaluate and compare the effectiveness of fixed (muscle)-sites and acupoint-sites injection of BTX-A for migraine therapy of patients in a randomly controlled trial extending over four months.Materials and MethodsRats with NTG-induced migraine were subcutaneously injected with vehicle or BTX-A (5 U/kg or 10 U/kg bodyweight). CGRP- and SP-like immunoreactivity (CGRP-LI and SP-LI) were determined by radioimmunoassay. In clinical trials, sixty patients respectively received BTX-A (2.5 U each site, 25 U per patient) at fixed-sites (group F, n = 30) including occipitofrontalis, corrugator supercili, temporalis and trapezius or at acupoint-sites (group A, n = 30) including EX-HN3, EX-HN5, GV20, GB8, GB20 and BL10.ResultsLocal BTX-A injection suppressed NTG-induced CGRP-LI and SP-LI levels in jugular plasma and oblongata. BTX-A injection for both groups with migraine significantly reduced the attack frequency, intensity, duration and associated symptoms. The efficacy of BTX-A for migraine in group A (93% improvement) was more significant than that in group F (83% improvement) (P < 0.01).ConclusionsThe evidence that BTX-A decreases NTG-induced CGRP-LI and SP-LI levels in trigeminovascular system suggests that BTX-A attenuates migraine by suppression of neuropeptide release. BTX-A injections for migraine at acupoint-sites and fixed-sites are effective. Acupoint-sites BTX-A administration shows more efficacy for migraine than fixed-sites application.

The effect and safety of monoclonal antibodies to calcitonin gene-related peptide and its receptor on migraine: a systematic review and meta-analysis

“…In clinical studies, serum and plasma levels of CGRP are increased in patients with migraine onsets as compared with healthy subjects [45–47]. In preclinical results, regulating disordered CGRP production may reduce continued occurrence of migraine after taking anti-migraine drug [48–51]. Based on these studies, it is possible to prevent migraine by blocking CGRP binding to its receptor.…”

Botulinum Toxin Type A as a Therapeutic Agent against Headache and Related Disorders

“…The ability of BoNTs to inhibit the release of CGRP and SP has been proven also for other botulinum neurotoxin serotypes, such as BoNT/D [ 47 ]. The effect of BoNT/A on immunoreactive levels of CGRP and SP was investigated in a model of migraine induced by nitroglycerine (NTG) in rats [ 48 ]. The authors found that local injection of BoNT/A, s.c. administered into the frontal and temporal area two hours after NTG administration, suppressed NTG-induced release of CGRP and SP in jugular plasma samples and in medulla oblongata.…”

Aspectos Relevantes Do Uso Da Toxina Botulínica No Tratamento Estético E Seus Diversos Mecanismos De Ação

“…-Enxaqueca: é um dos tipos de cefaleia, caraterizada como um distúrbio neurovascular do recorrente, com dor de cabeça latejante, e muitas vezes associada com aura, náuseas, vómitos, fotofobia, fonofobia, fadiga e maior irritabilidade (SHAO et al, 2013).…”