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

Cristina Tassorelli, Gioacchino Tedeschi, P. Sarchielli, Luigi Alberto Pini, Licia Grazzi, Pierangelo Geppetti, Marina De Tommaso, Marco Aguggia, P. Cortelli, Paolo Martelletti

Research output: Contribution to journalReview articlepeer-review


Introduction: Management of chronic migraine is challenging. OnabotulinumtoxinA (OBT-A) is the only medication licensed for prevention of chronic migraine, and has been widely adopted in clinical practice. Limited data is available on its long-term use. Areas covered: Data from controlled trials are combined with available data on the long-term use of OBT-A in real-life studies, with information obtained in a recent survey among Italian headache centers, and the clinical experience of the authors. Six areas were identified as relevant to patients with chronic migraine: 1) definition of responders to OBT-A; 2) management of responders to OBT-A; 3) optimal timing of prophylaxis with OBT-A; 4) position of OBT-A in prevention of chronic migraine; 5) management of medication overuse, and 6) patient education. Expert commentary: This review provides an update on the latest evidence regarding the long-term use of OBT-A in chronic migraine and analyzes the critical issues in the decision-making process that emerge from the analysis of the literature and routine practice. A treatment algorithm is proposed for the adoption in the daily practice.

Original languageEnglish
Pages (from-to)167-176
Number of pages10
JournalExpert Review of Neurotherapeutics
Issue number2
Publication statusPublished - Feb 1 2018


  • Botox
  • chronic migraine
  • headache
  • migraine prophylaxis
  • onabotulinumtoxinA

ASJC Scopus subject areas

  • Neuroscience(all)
  • Clinical Neurology
  • Pharmacology (medical)


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