Headache Diagnostic Laboratory, Danish Headache Center and Department of Neurology, Rigshospitalet-Glostrup, Faculty of Health Sciences, University of Copenhagen, Glostrup, Denmark.
Acta Neurol Scand. 2018 May;137(5):442-451. doi: 10.1111/ane.12906. Epub 2018 Feb 6.
Botulinum toxin serotype A (BoNT/A) was originally used in neurology for the treatment of dystonia and blepharospasms, but is now clinically used worldwide for the treatment of chronic migraine. Still, the possible mode of action of BoNT/A in migraine is not fully known. However, the mode of action of BoNT/A has been investigated in experimental pain as well as migraine models, which may elucidate the underlying mechanisms in migraine. The aim of this study was to review studies on the possible mode of action of BoNT/A in relation to chronic migraine treatment. Observations suggest that the mode of action of BoNT/A may not be limited to the injection site, but also includes anatomically connected sites due to axonal transport. The mechanisms behind the effect of BoNT/A in chronic migraine may also include modulation of neurotransmitter release, changes in surface expression of receptors and cytokines as well as enhancement of opioidergic transmission. Clinical and experimental studies with botulinum toxin in the last decade have advanced our understanding of headache and other pain states. More research into botulinum toxin as treatment for headache is warranted as it can be an attractive alternative for patients who do not respond positively to other drugs.
A型肉毒毒素（BoNT/A）最初用于神经病学治疗肌张力障碍和眼睑痉挛，但现在已在全球范围内用于治疗慢性偏头痛。然而，BoNT/A 在偏头痛中的可能作用机制尚不完全清楚。但是，BoNT/A 的作用机制已在实验性疼痛和偏头痛模型中进行了研究，这可能阐明偏头痛的潜在机制。本研究旨在综述 BoNT/A 在慢性偏头痛治疗中的可能作用机制的研究。观察表明，BoNT/A 的作用机制可能不仅限于注射部位，还包括由于轴突运输而与解剖上相连的部位。BoNT/A 在慢性偏头痛中的作用机制还可能包括调节神经递质释放、受体和细胞因子表面表达的变化以及增强阿片能传递。过去十年中，肉毒毒素的临床和实验研究提高了我们对头痛和其他疼痛状态的认识。更多关于肉毒毒素治疗头痛的研究是必要的，因为它可以为那些对其他药物反应不佳的患者提供一种有吸引力的替代治疗方法。
