BOTULINUM TOXIN TYPE A IN THE TREATMENT OF CHRONIC MIGRAINE: CURRENT STATE OF KNOWLEDGE AND THERAPEUTIC PERSPECTIVES

Migraine is one of the most common and burdensome neurological disorders, affecting approximately 15% of the global population. This paper provides a review of the current knowledge on the epidemiology, pathophysiology, and treatment of chronic migraine, with particular emphasis on the role of botulinum toxin type A. It presents the key biological mechanisms underlying migraine, including activation of the trigeminovascular system, the significance of neuropeptides such as CGRP, and the involvement of cortical spreading depression (CSD) in migraine with aura. Modern pathophysiological concepts related to autonomic and metabolic system dysfunction are also discussed. Based on an analysis of clinical trials and meta-analyses, the efficacy and safety of onabotulinumtoxinA therapy according to the PREEMPT protocol are evaluated, as well as its place in current therapeutic guidelines. The paper concludes with a discussion of future research perspectives, including the potential for synergy with biological therapies (anti-CGRP), optimization of treatment regimens, and the use of biomarkers.