Abstract
This article discusses the expanding application of botulinum neurotoxin in treating chronic migraines beyond aesthetic purposes. Special attention is given to the mechanisms underlying the therapeutic action of this treatment, namely, the blockade of neurotransmitter releases responsible for pain signal transmission, modulation of nociceptors, and its effects on the central nervous system. The article provides an analysis of existing literature, including preclinical and clinical data, to evaluate the efficacy and safety of using botulinum neurotoxin for the prevention and treatment of chronic migraine attacks. Additionally, the article explores novel approaches to using non-paralyzing botulinum molecules in the context of chronic migraines. These new molecules, such as Bitox or el-iBoNT, offer an alternative for patients who face limitations in using paralyzing forms of botulinum neurotoxin due to concerns about muscle function loss. The authors highlight research findings that confirm not only the effectiveness of these molecules in controlling chronic pain but also a reduced paralytic effect. The authors also discuss a potential cause for the diminished paralytic action of these molecules, specifically changes in the stereoisomeric parameters of the treatment. In summary, this article reviews current research that enhances our understanding of the application of botulinum neurotoxin in the context of chronic migraines and opens avenues for developing new, more efficient molecules for treating this condition.