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中华脑科疾病与康复杂志(电子版) ›› 2025, Vol. 15 ›› Issue (06) : 370 -376. doi: 10.3877/cma.j.issn.2095-123X.2025.06.008

综述

A型肉毒毒素治疗慢性偏头痛的研究进展
王雪1, 蒋晨阳1, 李杏2,†()   
  1. 1450052　郑州，郑州大学第一附属医院神经内科
    2102499　北京市房山区第一医院神经内科
  • 收稿日期:2024-12-18 出版日期:2025-12-15
  • 通信作者: 李杏

Recent progress in the type a botulinum toxin for the treatment of chronic migraine

Xue Wang1, Chenyang Jiang1, Xing Li2,†()   

  1. 1Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou 450052, China
    2Department of Neurology, The First Hospital of Fangshan District, Beijing 102499, China
  • Received:2024-12-18 Published:2025-12-15
  • Corresponding author: Xing Li
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王雪, 蒋晨阳, 李杏. A型肉毒毒素治疗慢性偏头痛的研究进展[J/OL]. 中华脑科疾病与康复杂志(电子版), 2025, 15(06): 370-376.

Xue Wang, Chenyang Jiang, Xing Li. Recent progress in the type a botulinum toxin for the treatment of chronic migraine[J/OL]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2025, 15(06): 370-376.

A型肉毒毒素（BT-A）是第一个被批准且现仍用于慢性偏头痛（CM）预防治疗的药物，主要作用于三叉神经和颈神经末梢，通过抑制降钙素基因相关肽、乙酰胆碱、P物质等炎症介质的释放来减少嗜离子性和代谢性受体在神经元膜的结合，从而增加了三叉神经和颈神经纤维的去极化阈值，抑制其激活。在临床上，BT-A对CM的疗效进行了大型随机安慰剂对照试验评估，并在多项长期观察性研究中得到验证。本文系统综述了使用BT-A治疗CM的证据，总结其作用机制、作用方式及其在预防治疗中的安全性和有效性，讨论BT-A对疼痛的治疗作用，以更全面地了解BT-A在CM治疗中的新进展。

关键词: A型肉毒毒素, 慢性偏头痛, 预防治疗

Botulinum toxin type A (BT-A) is the first medication approved for the preventive treatment of chronic migraine (CM) and remains one of the few drugs available for this purpose. BT-A primarily acts on the nerve endings of the trigeminal and cervical nerves by inhibiting the release of inflammatory mediators such as calcitonin gene-related peptide, acetylcholine, and substance P. This reduces the binding of ionotropic and metabotropic receptors on neuronal membranes, thereby increasing the depolarization threshold of trigeminal and cervical nerve fibers and reducing their activation. However, certain aspects of its mechanism of action remain controversial. Clinically, the efficacy of BT-A in CM has been evaluated through large randomized placebo-controlled trials, such as the Phase 3 studies of the Phase Ⅲ Research Evaluating Migraine Prophylaxis Therapy (PREEMPT) trial. These findings have also been validated in multiple long-term observational studies. This review summarizes the evidence for using BT-A in the treatment of CM, outlines its mechanism of action, mode of action, and its safety and efficacy in preventive therapy, and discusses the current role of BT-A in pain management to provide a comprehensive understanding of the advancements in BT-A for chronic migraine treatment.

Key words: Botulinum toxin type A, Chronic migraine, Preventive treatment
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