300 Section - Physical and Rehabilitation Medicine expertise and chronic migraine management with botulinum toxin: 15 years of experience.

Chronic migraine (CM) poses a significant clinical challenge due to its high prevalence, functional impact, and limited response to oral preventive therapies. Botulinum toxin type A has emerged as a validated alternative in refractory CM.  The aims of the study are to analyze the efficacy and safety of botulinum toxin in refractory CM over 15 years in a clinical cohort and to leverage the deep clinical expertise of physical and rehabilitation medicine (PRM) specialists in complex pain conditions.

Design: A retrospective longitudinal cohort study was conducted in adult patients with refractory CM managed by PRM specialists and treated with botulinum toxin type A following the PREEMPT protocol (155–195 U at 31 injection points every 12 weeks). Clinical outcomes included monthly headache days, pain intensity, use of symptomatic medication, continuation of treatment, and adverse effects. T

Results: A total of 57 patients were evaluated, 77.2% women. Sixty-five percent achieved a ≥50% reduction in headache days per month. There was a significant decrease in triptan and analgesic use, and treatment was generally well tolerated. Forty-seven percent of patients continued botulinum toxin treatment long-term, while 21% required subsequent therapy with monoclonal antibodies targeting CGRP pathways. Adverse effects were mild and reversible; 26.3% of the cohort had associated psychiatric comorbidities. The rehabilitation context allowed comprehensive assessment and multimodal management, integrating functional goals and pain coping strategies.

Conclusion: Botulinum toxin type A is an effective and safe therapeutic option for refractory CM in a real-world cohort and achieves sustained clinical benefit with a favorable safety profile. The PRM expertise in pain and functional rehabilitation enhances patient selection, multidisciplinary management, and long-term outcomes, underscoring the valuable role rehabilitation clinicians can play as experts in migraine treatment.