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Chronic migraines are a common debilitating headache disorder. Recently, there has been increasing interest in the use of onabotulinumtoxinA as a preventative treatment, as studies have shown significant benefits. In line with current accepted theories on the pathophysiology of migraines, the toxin works by both direct and indirect means to prevent peripheral and central nerve sensitization. While efficacy has been established, the technique for extracranial delivery of onabotulinumtoxinA continues to see changes in an effort to seek better outcomes. The PREEMPT injection protocol is the original injection paradigm design targeting broad muscle groups. The ART injection paradigm offers the ability to deliver onabotulinumtoxinA closer to culprit nerves, thus increasing its effect and also decreasing adverse effects. OnabotulinumtoxinA is an effective and well-tolerated option for selective patients seeking relief from migraine headaches.

Management of Migraine Headaches: OnabotulinumtoxinA Injection