Conflict of Interest:A. Blumenfeld: Research grants from Allergan, Inc., GlaxoSmithKline, Medtronic, Inc., and Pfizer, Inc., and consultancy with Allergan, Inc., GlaxoSmithKline, Medtronic, Inc., Merck, Ortho-McNeill, Pfizer, Inc.; S.D. Silberstein: Research grants from Advanced NeuroModulation Systems, AGA, Allergan, Inc., Boston Scientific, Coherex, Endo, GlaxoSmithKline, Lilly, MAP, Medtronic, Inc., Merck, NuPathe, and Valeant, and consultancy with Allergan, Inc., AGA, Capnia, Coherex, Endo, GlaxoSmithKline, MAP, Medtronic, Inc., Merck, NuPathe, and Valeant; D.W. Dodick: Honoraria for consulting with Allergan, Inc., Addex, Alexza, Coherex, Eli Lilly, Endo, GlaxoSmithKline, H. Lundbeck A/S, Kowa, MAP, Medtronic, Merck, Minster, Neuralieve, Neuraxon, Novartis, NuPathe, Pfizer, Inc., and research grants (to institution) on behalf of investigator from ANS, Medtronic, Inc., and St. Jude; S.K. Aurora: Research grants from Alexza, Allergan, Inc., AstraZeneca, GlaxoSmithKline, Merck, and Winston, and honoraria for consulting with Allergan, Inc., Astra Zeneca, GlaxoSmithKline, Merck, Ortho-McNeil, NMT, Pfizer, Inc., and Valeant; C.C. Turkel: Employee and shareholder of Allergan, Inc.; W.J. Binder: Consultant and shareholder of Allergan, Inc.
Method of Injection of OnabotulinumtoxinA for Chronic Migraine: A Safe, Well-Tolerated, and Effective Treatment Paradigm Based on the PREEMPT Clinical Program
Version of Record online: 4 OCT 2010
© 2010 American Headache Society
Headache: The Journal of Head and Face Pain
Volume 50, Issue 9, pages 1406–1418, October 2010
How to Cite
Blumenfeld, A., Silberstein, S. D., Dodick, D. W., Aurora, S. K., Turkel, C. C. and Binder, W. J. (2010), Method of Injection of OnabotulinumtoxinA for Chronic Migraine: A Safe, Well-Tolerated, and Effective Treatment Paradigm Based on the PREEMPT Clinical Program. Headache: The Journal of Head and Face Pain, 50: 1406–1418. doi: 10.1111/j.1526-4610.2010.01766.x
- Issue online: 4 OCT 2010
- Version of Record online: 4 OCT 2010
- Accepted for publication August 3, 2010.
- chronic migraine;
Chronic migraine (CM) is a prevalent and disabling neurological disorder. Few prophylactic treatments for CM have been investigated. OnabotulinumtoxinA, which inhibits the release of nociceptive mediators, such as glutamate, substance P, and calcitonin gene-related peptide, has been evaluated in randomized, placebo-controlled studies for the preventive treatment of a variety of headache disorders, including CM. These studies have yielded insight into appropriate patient selection, injection sites, dosages, and technique. Initial approaches used a set of fixed sites for the pericranial injections. However, the treatment approach evolved to include other sites that corresponded to the location of pain and tenderness in the individual patient in addition to the fixed sites. The Phase III REsearch Evaluating Migraine Prophylaxis Therapy (PREEMPT) injection paradigm uses both fixed and follow-the-pain sites, with additional specific follow-the-pain sites considered depending on individual symptoms. The PREEMPT paradigm for injecting onabotulinumtoxinA has been shown to be safe, well-tolerated, and effective in well-designed, controlled clinical trials and is the evidence-based approach recommended to optimize clinical outcomes for patients with CM.