Survey suggests approved toxin-for-headache protocol not followed

22 May 2020

A survey has indicated that only 22.5% of practitioners follow the recommended protocol for treating headaches with botulinum toxin.

According to the survey conducted by Headache, the journal of head and face pain, 141 respondents said they did not always follow the PREEMPT protocol – the only FDA-approved injection pattern for chronic migraine with use of onabotulinum toxin A.

Results found that 70% changed the number of injections, 63% changed the total units injected, 57.7% altered the location of injection sites, 55.5% do not aspirate, 12.1% change the dilution and 2.2% added lidocaine.

The main reasons cited for changing treatment approach were to adapt to individual patients’ pain, anatomy and preferences.

The authors of the survey analysis concluded, “The wide inter‐ and intra‐personal variations in BoNT‐A injections for chronic migraine prevention seen in this survey raise concerns about the standardisation of the procedure and suggest that an advisory protocol containing more evidence and discussion of the reasoning behind the recommendations might be more helpful than the current prescriptive protocol.”


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