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  • Chapter 31 - The Use of Botulinum Toxin in the Management of Headache Disorders

  • Edited by Daniel Truong, University of California, Riverside, Dirk Dressler, Hannover Medical School, Mark Hallett, National Institutes of Health (NIH), Christopher Zachary, University of California, Irvine, Mayank Pathak, Truong Neuroscience Institute
  • Book:
    Manual of Botulinum Toxin Therapy
    Published online:
    02 November 2023
    Print publication:
    23 November 2023, pp 252-259

  • Summary

    Migraine is a primary headache disorder characterized by enhanced sensitivity of the nervous system associated with a combination of neurological, gastrointestinal and autonomic disturbances (Silberstein, 2004). Chronic headache is a heterogeneous group of headache disorders that include chronic migraine (CM), chronic TTH (CTTH) and other headache types that occur 15 days or more per month (for a minimum of 3 months).

    OnatotulinumtoxinA (onabotA) therapy has been used for a variety of disorders associated with painful muscle spasms. It is generally believed that, following intramuscular injection, onabotA produces partial chemical denervation resulting in a reduction in muscle activity and a broader inhibition of peripheral and central pain sensitization. OnabotA therapy is FDA-approved for use in patients with chronic migraine. This chapter discusses the definition of chronic migraine, patient selection for treatment with onabotA, and presents the PREEMPT injection protocol for the application of onabotA, with clinical description and pictural illustration of the injection site.