Onabot is not a cure for migraine. In fact, in the trials leading to its approval, there were only about 2 fewer headache days per month in those who received it compared with those who received placebo, although the number of hours of headache per month was decreased by about 1/3. However, people who had received onabot in the studies were found to be better able to function AZD6738 mouse and perform their usual activities even when they did have headache. The 2 clinical trials that led to FDA approval used a standardized set of injections called the

PHASE III Research Evaluating Migraine Prophylaxis Therapy (PREEMPT) protocol. With this protocol, developed and tested extensively, 31 small injections of 5 units each are placed at prescribed locations over the forehead, sides of the head, and back of the head and neck. The injections Selumetinib are just under the skin, creating a small bubble or wheal at the site that is usually not visible beyond a few hours. The PREEMPT injection sites are illustrated in the Figure. The amount of medicine approved by the FDA for chronic migraine prevention, and administered in the PREEMPT protocol, is 155 units. However, onabot only comes in vials of 100 or 200 units. Rather

than throw out the remaining 45 units in the bottle, many practitioners will offer to administer the remainder in areas in which patients particularly have pain. This selleck chemicals llc additional treatment strategy is called “follow the pain,” and it was also

used by many of the PREEMPT testing sites before FDA approval. Unfortunately, although “follow the pain” injections are frequently administered, it is not fully established whether they provide additional benefit. The PREEMPT protocol for onabot injections is the only FDA-approved injection pattern for chronic migraine, and practitioners are specially trained in its administration. Although cosmetic onabot is chemically identical to that used for chronic migraine, the amounts and locations tested and approved for headache treatment are very different from that used for other indications. Onabot in general is well tolerated and usually is without systemic side effects. However, about 9% of people report neck pain, 5% headaches, and 4% may have a temporary drooping of the eyelid called ptosis. About 3% will experience muscle pains, and 2% will have some facial muscle paralysis, eyebrow elevation, or muscle spasms. All of these are temporary should they occur. Patients typically notice they cannot wrinkle their forehead after onabot injections, and when they resume being able to do this, it can be a sign that the drug is wearing off. The effectiveness of onabot tapers off at 3 months, sometimes sooner. If there are side effects, they typically are much shorter in duration than the 3 months of effect on headache.