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New Delhi: Chronic migraine is marked by frequent and often disabling headache episodes that can shift in intensity across days or even hours. For many patients, distinguishing one attack from another becomes difficult, disrupting work, sleep and daily functioning. Treatment commonly aims to reduce frequency and severity, with onabotulinumtoxinA administered under the PREEMPT protocol forming a key option in routine care. New findings now indicate that structured involvement of advanced practice nurses may improve how consistently this therapy is delivered.

A retrospective study conducted at a specialised Spanish Headache Clinic assessed treatment patterns among nearly three thousand patients receiving onabotulinumtoxinA. Researchers observed stronger adherence to recommended injection intervals after advanced practice nurses joined the care pathway. The analysis suggests that targeted nursing support may help stabilise scheduling, strengthen continuity and ease pressure on neurologist-led services, offering a more organised framework for managing chronic migraine in real-world clinical settings across routine outpatient practice.

Chronic migraine care and PREEMPT adherence

Study design and patient profile

The retrospective analysis included 2,991 participants, the majority women, with a median age of 48 years. Data were reviewed across three separate 18-month periods. The earliest phase reflected neurologist-only administration, while later phases incorporated advanced practice nurses into routine care.

Improved injection timing under PREEMPT protocol

Researchers evaluated compliance within a 75 to 105 day window, aligned with the recommended PREEMPT schedule for onabotulinumtoxinA. Adherence increased from 52.1 per cent during the neurologist-only period to 76.1 per cent after advanced practice nurse involvement was introduced.

More consistent treatment intervals

Median intervals between injections declined from 105 days in the first period to 96 days in the second, before adjusting slightly to 98 days in the third. Investigators interpreted these findings as evidence of shorter and more stable treatment spacing.

Implications for patient care delivery

Authors suggested benefits may extend beyond staffing expansion. Clearer communication, improved clinic access and structured agenda management may have supported better compliance. The model could reduce outpatient burden while maintaining continuity of care.

Study limitations to consider

Adherence served as a surrogate outcome. Direct measures such as headache frequency, acute medication use and patient-reported outcomes were not assessed. As a single-centre retrospective study, broader applicability may require further evaluation, though the large real-world sample strengthens clinical relevance.