Chronic Migraine Care and PREEMPT Adherence
Advanced practice nurse involvement improved PREEMPT interval adherence for chronic migraine patients receiving onabotulinumtoxinA in routine care.
Advanced practice nurse involvement was associated with better treatment scheduling for chronic migraine in a retrospective study of patients receiving onabotulinumtoxinA at a specialized Spanish Headache Clinic. The analysis included 2,991 participants, most of whom were women, with a median age of 48 years. Investigators found that the introduction of an advanced practice nurse was significantly associated with improved adherence to the PREEMPT protocol over time.
Chronic Migraine Injections Became More Consistent
The study assessed whether injections were delivered within a compliant 75 to 105 day window, reflecting the recommended PREEMPT protocol schedule used in routine practice. Data were examined across three separate 18 month periods, with the earliest period reflecting neurologist-only administration and the later periods including both neurologists and advanced practice nurses. Adherence rose from 52.1% in the first period to 76.1% in both subsequent periods after advanced practice nurse involvement was introduced.
Timing between visits also improved. The median interval between administrations fell from 105 days in the first period to 96 days in the second period, before increasing slightly to 98 days in the third. The authors interpreted this pattern as evidence of shorter and more consistent treatment intervals, supporting more reliable chronic migraine care delivery.
What the Findings Could Mean for Patient Care
The authors suggested that the benefit of advanced practice nurse involvement may extend beyond added staffing capacity alone. Improved communication with patients, greater access to the Headache Clinic, and more efficient agenda management may also have contributed to stronger adherence. They noted that this model may help reduce pressure on neurologist-led outpatient care while supporting continuity of treatment and more stable migraine control.
The study also highlighted important limitations. Adherence was used as a surrogate outcome, and direct efficacy measures such as headache frequency, acute medication use, and patient reported outcomes were not included. As a single center retrospective analysis, generalizability may be limited, though the large real world sample strengthens the findings. Overall, the results suggest that advanced practice nurses may play an important role in optimizing chronic migraine care pathways for patients receiving onabotulinumtoxinA.
Reference
Gine-Cipres E et al. Optimizing Chronic Migraine Care: The Impact of Advanced Practice Nurse Involvement in OnabotulinumtoxinA Administration. Revista de Neurología. 2026;81(3):45618.
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