Treatment with botulinum toxin: An update

Table 2 Method of injection of onabotulinumtoxinA for chronic migraine

Muscles injected	Injection sites (both sides)	Doses of A/Ona per muscle (both sides)
Frontalis	4	20 units
Corrugator	2	10 units
Procerus	1 (only one site in the midline of the forehead)	5 units
Temporalis	8	40 units
	Extra 2 optional sites	Extra 10 optional units
Occipitalis	6	30 units
	Extra 2 optional sites	Extra 10 optional units
Trapezius	6	30 units
	Extra 4 optional sites	Extra 20 optional units
Cervical paraspinal muscle group	4	20 units
Total sites range	31-39 total dose range	155-195 units

Adapted from the treatment paradigm based on the PREEMPT clinical program[132]: 155 units of onabotulinumtoxinA (A/Ona) every 12 wk administered to 31 injection sites across 7 specific head and neck muscle areas using a fixed-site, fixed-dose injection paradigm. Furthermore, up to 40 optional units could be administered using a “follow-the-pain” strategy. Each injection site = 0.1 mL = 5 units of A/Ona.