Botulinum Therapy for Migraine — Dr Lidiia Prakhova

Botulinum therapy for migraine is an evidence-based method for treating chronic migraine, recommended by international neurological societies and based on the PREEMPT protocol. The method significantly reduces the frequency and severity of attacks, improves quality of life, and is used in patients who do not respond to standard preventive medications.
Dr Lidiia Prakhova is a neurologist with 35 years of experience who has completed specialised training in botulinum toxin therapy for neurological conditions, including migraine, dystonia and spasticity. The procedure is performed using certified botulinum toxin formulations and in strict accordance with international guidelines.
Consultations are conducted at the Shamir Medical Center (Assaf HaRofeh).

Chronic migraine is diagnosed when:

• Headaches occur 15 days or more per month,
• At least 8 days have typical migraine features,
• This pattern continues for 3 months or longer.

This condition is associated with increased sensitivity of pain pathways, muscular triggers in the head and neck area, and persistent activation of neuroinflammatory mechanisms.

Botulinum toxin acts on several key migraine mechanisms:

• Reduces the release of pain-mediating neuropeptides, including CGRP,
• Decreases peripheral sensitisation of sensory nerve endings,
• Relaxes hyperactive muscles of the forehead, temples, occipital and cervical regions,
• Lowers the frequency and intensity of migraine attacks,
• Reduces the need for acute medications.

The effect builds gradually and becomes more pronounced after several treatment cycles.

Botulinum therapy may be recommended if the patient:

• Meets diagnostic criteria for chronic migraine,
• Experiences long-lasting or very frequent attacks,
• Does not respond to or cannot tolerate standard preventive medications,
• Wishes to reduce migraine days and improve quality of life.

The PREEMPT® protocol includes:

• Injections at 31–39 fixed points in the head, neck and shoulder areas,
• A total dose of 155–195 Units of onabotulinumtoxinA,
• Treatment repeated every 12 weeks,
• Procedure duration about 10–15 minutes,
• Noticeable improvement usually within 1–2 weeks, with maximal effect by 14 days.

The injections target muscles such as the frontal, temporal, occipital, cervical paraspinal and trapezius muscles — areas that often contribute to migraine chronification.

After 2–3 treatment cycles, most patients report:

• A reduction in migraine days by 50% or more,
• Milder and shorter attacks,
• Reduced dependence on acute pain medications,
• Improved physical, social and professional functioning.

Botulinum toxin is safe when administered by an experienced neurologist.
It should not be used in:

• Pregnancy and breastfeeding,
• Active infection in the injection area,
• Certain bleeding disorders,
• Known hypersensitivity to botulinum toxin components.
• Side effects are usually mild and temporary (local soreness, slight asymmetry, mild neck stiffness).

Botulinum therapy is particularly helpful for patients who:

• Have headaches on 15+ days per month,
• Experience frequent or medication-resistant migraine attacks,
• Need a stable and long-term preventive strategy.

Botulinum therapy is performed for adult patients by
Dr Lidiia Prakhova, Neurologist,
at the Shamir Medical Center (Assaf Harofeh), Israel.
Phone: 08-977-97-75, 08-977-91-45
Email: neuro@shamir.gov.il