skip to main content

Botox Chronic Migraine – PREEMPT Protocol — SCE Neurology MCQ

Instant feedback + full explanation. One question, done properly.

HardHeadache & Facial PainBotox Chronic Migraine – PREEMPT ProtocolSCE Neurology

A 50-year-old man with chronic migraine (18 headache days/month, 10 meeting migraine criteria) has failed 3 oral preventives. He is started on onabotulinumtoxinA (Botox) for chronic migraine. How is it administered?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — PREEMPT-pattern injections across specified head and neck muscles every 12 weeks

The best answer is “PREEMPT-pattern injections across specified head and neck muscles every 12 weeks”. Primary headache diagnosis follows attack phenotype and absence of secondary red flags; acute and preventive treatment is selected by headache type, frequency, disability and contraindications. The alternatives “Single injection to the forehead, within the relevant UK pathway”, “Oral tablet, after excluding important mimics, after specialist assessment”, “Intramuscular injection to the arm, after specialist assessment, when the phenotype supports it”, “Single injection to the neck, when the phenotype supports it” are clinically adjacent possibilities, but they do not match the defining chronology, localisation, physiology, investigation result or UK management sequence in this stem.

Reference: NICE CG150 headache recommendations: https://www.nice.org.uk/guidance/cg150/chapter/Recommendations