Advanced Practice Nurses Optimize Chronic Migraine Timing

A retrospective study published on March 10, 2026, indicates that the integration of advanced practice nurses (APNs) into specialized headache clinics significantly improves adherence to treatment protocols for patients with chronic migraine.

The research focused on the administration of onabotulinumtoxinA (OnabotA), a preventive treatment for chronic migraine. The study found that the involvement of APNs decreased the time interval between infiltrations and increased the rate of adherence to the Phase III Research Evaluating Migraine Prophylaxis Therapy (PREEMPT) protocol.

Study Methodology and Patient Demographics

The study was conducted in a specialized Headache Unit of a tertiary hospital in Spain. Researchers evaluated data from three distinct 18-month periods to analyze changes in interval adherence before and after the introduction of APNs into the care pathway.

A total of 2,991 participants were included in the analysis. Of these participants, 83.8% were women, and the median age of the group was 48.0 years, with an interquartile range of 40.0 to 57.0 years.

Impact on Treatment Adherence

For the purposes of the study, treatment was classified as interval-compliant if the injection interval fell between 75 and 105 days, as recommended by the PREEMPT protocol.

The data revealed a statistically significant association between the introduction of the APN and improved adherence over time (Z = -19.60, p < 0.001). Adherence rates rose from 52.1% in the first period (P1) to 76.1% in both the second (P2) and third (P3) periods.

The timing between patient visits also shifted. The median time between visits decreased from 105 days in P1 to 96 days in P2, followed by a slight increase to 98 days in P3.

The Role of Advanced Practice Nurses in Migraine Care

The findings suggest that APNs play a pivotal role in optimizing care pathways for patients receiving OnabotA. By managing the administration and timing of these treatments, APNs help ensure that patients receive preventive care within the clinically recommended windows.

The organizational change of integrating APNs into Headache Clinics is described as a key factor in developing this improved activity. Beyond specialized clinics, advanced practice practitioners can also serve as primary care providers, particularly for patients with stable chronic migraine.

Clinical Significance

Chronic migraine is characterized as a prevalent and disabling neurological disease that significantly impacts a patient’s quality of life. Because OnabotulinumtoxinA is a safe and effective preventive treatment, maintaining the correct timing between doses is critical for therapeutic efficacy.

The study concludes that the involvement of APNs optimizes patient care by reducing the gaps between infiltrations and ensuring the treatment aligns more closely with established medical protocols.

The research was authored by a team including Eulalia Gine-Cipres, Marta Torres-Ferrus, Víctor J Gallardo, Alicia Alpuente Ruiz, Edoardo Caronna, Laura Gomez-Dabo, and Patricia Pozo-Rosich, affiliated with the Headache Unit of the Neurology Department at Vall d’Hebron University Hospital and the Headache Research Group at the Vall d’Hebron Research Institute, Autònoma University of Barcelona.