Botox PREEMPT for Chronic Migraine | Family1st Integrated Therapy & Wellness

Clinical Evidence

What the Research Shows

The PREEMPT clinical trials established the FDA-approved protocol and demonstrated consistent, significant reductions in migraine days.

50%of patients see 50% or greater reduction in headache days after 2 treatment cycles

~8.9average reduction in headache days per month in PREEMPT clinical trials

31injection sites across 7 head and neck muscle groups per session

12 wksbetween treatment sessions — typically 2 cycles to assess full response

What Is Botox PREEMPT?

FDA-Approved Migraine Prevention — Not Cosmetic Botox

The PREEMPT protocol is the FDA-approved injection pattern for onabotulinumtoxinA (Botox) in chronic migraine prevention. It is entirely separate from cosmetic Botox and is covered by insurance as a medical treatment for qualifying patients.

Chronic migraine is defined as 15 or more headache days per month, with at least 8 meeting migraine criteria. For patients who meet this threshold and haven't responded adequately to oral preventives, Botox PREEMPT is the standard of care.

⚠ This is not cosmetic Botox. The PREEMPT protocol involves 31 injections across 7 specific head and neck muscle sites following a fixed, FDA-approved pattern. It is billed as a neurological and pain management service — not aesthetics — and requires prior authorization from most insurers.

At Family1st, Botox PREEMPT is offered as part of our integrated neuropsychiatric care model. Chronic migraine and mental health conditions — particularly depression, anxiety, and PTSD — frequently co-occur and benefit from coordinated treatment.

Your Treatment Journey

What to Expect

Consultation & eligibility confirmationWe review your migraine history, prior treatments, and confirm chronic migraine diagnosis before proceeding

Insurance verification & prior authWe handle prior authorization paperwork on your behalf before scheduling your first treatment

Treatment session (~30 min)31 injections across 7 muscle groups per PREEMPT protocol. Most patients find the injections well tolerated

Onset of effect (2–4 weeks)Most patients notice improvement 2–4 weeks post-treatment. Full response assessed after 2 cycles (24 weeks)

Ongoing treatment every 12 weeksTreatments repeat every 12 weeks per FDA protocol. Each session billed to insurance as a medical service

Eligibility

Do You Qualify for Botox PREEMPT?

Insurance requires specific clinical criteria. Your consultation confirms eligibility before scheduling treatment.

✓Chronic Migraine Diagnosis

15 or more headache days per month, at least 8 meeting migraine criteria, documented over at least 3 months.

✓Failed Oral Preventives

Most insurers require documented trial and failure of 2–3 oral preventives: topiramate, amitriptyline, propranolol, or valproate.

✓Adult Patient (18+)

FDA approval is for adults 18 and older. Not currently approved for pediatric migraine under the PREEMPT protocol.

✓No Contraindications

Contraindications include botulinum toxin allergy, active infection at injection sites, certain neuromuscular disorders, or pregnancy. Assessed at intake.

The PREEMPT Protocol

31 Injection Sites — 7 Muscle Groups

The FDA-approved PREEMPT protocol involves 155 units of onabotulinumtoxinA across 31 fixed injection sites in 7 specific head and neck muscle groups.

Frontalis4 sites — forehead

Corrugator2 sites — glabella (brow)

Procerus1 site — nose bridge

Occipitalis6 sites — back of head

Temporalis8 sites — temples

Trapezius6 sites — upper back/neck

Cervical Paraspinal4 sites — cervical neck

Session duration~20–30 min for injections. Plan 45 min total including intake documentation.

Onset of relief2–4 weeks after first session. Full response assessed after 2 cycles (24 weeks).

FrequencyEvery 12 weeks per PREEMPT protocol — required for insurance coverage.

Side effectsMild injection site discomfort, temporary neck stiffness. Serious effects rare at therapeutic doses.

Insurance billingCPT 64615 (chemodenervation) + J0585 (onabotulinumtoxinA) — not cosmetic codes.

LocationIn-person at our Las Vegas, NV office. Not available via telehealth.

Botox PREEMPT for Chronic Migraine Prevention