Date of Award

Spring 2026

Document Type

Scholarly Project

Degree Name

Master of Physician Assistant Studies (MPAS)

Department

Physician Assistant Studies

First Advisor

Julie Solberg

Keywords

Chronic migraine, OnabotulinumtoxinA, neuromodulation, migraine prophylaxis, headache prevention

Abstract

Chronic migraine is a disabling neurologic condition associated with significant functional impairment, reduced quality of life, and increased healthcare utilization. Preventive therapy is essential for long-term management, yet selecting the most appropriate prophylactic treatment remains challenging. OnabotulinumtoxinA is an established preventive option, while noninvasive peripheral neuromodulation has emerged as a nonpharmacologic alternative. Although both therapies are increasingly used in practice, most studies evaluate them independently rather than through direct comparison. A comprehensive search of PubMed and CINAHL identified 365 studies, with eight meeting criteria for final analysis. This literature review compares the efficacy of OnabotulinumtoxinA and non-invasive peripheral neuromodulation for chronic migraine prevention in adults. OnabotulinumtoxinA demonstrated greater and more consistent reductions in monthly headache days, with mean decreases of approximately 9–15 days from baseline. Neuromodulation therapies showed smaller but clinically meaningful reductions of 3–5 days per month, with earlier onset of benefit in some studies. Variability in study design, sample size, duration, and outcome measures limits direct comparison. Overall, current evidence supports OnabotulinumtoxinA as the more established and effective preventive therapy. However, noninvasive neuromodulation remains a valuable option for selected patients, particularly those seeking nonpharmacologic or noninjectable treatments. Further direct comparative research, including long-term and patient-centered outcomes, is needed to guide individualized treatment decisions.

Comments

Note: this is a corrected draft of the student work, not the final version

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