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The selected topic for my practice change scholarly project is enhancing patient education for adults receiving therapeutic onabotulinumtoxinA (commonly known as Botox) for chronic migraine in an outpatient clinical setting. Chronic migraine is a neurological condition characterized by frequent headache days with migraine features that significantly interfere with daily functioning and quality of life. OnabotulinumtoxinA has been shown to be an effective preventive intervention for individuals with chronic migraine, reducing headache frequency, headache severity, and associated disability. A recent clinical review highlights the neurophysiological mechanisms through which botulinum toxin modulates pain pathways and reduces migraine symptomatology, supporting its role in chronic migraine management (Paracka & Dressler, 2025). Despite this evidence, patients often receive inconsistent education about the treatment process, expected outcomes, and self-care after injections, which may contribute to unnecessary anxiety, misunderstandings, and increased post-treatment inquiries.

The population for this project includes adult patients diagnosed with chronic migraine who receive onabotulinumtoxinA injections at least once during the eight-week intervention period. These patients frequently require ongoing follow-up and education to understand the timeline of therapeutic effects, common mild side effects, and appropriate self-monitoring strategies. The intervention will involve the development and implementation of a standardized, easy-to-understand patient education handout that addresses what chronic migraine is, how therapeutic Botox works, what patients should expect in terms of benefit onset, how to manage common mild reactions, and clear instructions on when to contact the clinic. This handout will be paired with a brief teach-back conversation during the clinic visit to ensure patient comprehension before treatment.

Currently, the practice involves ad-hoc verbal education that varies depending on the provider’s communication style and time constraints. This inconsistency may leave patients unclear about expectations and aftercare, which can result in unnecessary follow-up calls or visits that burden both the patient and the clinical team. A systematic review of therapeutic Botox for migraine symptoms concluded that, while the treatment is effective in reducing migraine frequency and severity, structured patient education and follow-up strategies are often not standardized across clinical settings (Shaterian et al., 2022). This gap highlights the need for a structured educational intervention to support patients’ understanding and engagement with their care plan.

The desired outcomes of this project are improved patient understanding of the Botox treatment process and post-injection expectations, increased patient satisfaction with care, and a measurable reduction in unplanned post-treatment clinic contacts related to confusion or misunderstandings. These outcomes will be assessed using simple patient-reported satisfaction scores, teach-back accuracy, and tracking the number of unplanned phone calls or visits within the eight-week period.

The time frame for the intervention is eight weeks, which allows for the implementation of the education handout and teach-back method with multiple patients, as well as collection and analysis of feedback and outcome data. By standardizing patient education, this practice change project aims to enhance patient engagement and optimize therapeutic experiences for adults receiving Botox for chronic migraine, ultimately contributing to higher quality care and more efficient use of clinic resources.

ReferencesParacka, L., & Dressler, D. (2025). Botulinum toxin for chronic migraine.  Journal of neural transmission (Vienna, Austria : 1996), 10.1007/s00702-025-03055-2. Advance online publication. https://doi.org/10.1007/s00702-025-03055-2

Shaterian, N., Shaterian, N., Ghanaatpisheh, A., Abbasi, F., Daniali, S., Jahromi, M. J., Sanie, M. S., & Abdoli, A. (2022). Botox (OnabotulinumtoxinA) for Treatment of Migraine Symptoms: A Systematic Review.  Pain research & management2022, 3284446. https://doi.org/10.1155/2022/3284446