{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:23:03Z","timestamp":1760059383102,"version":"build-2065373602"},"reference-count":31,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2025,6,8]],"date-time":"2025-06-08T00:00:00Z","timestamp":1749340800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>OnabotulinumtoxinA (OnaBoNT-A) is approved for chronic migraine prevention and follows the PREEMPT protocol with injections in the glabellar and forehead regions. While aesthetic changes are considered a side effect, their effect on patient satisfaction has not been thoroughly assessed. This study evaluated patient satisfaction with facial aesthetic outcomes after repeated OnaBoNT-A treatment for chronic migraine. Conducted at specialist headache centers, it included adult patients with chronic migraine who had received at least three OnaBoNT-A cycles. Participants completed a structured questionnaire on demographics, migraine history, facial wrinkles and age perception, appearance satisfaction, psychological impact, treatment satisfaction, and adverse aesthetic events. A total of 124 patients (92.7% female; median age 42.5 years) participated. OnaBoNT-A reduced wrinkle severity (p &lt; 0.0001). Most patients (74.2%) reported aesthetic improvement post-treatment. The majority of patients (76.7%) declared that treatment met or exceeded expectations. 32% reported looking younger post-treatment, with a median perceived age difference of 5 years. Adverse event frequency was similar to pivotal trial outcomes, mostly mild, with no treatment discontinuations. OnaBoNT-A for chronic migraine, following the PREEMPT protocol, provides significant therapeutic benefits and high patient satisfaction regarding aesthetic outcomes. Although aesthetic side effects were generally mild, they were not uncommon.<\/jats:p>","DOI":"10.3390\/toxins17060292","type":"journal-article","created":{"date-parts":[[2025,6,9]],"date-time":"2025-06-09T05:54:05Z","timestamp":1749448445000},"page":"292","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Patient Satisfaction with Aesthetic Outcomes Following OnabotulinumtoxinA Treatment for Chronic Migraine: A Cross-Sectional Study"],"prefix":"10.3390","volume":"17","author":[{"given":"Magdalena","family":"Boczarska-Jedynak","sequence":"first","affiliation":[{"name":"Department of Neurology and Restorative Medicine, Health Institute dr Boczarska-Jedynak, 32-600 O\u015bwi\u0119cim, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marta","family":"Bott-Karo\u0144","sequence":"additional","affiliation":[{"name":"Department of Neurology, Medicam Specialist Hospital, 72-300 Gryfice, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9093-180X","authenticated-orcid":false,"given":"Karol","family":"Marschollek","sequence":"additional","affiliation":[{"name":"Department of Neurology, Wroclaw Medical University, 50-556 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mariola","family":"Antolak","sequence":"additional","affiliation":[{"name":"Department of Neurology, Wroclaw Medical University, 50-556 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maciej","family":"\u015awiat","sequence":"additional","affiliation":[{"name":"Neurology Department with Stroke Unit, Regional Specialist Hospital, 44-200 Rybnik, Poland"},{"name":"Department of Neurology, Faculty of Medicine, Academy of Silesia, 40-555 Katowice, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9074-2803","authenticated-orcid":false,"given":"Marta","family":"Waliszewska-Pros\u00f3\u0142","sequence":"additional","affiliation":[{"name":"Department of Neurology, Wroclaw Medical University, 50-556 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Onan, D., Farham, F., and Martelletti, P. (2024). Clinical Conditions Targeted by OnabotulinumtoxinA in Different Ways in Medicine. Toxins, 16.","DOI":"10.3390\/toxins16070309"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1259","DOI":"10.1111\/head.13849","article-title":"Mechanism of Action of OnabotulinumtoxinA in Chronic Migraine: A Narrative Review","volume":"60","author":"Burstein","year":"2020","journal-title":"Headache"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1002\/der2.158","article-title":"A comprehensive review on the history, uses, and safety of onabotulinum toxin type A (Botox)","volume":"3","author":"Patel","year":"2022","journal-title":"Dermatol. Rev."},{"key":"ref_4","first-page":"344","article-title":"Botulinum toxin A (Botox) for treatment in migraine headache: An open label assessment","volume":"39","author":"Binder","year":"1999","journal-title":"Headache"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1067\/mhn.2000.110960","article-title":"Botulinum toxin type A (BOTOX) for treatment of migraine headaches: An open-label study","volume":"123","author":"Binder","year":"2000","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1177\/0333102410364676","article-title":"OnabotulinumtoxinA for treatment of chronic migraine: Results from the double-blind, randomized, placebo-controlled phase of the PREEMPT 1 trial","volume":"30","author":"Aurora","year":"2010","journal-title":"Cephalalgia"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1177\/0333102410364677","article-title":"OnabotulinumtoxinA for treatment of chronic migraine: Results from the double-blind, randomized, placebo-controlled phase of the PREEMPT 2 trial","volume":"30","author":"Diener","year":"2010","journal-title":"Cephalalgia"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1111\/head.14588","article-title":"Injection technique of the upper face with onabotulinumtoxinA in chronic migraine","volume":"63","author":"Blumenfeld","year":"2023","journal-title":"Headache"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Corasaniti, M.T., Bagetta, G., Nicotera, P., Tarsitano, A., Tonin, P., Sandrini, G., Lawrence, G.W., and Scuteri, D. (2023). Safety of Onabotulinumtoxin A in Chronic Migraine: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Toxins, 15.","DOI":"10.3390\/toxins15050332"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"363","DOI":"10.5603\/PJNNS.a2023.0049","article-title":"Experience of treatment of chronic migraine with botulinum toxin type A among aesthetic medicine professionals in Poland","volume":"57","year":"2023","journal-title":"Neurol. Neurochir. Pol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"840","DOI":"10.1067\/mjd.2002.121356","article-title":"A multicenter, double-blind, randomized, placebo-controlled study of the efficacy and safety of botulinum toxin type A in the treatment of glabellar lines","volume":"46","author":"Carruthers","year":"2002","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1089","DOI":"10.1097\/01.PRS.0000076504.79727.62","article-title":"Double-blind, placebo-controlled study of the safety and efficacy of botulinum toxin type A for patients with glabellar lines","volume":"112","author":"Carruthers","year":"2003","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"S274","DOI":"10.1097\/DSS.0000000000001414","article-title":"Forehead Line Treatment with OnabotulinumtoxinA in Subjects with Forehead and Glabellar Facial Rhytids: A Phase 3 Study","volume":"43","author":"Fagien","year":"2017","journal-title":"Dermatol. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1437","DOI":"10.1097\/DSS.0000000000001612","article-title":"Phase 3 Study of OnabotulinumtoxinA Distributed Between Frontalis, Glabellar Complex, and Lateral Canthal Areas for Treatment of Upper Facial Lines","volume":"44","author":"Werschler","year":"2018","journal-title":"Dermatol. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1097\/DSS.0000000000000424","article-title":"Subject satisfaction with onabotulinumtoxinA treatment of glabellar and lateral canthal lines using a new patient-reported outcome measure","volume":"41","author":"Rivers","year":"2015","journal-title":"Dermatol. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"ojz015","DOI":"10.1093\/asjof\/ojz015","article-title":"The Psychological Impacts of Upper Facial Lines: A Qualitative, Patient-Centered Study","volume":"1","author":"Dayan","year":"2019","journal-title":"Aesthet. Surg. J. Open Forum"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1097\/DSS.0000000000001779","article-title":"OnabotulinumtoxinA for Treatment of Forehead and Glabellar Lines: Subject-Reported Satisfaction and Impact From a Phase 3 Double-Blind Study","volume":"45","author":"Ogilvie","year":"2019","journal-title":"Dermatol. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1097\/DSS.0000000000001883","article-title":"OnabotulinumtoxinA for Simultaneous Treatment of Upper Facial Lines: Subject-Reported Satisfaction and Impact From a Phase 3 Study","volume":"46","author":"Rivkin","year":"2020","journal-title":"Dermatol. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"S67","DOI":"10.1097\/DSS.0000000000000146","article-title":"Effects of OnabotulinumtoxinA treatment for crow\u2019s feet lines on patient-reported outcomes","volume":"41","author":"Dayan","year":"2015","journal-title":"Dermatol. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"3331024241269735","DOI":"10.1177\/03331024241269735","article-title":"International Headache Society Global Practice Recommendations for Preventive Pharmacological Treatment of Migraine","volume":"44","author":"Puledda","year":"2024","journal-title":"Cephalalgia"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"996","DOI":"10.1136\/jnnp-2013-307149","article-title":"Per cent of patients with chronic migraine who responded per onabotulinumtoxinA treatment cycle: PREEMPT","volume":"86","author":"Silberstein","year":"2015","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_22","first-page":"Cd011616","article-title":"Botulinum toxins for the prevention of migraine in adults","volume":"6","author":"Herd","year":"2018","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1406","DOI":"10.1111\/j.1526-4610.2010.01766.x","article-title":"Method of injection of onabotulinumtoxinA for chronic migraine: A safe, well-tolerated, and effective treatment paradigm based on the PREEMPT clinical program","volume":"50","author":"Blumenfeld","year":"2010","journal-title":"Headache"},{"key":"ref_24","unstructured":"(2018). Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia, 38, 1\u2013211."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1097\/00006534-199407000-00009","article-title":"Botulinum toxin A for hyperkinetic facial lines: Results of a double-blind, placebo-controlled study","volume":"94","author":"Keen","year":"1994","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1055\/s-0030-1262313","article-title":"Measuring patient-reported outcomes in facial aesthetic patients: Development of the FACE-Q","volume":"26","author":"Klassen","year":"2010","journal-title":"Facial Plast. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1111\/jocd.12117","article-title":"The impact of upper facial lines and psychological impact of crow\u2019s feet lines: Content validation of the Facial Line Outcomes (FLO-11) Questionnaire","volume":"13","author":"Yaworsky","year":"2014","journal-title":"J. Cosmet. Dermatol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1097\/00042728-200305000-00002","article-title":"Development of the Facial Lines Treatment Satisfaction Questionnaire and initial results for botulinum toxin type A-treated patients","volume":"29","author":"Cox","year":"2003","journal-title":"Dermatol. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1111\/jocd.12166","article-title":"Development and validation of a novel patient-reported treatment satisfaction measure for hyperfunctional facial lines: Facial line satisfaction questionnaire","volume":"14","author":"Pompilus","year":"2015","journal-title":"J. Cosmet. Dermatol."},{"key":"ref_30","unstructured":"US Food and Drug Administration (2009). Patient-Reported Outcome Measures: Use in Medical Product Development to Support Labeling Claims, Food and Drug Administration."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"Np710","DOI":"10.1093\/asj\/sjaa101","article-title":"Facial Line Outcomes (FLO-11) and Facial Line Satisfaction Questionnaire (FLSQ) Meet FDA Patient-Reported Outcome Guidance","volume":"40","author":"Patel","year":"2020","journal-title":"Aesthet. Surg. 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