Please answer each of the following questions by clicking the YES or NO button. If you qualify, you will be able to access a Trial Site Locater to find a physician near you who is participating in the Premium Trial.
Are you between the ages of 18 and 55?
Yes
No
Do you suffer or have you been diagnosed with migraine headaches?
Yes
No
Do you experience approximately 6 to 14 migraine headache days per month?
Yes
No
Have your migraine headaches been unresponsive to 2 or more different preventive headache medications?
Yes
No
Have you ever been diagnosed with a stroke or Transient Ischemic Attack (known as TIA)?
Yes
No
Have you been diagnosed with any of the following: Parkinson's disease, Amyotrophic lateral sclerosis (ALS), Dementia, Multiple Sclerosis or Brain tumor?
Yes
No
Do you have any serious health problems related to your kidneys, liver, pancreas, heart or lungs (such as kidney failure, liver failure, tumors, etc.)?
Yes
No
Have you been treated with Botox for any reason in the last four months?
Yes
No
Are you currently pregnant or have the desire to become pregnant within the next year?
Yes
No
Are you currently participating in any other clinical trials?
Yes
No
