NICE recommends botulinum toxin type A as a possible treatment for preventing headaches in some adults with chronic migraine (see below).

Who can have botulinum toxin type A?

You should be able to have botulinum toxin type A if you have chronic migraine (that is, you have headaches on at least 15 days each month, with migraine on at least 8 of these days) and:

  • you have already tried at least three different drug treatments to prevent your chronic migraine headaches, but these have not worked and
  • you are not taking too many painkillers or using them too often.

Botulinum toxin type A treatment should be stopped if:

  • the number of days you have a chronic migraine headache each month hasn’t reduced by at least 30% after two courses of botulinum toxin type A treatment or
  • your chronic migraine changes to episodic migraine (that is, you have fewer than 15 days with headaches each month) for 3 months in a row.

Why has NICE said this?

NICE looks at how well treatments work, and also at how well they work in relation to how much they cost the NHS. In clinical trials, botulinum toxin type A treatment was shown to reduce the severity of chronic migraine headaches and how often they occur. The cost of botulinum toxin type A treatment is justified by the benefits it provides.

Your responsibility

The recommendations in this guidance represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take this guidance fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this guidance is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.

Commissioners and/or providers have a responsibility to provide the funding required to enable the guidance to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.

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