1 Guidance

1.1 Botulinum toxin type A is recommended as an option for the prophylaxis of headaches in adults with chronic migraine (defined as headaches on at least 15 days per month of which at least 8 days are with migraine):

  • that has not responded to at least three prior pharmacological prophylaxis therapies and

  • whose condition is appropriately managed for medication overuse.

1.2 Treatment with botulinum toxin type A that is recommended according to 1.1 should be stopped in people whose condition:

  • is not adequately responding to treatment (defined as less than a 30% reduction in headache days per month after two treatment cycles) or

  • has changed to episodic migraine (defined as fewer than 15 headache days per month) for three consecutive months.

1.3 People currently receiving botulinum toxin type A that is not recommended according to 1.1 and 1.2 should have the option to continue treatment until they and their clinician consider it appropriate to stop.

  • National Institute for Health and Care Excellence (NICE)