HNY Policy and Pathway Repository - Hull

Chronic Migraine

Trial of this intervention is commissioned if:

• chronic migraine has been diagnosed by a neurologist

AND

• not responded to at least three pharmacological prophylaxis therapies

AND

• the person has been appropriately managed if there is concomitant medication overuse

Continuation of treatment is commissioned if:

• there is at least a 30% reduction in headache days per month after two treatment cycles

OR

• there has not been a change to episodic migraine (fewer then 15 headache days per month) for three consecutive months

It is good practice to address medication overuse prior to commencing Botulinum toxin treatment. Patients should restrict their acute headache medication to no more than two days a week on a regular basis.

A good response to treatment is typically considered to be a 30–50% reduction in the frequency of headache days or headache episodes.

Botulinum toxin is not known to be effective in episodic migraine (< 15 days a month).

TA260 Botulinum toxin type A for the prevention of headaches in adults with chronic migraine (NICE)

NATIONAL Headache Management SYSTEM FOR Adults 2018 (BASH)