This site is intended for healthcare professionals

Go to /sign-in page

You can view 5 more pages before signing in

Migraine prophylaxis and botulinum toxin type A

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

NICE have issued guidance regarding the use of botulinum toxin in management of migraine (1).

NICE state that 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

When treatment with botulinum toxin type A that is recommended then it 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

Notes:

  • Botulinum toxin type A is a purified neurotoxin complex, which is derived from the bacterium Clostridium botulinum
    • has neuromuscular transmitter blocking effects
    • has a UK marketing authorisation 'for the prophylaxis of headaches in adults with chronic migraine (headaches on at least 15 days per month of which at least 8 days are with migraine)'
    • recommended reconstituted dose is 155-195 units, administered intramuscularly as 0.1 ml (5 units) injections to between 31 and 39 sites around the head and back of the neck
    • recommended re-treatment schedule is every 12 weeks (see the summary of product characteristics)
  • common adverse reactions include:
    • headache, migraine, facial paresis, eyelid ptosis, pruritus, rash, neck pain, myalgia, musculoskeletal pain, musculoskeletal stiffness, muscle spasms, muscle tightness, muscular weakness, and injection site pain
    • in general, adverse reactions occur within the first few days following injection and while generally transient, may have a duration of several months or, in rare cases, longer
    • for full details of adverse reactions and contraindications, see the summary of product characteristics

Reference:


Create an account to add page annotations

Annotations allow you to add information to this page that would be handy to have on hand during a consultation. E.g. a website or number. This information will always show when you visit this page.

The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

Connect

Copyright 2024 Oxbridge Solutions Limited, a subsidiary of OmniaMed Communications Limited. All rights reserved. Any distribution or duplication of the information contained herein is strictly prohibited. Oxbridge Solutions receives funding from advertising but maintains editorial independence.