The National Institute for Health and Clinical Excellence (NICE) has just approved the use of Botox® for treating some forms of migraine. What’s next, I hear you ask. Breast implants for indigestion? In fact, while most headlines in recent years have been about frown line-free celebrities, Botox® has been used for years to treat a wide variety of serious medical conditions. It’s widely used for arm muscle spasm after stroke; cerebral palsy in children; a painful neck muscle condition called cervical dystonia; and even excess sweating.
Botox® is actually a brand name for a medicine manufactured by a company called Allergan. It comes from the poison which causes botulism – botulinum toxin A. Other companies do make a similar medicine, but Botox® is used so much more than the other products that most people, including doctors, use the name when they mean any product – just as we often talk about a ‘Hoover’ rather than vacuum cleaner, even if it’s not made by the Hoover company.
Botox® has been licensed for use in patients with severe chronic migraine since 2010, but these days new treatments rarely become widely available on the NHS until NICE has approved them.
So which migraine sufferers will Botox® be suitable for? Certainly not everyone who ever gets migraine – that’s about 1 in 4 women and 1 in 12 men in a lifetime. It’s only licensed for people with chronic migraine, which means migraine sufferers who get headaches on at least 15 days a month. There are at least 700,000 chronic migraine sufferers in the UK. Perhaps not surprisingly, having headaches on more days than not is hugely debilitating, and many patients with chronic migraine end up over-using painkillers. What they don’t realise is that this overuse of medications can actually make the headaches worse. NICE has recommended that Botox® should only be considered for people with chronic migraine who have already had any appropriate treatment for medication overuse, and who have tried at least three preventive medications without getting relief.
Even if you do fall into this category, treatment isn’t going to be widely available overnight. In the right hands, Botox® is remarkably safe, but to use it both safely and effectively for chronic migraines, specialists will need to be trained. But at least, with this announcement, the training can start.
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