The National Institute for Health and Clinical Excellence (NICE) issued guidance in June 2012 recommending Botox® is made available on the NHS as a preventive treatment option for adult patients with chronic migraine – this applies to NHS settings in England and Wales.
Only patients with chronic migraine are eligible for treatment with Botox®. Chronic migraine is defined as headaches occurring on 15 or more days each month, at least half of which have migrainous features.
How does botulinum toxin work in chronic migraine?
The simple answer is that we don’t know – yet. Unlike many of the other conditions in which it is used, it is not thought to work by relaxing overactive muscle. Botulinum toxin is believed to inhibit the release of peripheral nociceptive neurotransmitters, which may then have a knock-on effect on the central pain processing systems that generate migraine headaches.
Patient referral process
In the first instance, patients who are struggling to manage their symptoms should discuss this with their general practitioner. Before referral to a Consultant Neurologist:
• Chronic migraine must have been diagnosed
• Medication over-use discussed and addressed
• At least 3 prophylactics tried, of which two given at the maximum tolerated dose for 3 months
A referral algorithm for GPs can be downloaded here.
Consultant Neurologist, Dr Saldanha MA (Oxon) FRCP, is now taking private referrals to treat chronic migraine sufferers using Botox® at The Wells Suite, Tunbridge Wells Hospital. An initial consultation will confirm if a patient is eligible for the treatment and arrangements made for subsequent administration of Botox.
Dr Saldanha’s specialist interests include: headache (especially migraine); Multiple Sclerosis; peripheral nerve disorders, and neuropathic pain. For more information, visit www.drgerrysaldanha.co.uk.
To make a referral to Mr Saldanha, please call 01892 635888, fax a referral letter to 01892 634848 or upload your referral here.