Chronic Migraines

A migraine as defined by the NHS is usually a moderate or severe headache felt as a throbbing pain on one side of the head. Many people who suffer from this consistently experience symptoms of sickness or sensitivity to light.

Migraines often begin in young adulthood and is considered a common health problem , affecting 1 in every 5 women and 1 in every 15 men. Some people suffer with migraines all the time and others have their symptoms rarely. Over-the-counter or prescription medications may help ease some of the symptoms initially, but this will depend on the patient.

The NHS defines the different types of migraines as follows:

  • migraine with aura – where there are specific warning signs just before the migraine begins, such as seeing flashing lights
  • migraine without aura – the most common type, where the migraine happens without the specific warning signs
  • migraine aura without headache, also known as silent migraine – where an aura or other migraine symptoms are experienced, but a headache does not develop

The exact cause of migraines is unknown, but the general consensus is that they are the result of temporary changes in the chemicals, nerves and blood vessels in the brain due to tiredness, stress, hormonal changes and some food and drinks.

The Migraine Trust estimates that a chronic migraine affects fewer than 1% of the population, but this still means that there are over 610,000 chronic migraine sufferers in the UK. Chronic Migraines have been categorised by The World Health Organisation (WHO) as the same level of disability as dementia, quadriplegia and acute psychosis.

Botox® was licensed specifically for the treatment of chronic migraines in July 2010 by the Medicines and Healthcare products Regulatory Agency (MHRA) and by NICE in 2012. Botox® is not effective for any other headache type (e.g. episodic migraine, tension-type headache, cluster headache) as yet, so if you are unsure if your symptoms are eligible for Botox®, check with your GP first.

The NICE guidelines advise that botulinum toxin type A may be prescribed on the NHS for the prevention of chronic migraine, if the following criteria are met:

  • The person has chronic migraine, defined as headaches on at least 15 days a month, of which at least eight days are with migraine.
  • The person has not responded to at least three drug-based treatments intended to prevent migraines.
  • The person is being appropriately managed for medication overuse.

If botulinum toxin type A is prescribed, NICE recommends that it should then be stopped if the following criteria are met:

  • the person is not adequately responding to treatment (defined as less than a 30% reduction in headache days per month after two treatment cycles)
  • the headache has changed from chronic to episodic migraine (defined as fewer than 15 headache days per month) for three consecutive months

The reality is that very few people will be eligible for this treatment on the NHS and so private clinics, such as Hunar are able to offer this treatment to chronic migraine sufferers instead but a fee will be charged.

*Patients experiences will vary dependent on age, lifestyle and medical history

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