Treating chronic migraines with botulinum toxin

2021 ◽  
Vol 10 (10) ◽  
pp. 440-444
Author(s):  
PAUL CHARLSON
Keyword(s):  
Botulinum Toxin ◽  
Chronic Migraine ◽  
Prophylactic Treatment ◽  
Treatment Session ◽  
Care Quality ◽  
Variable Frequency ◽  
Common Condition ◽  
Significant Morbidity ◽  
Safe Treatment ◽  
Care Quality Commission

Migraine is a common condition that causes significant morbidity. It is often divided into acute and chronic, but there can be overlap between those who have variable frequency acute episodes and those who have chronic migraine with 15 headache-associated days per month. Botulinum toxin is a prophylactic treatment licensed for chronic migraine, where it has been shown to be an effective and safe treatment. It requires approximately 200 units per treatment session, usually at 3-month intervals. The protocols allowing NHS treatment strictly limit its use. Patients may seek this on a private basis, and suitably qualified aesthetic clinicians who are Care Quality Commission-registered could reasonably treat patients.

OHP-026 Prophylactic treatment of chronic migraine with botulinum toxin: study population

2017 ◽  
Author(s):  
C García Fernández ◽  
C Gómez Peña ◽  
S Belda Rustarazo ◽  
A Rodriguez Delgado ◽  
I Casas Hidalgo ◽  
...  
Keyword(s):  
Botulinum Toxin ◽  
Chronic Migraine ◽  
Prophylactic Treatment ◽  
Study Population

A Critical Review of Botulinum Toxin Type A in the Prophylactic Treatment of Chronic Migraine in Adults

2018 ◽  
Vol 39 (8) ◽  
pp. 898-907
Author(s):  
Hanieh Mimeh ◽  
Anna Maria Fenech Magrin ◽  
Simon Myers ◽  
Ali M Ghanem
Keyword(s):  
Botulinum Toxin ◽  
Chronic Migraine ◽  
Prophylactic Treatment ◽  
Financial Burden ◽  
Botulinum Toxin Type A ◽  
Type A ◽  
Botulinum Toxin Type ◽  
World Health ◽  
Evidence Based ◽  
Increased Risk

Abstract Background Migraine is a severe, disabling condition, ranked by World Health Organization as the sixth highest cause of disability worldwide. It greatly affects patients’ quality of life, functionality, and physical and mental health. The financial burden of migraine on the UK economy is conservatively estimated at £3.42 billion per year. Objectives The authors sought to perform an evidence-based literature review of the safety and efficacy of botulinum toxin type A (onaBoNTA) in the prophylactic treatment of adult patients suffering with chronic migraine (CM) compared to placebo. After the best evidence is identified, it will be utilized to formulate a protocol for doctors managing CM in their aesthetic clinic. Methods A comprehensive search of the current literature on the topic was performed by H.M. using Pubmed MEDLINE electronic database on March 1, 2018. All articles up to and inclusive of this date were included. Articles were limited to human studies and those in the English language. In vitro and animal studies were excluded. Results A total of 260 articles were identified. Of these, the excellent-quality, high-strength (level 1A) trials were short-listed to answer the research question. Conclusions There is high-quality, level 1A evidence to support onaBoNTA treatment in adults with CM is well tolerated and considered safe. However, it is associated with increased risk of adverse events and still some uncertainty exists associated with the degree onaBoNTA improves outcome measures compared to placebo. These data have been used to formulate The London Aesthetic Migraine Protocol (LAMP) to provide safe, evidence-based guidance for appropriately trained and experienced aesthetic practitioners to manage CM in their aesthetic clinics. Level of Evidence: 1

scholarly journals Margaret McCartney: The Care Quality Commission is not fit for purpose

BMJ ◽  
2014 ◽  
Vol 349 (dec12 3) ◽  
pp. g7460-g7460 ◽  
Author(s):  
M. McCartney
Keyword(s):  
Care Quality ◽  
Care Quality Commission ◽  
Fit For Purpose

scholarly journals Botulinum toxin in the management of chronic migraine: clinical evidence and experience

2016 ◽  
Vol 10 (2) ◽  
pp. 127-135 ◽  
Author(s):  
Claus M Escher ◽  
Lejla Paracka ◽  
Dirk Dressler ◽  
Katja Kollewe
Keyword(s):  
Chronic Migraine ◽  
Botulinum Neurotoxin ◽  
Prophylactic Treatment ◽  
Clinical Evidence ◽  
The United States ◽  
Headache Frequency ◽  
United States Food ◽  
History Of ◽  
States Food ◽  
Review Reports

Chronic migraine (CM) is a severely disabling neurological condition characterized by episodes of pulsating unilateral or bilateral headache. The United States Food and Drug Administration (FDA) approved onabotulinumtoxinA (Botox®) for the prophylactic treatment of CM in 2010. It has been shown that onabotulinumtoxinA is effective in the reduction of headache frequency and severity in patients with CM. Treatment is well tolerated by the patients. This review reports on the history of botulinum neurotoxin (BoNT) in CM and presents the current clinical evidence for the use of onabotulinumtoxinA in the treatment of CM.

Do not attempt resuscitation decisions during the COVID-19 pandemic

2021 ◽  
Vol 30 (9) ◽  
pp. 562-563
Author(s):  
Alan Glasper
Keyword(s):  
Care Quality ◽  
Emeritus Professor ◽  
Do Not Resuscitate ◽  
Care Quality Commission ◽  
Do Not Resuscitate Orders ◽  
The University

Emeritus Professor Alan Glasper, from the University of Southampton, discusses concerns raised by the Care Quality Commission about the imposition of do not resuscitate orders on some patients during the pandemic

The efficacy of botulinum toxin type-A for intractable chronic migraine patients with no pain-free time

2021 ◽  
pp. 204946372110145
Author(s):  
Dominic Atraszkiewicz ◽  
Rieko Ito ◽  
Anish Bahra
Keyword(s):  
Botulinum Toxin ◽  
Chronic Migraine ◽  
Botulinum Toxin A ◽  
Botulinum Toxin Type A ◽  
Botulinum Toxin Type ◽  
Free Time ◽  
Phase Iii ◽  
Pharmacological Management ◽  
Sustained Reduction ◽  
New Onset

Aim: This is a retrospective report of the efficacy of botulinum toxin-A, Botox® (Allergan), in intractable chronic migraine patients non-responsive to previous pharmacological management and with largely no pain-free time, including those with new onset daily persistent headache. Methods: Thirty-three patients, all with severe Headache Impact Test (HIT)-6 scores at baseline, received 3-monthly injections of Botox® as per Phase III REsearch Evaluating Migraine Prophylaxis Therapy (PRE-EMPT) protocol over a maximum 33-month period. Response criteria were a sustained reduction of HIT-6 scores below 60. Results: Four patients had headache on at least 20 days a month; the remaining patients had daily headache with no pain-free time, including nine patients with new onset persistent migraine. There was a significant reduction in HIT-6 scores following Botox® therapy ( x̅ = −5.45, p = 0.000920). Twenty-one percent of the cohort exhibited a sustained reduction in HIT-6 scores below 60. The number of headache days and pain-free time did not change in five of the six responders, but disability improved. There was no difference between patients with episodic migraine evolving to chronic as opposed to those with chronic migraine from onset. Conclusion: This report suggests that Botox® treatment is efficacious in intractable chronic migraine without pain-free time. The HIT-6 is a reliable and practical parameter to assess disability in this patient group. Use of such validated parameters should be considered with greater weight in future International Classification of Headache Disorders (ICHD) guidelines for controlled clinical trials.

Care Quality Commission slams blanket ‘do not attempt cardiopulmonary resuscitation’ decisions during the pandemic

2021 ◽  
Vol 15 (4) ◽  
pp. 196-200
Author(s):  
Alan Glasper
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Care Quality ◽  
Emeritus Professor ◽  
Care Quality Commission ◽  
The University

Emeritus Professor Alan Glasper from the University of Southampton examines why the Care Quality Commission (CQC) has raised serious concerns relating to the use of ‘do not attempt cardiopulmonary resuscitation’ (DNACPR) orders throughout the ongoing Covid-19 pandemic.

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