Botulinum Toxin Type A for the Prevention of Headaches in Adults with Chronic Migraine (TA260)

Technology Appraisal Guidance No. 260

Source: National Institute for Health and Care Excellence

1. Guidance

1.1 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.

1.2 Treatment with botulinum toxin type A that is recommended according to 1.1 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.

1.3 People currently receiving botulinum toxin type A that is not recommended according to 1.1 and 1.2 should have the option to continue treatment until they and their clinician consider it appropriate to stop.

The guidance shown above constitutes Section 1 of the full document. A copy of the full document and a summary of the evidence is available on the Internet at

This guidance represents the view of the Institute which was arrived at after careful consideration of the available evidence. Health professionals are expected to fully take it into account when exercising their clinical judgement. This guidance does not, however, override the individual responsibility of health professionals to make appropriate decisions in the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.

© Copyright National Institute for Health and Care Excellence. All rights reserved. This material may be freely reproduced for educational and not for profit purposes within the NHS. No reproduction by or for commercial organisations is permitted without the express written permission of the Institute.

Enquiries concerning the guidance should be addressed to: National Institute for Health and Care Excellence, MidCity Place, 71 High Holborn, London WC1V 6NA.

Botulinum toxin type A for the prevention of headaches in adults with chronic migraine
Issue Date: June 2012

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