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Botulinum Toxin Chronic Migraine – NICE Reassessment — SCE Neurology MCQ

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ModerateHeadache & Facial PainBotulinum Toxin Chronic Migraine – NICE ReassessmentSCE Neurology

A 55-year-old man with known chronic migraine (20 headache days/month) has been on botulinum toxin A injections for 1 year with good response (headache days reduced from 20 to 8 per month). NICE recommends a reassessment point. When should botulinum toxin be stopped to assess ongoing need?

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Correct answer: B — After 2 treatment cycles that do not show a ≥30% reduction in headache days — OR a trial withdrawal should be considered after 12 months of sustained improvement to assess whether chronic migraine has resolved

NICE TA260 recommends that botulinum toxin for chronic migraine should be stopped after 2 treatment cycles (24 weeks) if there is NOT a ≥30% reduction in headache days or ≥33% increase in headache-free days. For patients who respond well, ongoing treatment is continued but a trial withdrawal should be considered after 12 months of sustained response to determine whether the chronic migraine has resolved — some patients find their headache pattern has reverted to episodic after treatment. A: Regular reassessment is required. C: 2 cycles minimum for assessment. D: Earlier reassessment is needed. E: Clinician-led reassessment is recommended.

Reference: NICE TA260 Botulinum Toxin for Chronic Migraine (2012)