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      • This website is for UK Healthcare Professionals only

      +30 YEARS' GLOBAL EXPERIENCE ACROSS MULTIPLE INDICATIONS1-4

       

      CHRONIC MIGRAINE

      BOTOX® (botulinum toxin type A) is indicated for the prophylaxis of headaches in adults with chronic migraine (headaches on at least 15 days per month of which at least 8 days are with migraine).5

      UK-BCM-240035. DOP: April 2024.

      How to diagnose

      Headache, including migraine, is one of the top 10 reasons for visiting a GP, with consultation rates in the UK of 6.4 per 100 female adult patients per year and 2.5 per 100 male adult patients.6 25% of new referrals to neurologists are for headache.7

      It can be challenging to accurately diagnose patients with chronic migraine.8 In one study of 512 patients who met the criteria for chronic migraine and were consulting a healthcare professional, only 24.6% had received an accurate diagnosis.8 The first diagnostic step is to distinguish a primary headache from a secondary headache; secondary headaches can be indicated by ‘red flag’ symptoms and will likely require specific tests for confirmation of diagnosis.9

      Red flags for secondary headaches

      Having excluded secondary headaches, the next step is to diagnose a specific primary headache syndrome, based on frequency and duration of headache.9-11

      Three steps to making a chronic migraine diagnosis10,11

      Adapted from  International Headache Society, 201810 and Lipton R B et al, 201111

      Tutorial video: accurate diagnosis of chronic migraine

      Listen to Dr Andrew Blumenfeld, Director of the Headache Center of Southern California, US, discuss the unmet need for better diagnosis in chronic migraine, differential diagnoses and chronic daily headache classification.

      Risk factors for developing chronic migraine

      Chronic migraine often develops from episodic migraine after a period of increasing headache frequency. This higher frequency is associated with a number of risk factors, including:11,12

      • age
      • sex (female)
      • obesity
      • snoring
      • head injury
      • stressful life events
      • depression and/or anxiety
      • cutaneous allodynia
      • overuse of opioids
      • overuse of barbiturates
      • high caffeine intake
      • ineffective acute headache treatment

      Chronic migraine is a complex neurological disease requiring appropriate effective management - including treatment or referrals to improve patient outcomes2,10,13

      CM: chronic migraine.

      Red flag signs/symptoms for secondary headache9,14

      AVM: arteriovenous malformation.
      Adapted from Bigal M E et al, 20079

      In all cases, neuroimaging may assist diagnosis. Other possible investigations include lumbar puncture, collagen vascular evaluation, biopsy and blood tests.9

      Prescribing information and adverse event reporting

      References: 9. Bigal M E et al. J Headache Pain 2007;8:263-272; 14. Dodick D W. Adv Stud Med 2003;3:S550-S555

       

      References

      1. Allergan. Data on file. INT/0423/2016
      2. Aurora S K, Winner P et al. OnabotulinumtoxinA for treatment of chronic migraine: pooled analyses of the 56-week PREEMPT clinical program. Headache. 2011;51(9):1358-1373
      3. Blumenfeld A M, Stark R J et al. Long-term study of the efficacy and safety of Onabotulinum toxin A for the prevention of chronic migraine: COMPEL study. J Headache Pain. 2018;19(1):13
      4. AbbVie Data on file. Approval Dates for BOTOX® in UK. UK-BTX-230044. April 2023
      5. BOTOX® Summary of Product Characteristics. Available at: https://www.medicines.org.uk/emc/product/859/smpc. Accessed March 2024
      6. Latinovic R, Gulliford M, Ridsdale L. Headache and migraine in primary care: consultation, prescription, and referral rates in a large population. J Neurol Neurosurg Psychiatry. 2006;77(3):385-387
      7. Buture A, Ahmed F et al. Perceptions, experiences, and understandings of cluster headache among GPs and neurologists: a qualitative study. Br J Gen Pract. 2020;70(696):e514-e522
      8. Dodick D W, Loder E W et al. Assessing barriers to chronic migraine consultation, diagnosis, and treatment: results from the Chronic Migraine Epidemiology and Outcomes (CaMEO) study. Headache. 2016;56(5):821-834
      9. Bigal M E, Lipton R B. The differential diagnosis of chronic daily headaches: an algorithm-based approach. J Headache Pain. 2007;8(5):263-272
      10. International Headache Society (IHS). International classification of headache disorders (3rd edition) guidelines. Available at: ihs-headache.org. Accessed March 2024
      11. Lipton R B. Chronic migraine, classification, differential diagnosis, and epidemiology. Headache. 2011;51 Suppl 2:77-83
      12. May A, Schulte L H. Chronic migraine: risk factors, mechanisms and treatment. Nat Rev Neurol. 2016;12(8):455-464
      13. Weatherall M W. The diagnosis and treatment of chronic migraine. Ther Adv Chronic Dis. 2015;6(3):115-123
      14. Dodick D W. Clinical clues and clinical rules: primary vs secondary headache. Adv Stud Med. 2003;3(6C):S550-S555

       

      References

      1. Allergan. Data on file. INT/0423/2016
      2. Aurora S K, Winner P et al. OnabotulinumtoxinA for treatment of chronic migraine: pooled analyses of the 56-week PREEMPT clinical program. Headache. 2011;51(9):1358-1373
      3. Blumenfeld A M, Stark R J et al. Long-term study of the efficacy and safety of Onabotulinum toxin A for the prevention of chronic migraine: COMPEL study. J Headache Pain. 2018;19(1):13
      4. AbbVie Data on file. Approval Dates for BOTOX® in UK. UK-BTX-230044. April 2023
      5. BOTOX® Summary of Product Characteristics. Available at: https://www.medicines.org.uk/ emc/product/859/smpc. Accessed March 2024
      6. Latinovic R, Gulliford M, Ridsdale L. Headache and migraine in primary care: consultation, prescription, and referral rates in a large population. J Neurol Neurosurg Psychiatry. 2006;77(3):385-387
      7. Buture A, Ahmed F et al. Perceptions, experiences, and understandings of cluster headache among GPs and neurologists: a qualitative study. Br J Gen Pract. 2020;70(696):e514-e522
      8. Dodick D W, Loder E W et al. Assessing barriers to chronic migraine consultation, diagnosis, and treatment: results from the Chronic Migraine Epidemiology and Outcomes (CaMEO) study. Headache. 2016;56(5):821-834
      9. Bigal M E, Lipton R B. The differential diagnosis of chronic daily headaches: an algorithm-based approach. J Headache Pain. 2007;8(5):263-272
      10. International Headache Society (IHS). International classification of headache disorders (3rd edition) guidelines. Available at: ihs-headache.org. Accessed March 2024
      11. Lipton R B. Chronic migraine, classification, differential diagnosis, and epidemiology. Headache. 2011;51 Suppl 2:77-83
      12. May A, Schulte L H. Chronic migraine: risk factors, mechanisms and treatment. Nat Rev Neurol. 2016;12(8):455-464
      13. Weatherall M W. The diagnosis and treatment of chronic migraine. Ther Adv Chronic Dis. 2015;6(3):115-123
      14. Dodick D W. Clinical clues and clinical rules: primary vs secondary headache. Adv Stud Med. 2003;3(6C):S550-S555

      Please refer to the BOTOX® Summary of Product Characteristics for further information on adverse events, contraindications and special warnings and precautions for use.

      BOTOX® PRESCRIBING INFORMATION

       

      Adverse events should be reported. Reporting forms and information can be found at https://yellowcard.mhra.gov.uk/

      Adverse events should also be reported to AbbVie on [email protected] 

       

      Date of preparation: March 2024. UK-BCM-240037

       

       

      Adverse events should be reported. Reporting forms and information can be found at https://yellowcard.mhra.gov.uk or via the MHRA Yellow Card app, available in the Google Play or Apple App Stores. Adverse events should also be reported to AbbVie on [email protected]

       

      This website is for UK Healthcare Professionals only

      UK-ABBV-230225. Date of preparation June 2023. This website has been developed and funded by AbbVie Ltd.

      © 2023 AbbVie Ltd. All rights reserved. Registered Number: 08004972 England.