Chronic Pain Treatment, Belfast

Treatment of Chronic Migraine

chronic migraine

Migraine Awareness Week – 6th – 12th September 2020

Chronic migraine and its treatment is a major problem in the UK as well as all other Western countries. The week of September 6th – 12th 2020 was migraine awareness week in the UK. This event is organised to raise awareness of this often silent and invisible condition that affects up to 20% of the population. This is predominantly (but not exclusively) a condition of young adults, often arising in the teen years and continuing into middle age and beyond. This adds to the debilitation of the condition as it essentially appears at school or university age and continues throughout working life. Chronic migraine effectively attacks people trying to get qualifications or find and maintain employment. For this reason, it is sometimes referred to as a condition of the tax payers.

Chronic Migraine can be a crippling condition for those affected

As can be seen, acute and episodic migraine occurs in up to 20% of the population. Approximately 7.5% of this group (1.5 – 2% overall) may go on to develop chronic migraine. Chronic migraine is defined as more than 15 headache days per month, of which more than 8 are migraine in character.

The clinical definition of migraine can be found HERE

Read more about migraine awareness HERE and HERE

Treatment for Chronic Migraine

Treatment for migraine typically falls into 2 groups – preventative and abortive. Preventative treatment is taken regularly with the intention of reducing the number of migraine attacks. This is done with medications such as beta blockers (propranolol), anti-epileptic drugs such as topiramate, gabapentin or pregabalin, antidepressants such as the tricyclic drugs and pizotifen, and ACE II blockers such as candesartin.

Abortive drugs are used with the intention of shutting down an attack. The most common group of drugs used for this purpose are the triptan drugs ie sumatriptan, frovitriptan, rizatriptan and zolmitriptan. High dose aspirin (1000mg) may also have a abortive role in the management of migraine attacks.

Read more HERE on the management of migraine attacks.

Botulinum Toxin Injections for Chronic Migraine

Chronic migraine is defined as more than 15 headache days per month of which 8 or more are migrainous in nature. In certain circumstances, botulinum toxin injections can be offered for the treatment of chronic migraine. The criteria for this treatment are very clearly defined in the UK, namely

A diagnosis of chronic migraine from a neurologist

More than 15 headache days per month, of which more than 8 are migraine

Offered as a 4th line treatment ie after 3 recognised treatments as indicated above have failed.

If these criteria are met, botulinum toxin injections can be offered as a 4th line therapy. This is on the basis of 2 scientific papers that were published around 2005-7, known as PREEMPT 1 and PREEMPT 2

This treatment is currently recommended by NICE as a 4th line therapy for chronic migraine

Click on the link below to read the guidance

Botulinum toxin type A for the prevention of headaches in adults with chronic migraine

Injection Sites of Botulinum Toxin A for Chronic Migraine

injection sites for botulinum toxin in chronic migraine

For injection technique – see this video – sound quality is poor, but the practitioner is skilled and demonstrates the technique very well

Video Demonstrating Injection Technique for Botulinum Toxin in Chronic Migraine

Injection technique for chronic migraine

Further Reading

The Migraine Trust

Pain Australia

National Migraine Centre

Migraine Support

Migraine NHS

Migraine Treatment NHS

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