GUIDELINES ON PROPHYLACTIC TREATMENT WITH BOTULINUM TOX-IN TYPE A IN PATIENTS WITH CHRONIC MIGRAINE
Davor Jančuljak, Damir Petravić, Darija Mahović Lakušić, Koraljka Bačić Baronica, Vanja Bašić Kes
In chronic migraine prophylaxis, drugs that had been proven effective in episodic migraine have been used according to the international guidelines. After the two major controlled studies PREEMPT 1 and 2 demonstrated the efficacy and good tolerability of botulinum toxin A in chronic migraine prophylaxis, in Europe (first in the United Kingdom) and in the United States, expert committees approved the use of botulinum toxin type A for the indication of chronic migraine in respective national health insurance systems as the second line of prophylactic treatment. In Croatia, migraine prophylactic drugs are available in the group of beta-adrenergic receptor blockers (registered for migraine indication) and anticonvulsants (not registered for migraine). In these recommendations we consider that in Croatia, given the cost-benefit ratio and the usefulness of treatment, botulinum toxin type A should be used in the second line as a medication for the prophylaxis of chronic migraine only after exhaustion of the effect or intolerance of two oral prophylactic drugs given in previous treatment cycles. Botulinum toxin type A should be applied according to the protocol of studies PREEMPT 1 and 2 with a three month application interval. The drug should be administered in hospital centers under the supervision of a fully trained neurologist from the Headache Outpatient Clinic/Center/Department or by a neurologist who is competent in the field of headache treatment. The decision on the extension /discontinuation of treatment is made by the neurologist on the basis of the existence /absence of a favorable drug effect on the reduction of headache by 30% per month for a period of three months after the second drug administration.