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Botox as a treatment for migraines

2nd March 2012  : 

The hot debate about Botox and the NHS is made complex because many people misunderstand exactly what officials have said. While there's some evidence it can successfully alleviate the symptoms of chronic migraines, it's not conclusive enough to allow public funding at this stage.

There have actually been two separate official rulings on the treatment. The first, in July 2010, was made by the Medicines and Healthcare Products Regulatory Agency. Their decision meant clinics would be allowed to offer Botox treatment for the express purpose of treating chronic migraines rather than for cosmetic reasons. However, contrary to some reports at the time, that didn't mean it was approved for NHS use.

That decision is down to the National Institute of Clinical Excellence. While the MHPRA decides if a treatments and/or drugs are medically safe, NICE's role is to decide if it is proven to be effective enough to justify the cost of Botox prices to the taxpayer. It's made a preliminary ruling against that approval, but has given Botox manufacturer Allergan more time to provide stronger evidence of its effectiveness.

The controversy isn't helped by Botox's more common use in cosmetic surgery: as the recent faulty breast implants scandal has shown, the public is uneasy about taxpayer-funded procedures for cosmetic purposes. In this case however, the NHS funding would only be for patients who suffer headaches at least 15 days a month, with the more severe migraines on at least eight days.

It's worth noting that NICE's evidence does suggest that Botox has a benefit for migraines; it's simply that the reported benefits weren't substantial enough to say for certain they weren't down to faults in the test procedure.

While those who say the treatment does work will be disappointed, it's perhaps only understandable that in tough financial times for public healthcare, the onus be on proving that Botox eases migraine pain, rather than for critics to prove it doesn't.

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