Botulinum toxin type A is recommended as an option for the prophylaxis of headaches in adults with chronic migraine (defined as headaches on at least 15 days per month of which at least 8 days are with migraine), only if:
at least 3 preventive medicines have not worked, or are not tolerated or are unsuitable because of safety concerns, and
the condition is appropriately managed for medication overuse.
Treatment with botulinum toxin type A that is recommended according to section 1.1 should be stopped in people whose condition:
is not adequately responding to treatment (defined as less than a 30% reduction in headache days per month after 2 treatment cycles) or
has changed to episodic migraine (defined as fewer than 15 headache days per month) for 3 consecutive months.
People currently receiving botulinum toxin type A that is not recommended according to sections 1.1 and 1.2 should have the option to continue treatment until they and their clinician consider it appropriate to stop.