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01.12.2014 | Meeting abstract | Sonderheft 1/2014 Open Access

The Journal of Headache and Pain 1/2014

EHMTI-0090. Botox in the prevention of chronic migraine; comparing NICE criteria versus hull criteria for evaluating responder rate

The Journal of Headache and Pain > Sonderheft 1/2014
H Zafar, M Khalil, F Ahmed


Chronic migraine (CM) affects 2% of the population and Botox is the only licensed treatment for prevention of adult patients with CM.
In the UK, National Institute for Clinical Excellence (NICE) approved its use on the National Health Service (NHS) provided patients had failed three preventive medications and appropriately addressed for medication overuse.
NICE defines responder with 30% reduction in headache days without emphasis on severity of headache or number of migraine days.
We developed Hull Criteria that defines responder as one with either:
50% reduction in either
Headache days
Or migraine days
An increment in crystal clear days twice that of baseline


To compare the outcomes of patients receiving Botox treatment in CM according to NICE and Hull Criteria.


Adult patients with CM attending the Hull migraine clinic were offered Botox based on clinical needs and maintained a headache diary.
Data were extracted for headache, migraine, and headache-free days
Responder rate was assessed applying Hull and NICE criteria.


Out of a cohort of 357 patients having received a total of 858 cycles, we analysed 151 patients who had received two treatment cycles as recommended by NICE.
A Significant number of patients who responded with Hull Criteria did not satisfy NICE criteria and were denied treatment.


We recommend that severity of headache and number of migraine days must be taken in to account in evaluating response rate to Botox.
NICE criteria should include reduction in migraine days in addition to headache days.
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( https://​creativecommons.​org/​licenses/​by/​4.​0), which permits use, duplication, adaptation, distribution, and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
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