Advanced Headache Treatments 

Monoclonal antibodies are proteins created in a laboratory to target specific cells or substances. Calcitonin Gene-Related Peptide (CGRP) is a protein that is involved in the transmission of pain signals in the nervous system. When a person has a migraine attack, CGRP is released by the nerves and this contributes to the symptoms experienced during an attack.

​​Eptinezumab is a monoclonal antibody that works by targeting and blocking (CGRP). By binding to CGRP and it’s receptor, eptinezumab stops it from working properly which can decrease frequency and severity of migraine attacks. Eptinezumab is administered by intravenous infusion during a hospital appointment every 3 months to patients suffering from chronic migraines. 

Monoclonal antibody therapy for patients suffering from chronic migraines tends to be used for patients who:

- Are having at least four migraine attacks a month and

- Have tried 3 or more different preventive medicines at the maximum doses they are able tolerate for several months each, with no improvement​.

Botulinum toxin type A (Botox) blocks release of neurotransmitters associated with peripheral sensitisation.

As a result, peripheral pain signals to the central nervous system are reduced and, indirectly, central sensitisation is reduced.

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Botox treatment for chronic migraine involves administering 155 units of Botox by injection over 31 small points in a single sitting.

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NICE (National Institute of Clinical Excellence) recommends Botox for patients suffering from chronic migraine who:

- Experience headaches on at least 15 days each month, with migraine on at least 8 of these days and

- Have tried 3 or more different preventive medicines at the maximum doses they are able tolerate for several months each, with no improvement​.

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https://www.nice.org.uk/guidance/ta260

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