Bill Harvey: Needle and the damage done

Watching TV in the US is a real pleasure for a connoisseur of commercials. I am particularly fond of the many ads for prescription-only medicines within which fragments of TV programmes are scattered, ads that would be illegal to broadcast here. Most of the several minutes of each of these is taken up by the requirement to list all of the many possible adverse reactions of each drug, each as severe and unlikely as the smiles of the actors desperately trying to distract you from the list.

My ears pricked up, however, when a treatment for chronic migraine using Botulinum toxin injections was promoted. I can’t believe I had never heard of this and, on my return, was equally surprised to find that the treatment has been approved by NICE in England and Wales since 2012, and in Scotland since 2017. Apparently, Botox can be considered ‘as an option for the prevention of headaches for people who have chronic migraine (headaches on at least 15 days of every month, at least eight days of which are migraine) that has not responded to at least three prior preventative drug treatments.’ The exact mode of action is unclear, but the PREEMPT trials have shown the treatment to be effective.