Chronic migraine affects approximately 2 percent of the world population. Although the pathophysiology of the transformation from episodic to chronic migraine is not well-understood, it is hypothesized that atypical pain processing, cortical hyperexcitability, neurogenic inflammation, and central sensitization are involved. The chronic migraine causes significant reductions in quality of life and is even more disabling than episodic migraine. Among patients with episodic migraine, transformation to chronic migraine occurs in approximately 3 percent per year.
Daily or near daily low to moderate intensity headaches and mild migrainous features with superimposed severe intensity headaches with more prominent migrainous features are common with chronic migraine. The diagnostic criteria for chronic migraine required the presence of headache for 15 or more days per month for more than three months, with the features of migraine headache present on at least 8 days per month.
Treatment of chronic migraine focuses on prophylactic therapy. Acute specific medication should be minimized to maximum of 10 days per month. The same prophylactic medications used for episodic migraine are used for the prevention of chronic migraine as first line treatment. If two tried first line medication does not help or are discontinued because of side effect, botulinum toxin is the possible second line medication.
According to PREEMPT studies, botulinum toxin prevents on average 8 or 9 headache days and migraine days a month. It's given every 12 weeks. It will take 2 treatments to determine how well it is working. The injections take about 30 minutes, and are injected right in my doctor's office.
The price of botulinum toxin in Finland is 437,05 € (without KELA reimbursement). The total cost of botulinum toxin treatment with 200 units of Botox for chronic migraine is 610€ (or 421€ with Kela reimbursement). The total cost includes medication, equipment, outpatient clinic fee and injection appointment. You don't have to be citizen of Finland to be treated.
Please, don't hesitate to contact me if you need help with your migraine and you are in Helsinki, the capital of Finland (North Europe).