We should not complain about our health care system. People in such advanced European countries as Netherlands have it much worse. I just saw a 27-year-old Dutch woman with chronic migraines who has been coming to see me for Botox injections every three months for the past 3 years. Three years ago she was told by her neurologist to quit law school because even if she was able to graduate, her migraines will prevent her from being able to hold a job. She is graduating from law school this June. Her doctors also told her not to take sumatriptan (called Imigran in Europe and Imitrex in the US) more than once or twice a week and take only aspirin on other days. This approach made her unable to function on the five days when she did not take sumatriptan, but even with sumatriptan her headaches were still disabling. Botox injections produced a significant improvement in the severity of her attacks, although not in the frequency. However, now sumatriptan provides complete relief and she can function normally. She tried to find a way to get Botox injections in Holland and offered to pay the doctor. He was not able to do it because medicine is socialized in Holland and he could not accept payment for procedures not covered by the health service. She turned to the government and offered to reimburse the health service for Botox, but they also refused. She is fortunate in that she is able to afford to come to New York every three months and buy as much sumatriptan as she needs to function normally.
Things are not much better in the UK and other European countries. The UK approved the use of Botox for chronic migraine before it was approved in the US. However, their national health service also refuses to pay for it. My Italian colleagues have told me that as a society they’ve decided that Botox was too expensive to be used for the treatment of migraines, despite the evidence that it works. I should note that just like many other drugs, Botox is significantly cheaper in Europe than in the US.
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