Migraines Treatment
from £800
What is chronic migraine?
Chronic migraine is defined as having a headache on 15 or more days per month, with at least 8 of those days carrying migraine features, for longer than three months. It sits at the more disabling end of the migraine spectrum, and for many people it becomes the thing that quietly organises their life around it. This treatment is intended specifically for chronic migraine rather than occasional or episodic headaches, which is one of the reasons a proper assessment matters before any injection is given.
Could this treatment help you?
This treatment tends to suit people who recognise several of the following. You have frequent headache days rather than the occasional one. You have already tried preventive tablets and either found them ineffective or difficult to tolerate. You are relying on acute painkillers or triptans often enough to worry about it. And the migraines are genuinely interfering with your work, your sleep, or your day-to-day life.
If that describes where you are, a consultation is the sensible first step. It gives Dr Karwal the chance to confirm that what you are experiencing is chronic migraine, to rule out other causes of frequent headache, and to be honest with you about whether this treatment is likely to help.
Prices
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£800
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£300
The PREEMPT protocol
The injection technique used for chronic migraine is based on the PREEMPT programme, short for Phase III Research Evaluating Migraine Prophylaxis Therapy. These were the large clinical trials that established which muscles to inject, how much to use, and how to administer it, and they form the evidence base on which this treatment was approved.
The standard paradigm delivers a total of 155 units of botulinum toxin type A across 31 fixed injection sites, spread over seven muscle areas of the head and neck. Injections are given symmetrically on both sides, with the single exception of the procerus at the midline, and each site receives a small, precise, shallow intramuscular dose.
Where a patient's pain is concentrated in particular areas, up to 40 additional units may be added using a "follow the pain" approach, allowing the treatment to be tailored to the individual rather than applied identically to everyone. This flexibility is part of the original protocol, not an add-on.
The seven injection areas
Frontalis (forehead): 20 units across 4 sites
Corrugator (between the eyebrows): 10 units across 2 sites
Procerus (bridge of the nose): 5 units at 1 midline site
Occipitalis (back of the head): 30 units across 6 sites
Temporalis (temples): 40 units across 8 sites
Cervical paraspinal (upper neck): 20 units across 4 sites
Trapezius (upper shoulders): 30 units across 6 sites
Following a standardised paradigm like this is not about rigidity. It is about delivering the treatment in the same way it was delivered in the trials that proved it worked, so that your treatment is grounded in real evidence rather than guesswork.
FAQs
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It reduces the release of the pain-signalling chemicals involved in migraine and calms the sensitisation of the pain pathways in the head and neck. The aim is to prevent attacks, so you have fewer migraine days, rather than to treat a headache once it has started.
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Across seven muscle areas of the head and neck: the forehead, the area between the eyebrows, the bridge of the nose, the temples, the back of the head, the upper neck and the upper shoulders. This multi-site approach targets the muscles and nerves most commonly involved in migraine.
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The full appointment is around 15 to 20 minutes, with the injecting itself taking only a few minutes.
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The needle used is very fine, so most people find it very tolerable and no anaesthetic is usually needed. Any discomfort is brief.
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Some people notice an early change within the first couple of weeks, but the meaningful benefit builds over the first two to three cycles, so it is best judged over months rather than after a single session.
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Botulinum toxin type A has been an approved preventive treatment for chronic migraine for over a decade, first receiving regulatory approval for this use in 2010, with NICE guidance following in the UK in 2012. This is a well-established, evidence-based treatment rather than an off-label experiment.
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Most are mild and temporary: neck stiffness or discomfort, a short-lived headache before improvement, mild neck or shoulder muscle weakness, and tenderness, bruising or swelling at the injection sites. Temporary eyelid drooping is uncommon. Serious effects, such as difficulty swallowing or breathing, marked muscle weakness or an allergic reaction, are rare, and you would be advised to contact us immediately if you experienced anything concerning.
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No. This is a treatment that helps many people with chronic migraine but not all, which is exactly why the assessment before treatment matters.
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Every 12 weeks. Consistency is part of what makes the treatment work.