Chronic migraine
Preventive treatment for chronic migraine
Chronic migraine means headache on 15 or more days a month, with migraine on at least eight of them. For adults in that position there is a licensed preventive treatment. It is a prescription-only medicine, given as a set pattern of small injections across the forehead, temples, back of the head, neck and shoulders, and repeated every 12 weeks.1 I provide it personally, after a consultation that confirms the diagnosis first.
- Free consultation, 30 minutes
- £595 per treatment
- Every 12 weeks, each one a separate decision
- Reviewed against your headache diary after the second treatment
01 — is this chronic migraine?
The diagnosis rests on counting days
Most people with migraine have attacks that come and go, with clear days in between. That is episodic migraine, and this treatment is not licensed for it. Chronic migraine is different. Headache is present on more days than not, for at least three months, and on at least eight of those days it has the features of migraine: a throbbing pain, often on one side, with nausea or a dislike of light and sound.2
The reliable way to tell the two apart is to count. So the first thing I will ask for is a headache diary.
The diary
Keep one for four weeks before we meet if you can. Each day, note whether you had a headache, whether it felt like migraine, and what you took for it. A note on your phone is enough. The diary does two jobs. It confirms the diagnosis, and it gives us the baseline that any treatment is later judged against.
02 — what the treatment is
A fixed map of small injections
The medicine is thought to work by blocking the release of pain-signalling chemicals from nerve endings in the scalp and neck. With fewer of those signals reaching the brain, the pain system becomes less sensitised over time. That is the proposed mechanism, and it is not fully settled.
The injections follow a fixed map, which comes from the clinical trials.3 There are 31 sites in seven muscle areas. Each injection is a very small volume, placed into the muscle just under the skin with a fine needle. Up to eight further sites can be added at the temples, the back of the head or the shoulders if that is where your pain concentrates. The map is otherwise the same for everyone, because that is the pattern that was tested.
03 — before treatment is considered
Four things need to be true first
Adults with chronic migraine Headache on 15 or more days a month for at least three months, with migraine on at least eight of those days.
Preventive medicines already tried National guidance places this treatment after at least three preventive medicines have failed or could not be tolerated.4 Bring a list of what you have taken, at what dose, and for how long.
Painkiller use looked at first Taking painkillers or triptans on many days of the month can itself keep a headache going. If that is happening it needs addressing first, because no preventive works properly until it is.
No warning signs A new or changing headache needs a diagnosis before it needs a preventive. If your headache began in the last few months, started after the age of 50, or comes with weakness, confusion, fever or loss of vision, see your GP or call 111. If it came on suddenly and severely, call 999.
Things that need discussing first (not a complete list)
- Pregnancy, trying to conceive, or breastfeeding
- A condition affecting nerves or muscles, such as myasthenia gravis
- Difficulty swallowing
- Blood-thinning medicine
- Anti-wrinkle injections, or similar injections for a medical reason, in the last three months
- A skin infection where the injections would go
04 — what happens
Two treatments, then a decision
Thirty minutes, free. I take a history, go through your diary and your medicine list, and examine you. If the diagnosis is not chronic migraine, or something needs investigating first, I will say so, and with your permission I will write to your GP. Treatment is never given at this visit.
Booked for 45 minutes. The injections themselves take about 15. You sit upright, no anaesthetic is needed, and you can go back to normal activities the same day. Avoid rubbing the areas for the rest of the day.
Little changes in the first week or two. Any effect builds gradually after that, and the first treatment often tells you less than the second. Keep the diary going.
A second treatment, if you choose to have it.
After the second treatment we put your diary next to the baseline. National guidance says to stop if headache days have not fallen by at least 30 per cent.4 I apply the same rule. If it has not done enough by then, I will tell you, and we stop.
Treatment continues every 12 weeks and is reviewed each time. If your headache days fall below 15 a month for three months running, you no longer have chronic migraine. Guidance is then to stop and see whether the improvement holds.4
05 — side effects
Side effects to weigh up
The commonest are neck pain or stiffness, and a headache in the days after treatment. The forehead injections can lower a brow or an eyelid for a few weeks. They can also soften forehead lines, which is a side effect and not the aim. The patient information leaflet has the full list, and I go through it with you before you decide.
Seek urgent medical help if you develop difficulty swallowing, speaking or breathing at any point in the weeks after treatment.
06 — fee
One fee per treatment, nothing in advance
The fee covers the medicine and the appointment. There is no course to buy. Each treatment is a separate decision and is paid for on the day.5
07 — the NHS route
The same treatment is available on the NHS
This treatment is available on the NHS. Your GP can refer you to a neurologist or a headache clinic, and the NHS criteria are the ones set out above: chronic migraine, three preventive medicines tried, and painkiller overuse addressed. Waiting times vary by area. If you would rather take that route, the diary and the medicine list are what the clinic will ask for too, so neither is wasted.
Other preventive options exist, including newer medicines available through NHS headache clinics. If I think one of those is the better next step for you, I will say so.
08 — questions
Common questions
Do I need a referral?
No. You can book directly. With your permission I write to your GP after the consultation and after each treatment, so your NHS record stays complete.
I get migraines, but not on 15 days a month. Can I have this?
No. The medicine is licensed only for chronic migraine, and trials in less frequent migraine did not show a benefit.1 Your GP can discuss other preventives with you.
Why see a GP for this rather than a neurologist?
Chronic migraine is diagnosed and managed in general practice every day, and the injection map is a standard, trained technique. If your headache does not fit the pattern, or I think you need a neurologist, I will tell you and refer you.
Does it hurt?
Each injection is a brief sting from a fine needle. The ones at the temples and the back of the head tend to be felt the most. No anaesthetic is needed.
Should I stop my other migraine medicines?
No. Keep taking them unless we agree a change. Your usual treatment for attacks carries on as before.
How soon would I know if it is working?
Judge it after the second treatment, not the first. That is why the review sits at that point, and why the diary matters.
Will my health insurance cover it?
Some insurers cover this treatment when a consultant neurologist provides it. I am a GP, so assume not, and check with your insurer before you book.
09 — who treats you
Personally treated by Dr Gohar Shah
Every consultation and every treatment is carried out personally by Dr Gohar Shah. He is a GMC-registered doctor, a practising NHS GP, and holds a postgraduate diploma in dermatology.
Ready when you are
Book a consultation
A one-to-one consultation with Dr Shah, so you explain the problem once and the same doctor sees you throughout. It is free, and it commits you to nothing.
Booking takes two minutes.
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Your consultation and treatment are provided personally by Dr Gohar Shah (GMC 6127983), at a private consulting room in Bethnal Green.
Notes
- Summary of Product Characteristics for the licensed medicine, sections 4.1 and 4.4. Electronic medicines compendium, accessed September 2026. ↩
- Headache Classification Committee of the International Headache Society. Cephalalgia 2018;38:1–211. ↩
- Aurora SK et al. Cephalalgia 2010;30:793–803. Diener HC et al. Cephalalgia 2010;30:804–814. Dodick DW et al. Headache 2010;50:921–936. ↩
- National Institute for Health and Care Excellence. Technology appraisal guidance TA260, 2012. ↩
- Your medical care is provided by Dr Gohar Shah as an independent practitioner. Payment is collected by GS Medical Services Ltd, trading as Victoria Park Clinic, which issues invoices and handles refunds; it appears as “VICTORIA PARK CLINIC” on your statement. The consultation is free of charge, and there is nothing to pay if treatment is not recommended or you decide not to proceed. ↩