Published on 11 November 2026
At the pharmacy, there’s a long shelf with a large number of painkillers displayed.
As a migraine sufferer you know that whatever you pick is unlikely to help much when your next attack arrives.
Fortunately, there are good alternatives to over-the-counter medicines.
What exactly is chronic migraine?
If you have a headache on 15 or more days a month for at least three months, with migraine symptoms on at least eight of the 15 days, then you are likely to have what is defined as chronic migraine.
What might be best for you?
If medicines often used to prevent and treat migraine are not working for you, a neurologist might suggest Botox® treatment or CGRP-targeting therapies.
What is Botox® for migraine treatment?
This preventative treatment involves a set of Botox® injections.
Botulinum toxin type A (Botox®) is a natural protein that is made by a certain kind of bacteria. The protein is removed from the bacteria and then specially prepared before use. This protein is the “active ingredient”. It is the part of the medicine that does the work, and it can be helpful in medical conditions such as chronic migraine.
Rather than stop your headaches once they have started, the treatment aims to reduce the number of days on which you have headaches.
It is thought that the treatment blocks the chemicals (neurotransmitters) that carry pain signals before they reach the nerve endings and that this, indirectly, blocks the development of migraine.
Tiny amounts of botulinum toxin type A are injected into the muscles around your head, neck and shoulders.
Patients will only require this treatment once every 12 weeks. As with any type of injection, you may experience some discomfort during your treatment session, but this should not last for long.
After your treatment is complete you will be asked to stay at the clinic for a short while, to check you are comfortable following your treatment.
What are CGRP-targeting therapies?
These therapies target the CGRP (calcitonin gene-related peptide) pathway, which is involved in migraine. They are effective for many people with episodic and chronic migraine and are increasingly recommended when preventive treatment is needed.
How do Botox® injections and CGRP treatments compare?
Botox® is used particularly for chronic migraine while CGRP treatments are used for both episodic and chronic migraine.
Botox® is delivered in injections around the head and neck every 12 weeks while CGRP treatment delivery if by monthly or quarterly injections, IV infusion, or oral tablets (taken daily or every other day).
Full benefit of Botox® treatment can take six to nine months. With some patients, there is noticeable benefit within weeks.
Common side effects with Botox® are neck pain, injection-site discomfort, and, possibly, a drooping eyelid. With CGRP treatment, side effects may be injection-site reactions, constipation, nausea and fatigue.
How convenient are the two approaches?
With Botox® injections, you would need to visit a clinic every 12 weeks, and with CGRP treatments there would be home injections for most antibodies (tablets for gepants).
Which works better?
Studies generally show that both Botox® and CGRP-targeting therapies are effective but that the CGRP-targeting approach often produces slightly greater reductions in monthly migraine days and tends to be easier to tolerate.
Can the approaches be used together?
If you do not get sufficient relief from one of the approaches, a neurologist my advise combining Botox® and a CGRP medication. There is evidence that using both can provide additional benefit in selected patients.
How Benenden Hospital can help you
Benenden Hospital offers private migraine assessment and treatment though its neurology service.
The hospital’s neurologists can help diagnose migraine, identify triggers, rule out other neurological conditions, and develop a treatment plan.
Accessing treatment
You can contact Benenden Hospital’s Private Patient Team om 01580 363158. A GP referral is required for a neurology appointment.