There are several causes of migraine, including:

Neurological causes

If you have migraine, the nerves in your brain are thought to be more sensitive than normal. A migraine attack starts when the nerves become over-stimulated, leading to a series of changes involving nerve signals, chemicals and blood vessels in the brain. This causes a migraine attack.

Genetic causes

Your risk of developing migraine is higher if you have a family member who has the condition.

Triggers

Migraine attacks often happen without any clear reason, but there can be certain triggers that may make you more likely to have one. These are different for everyone but include:

• Stress
• Skipping meals
• Hormonal changes
• Changes in your sleep pattern

Before a migraine attack occurs, you may experience the following symptoms:

• Feeling very tired and yawning a lot
• Craving certain foods or feeling thirsty
• Changes in your mood
• A stiff neck
• Increased need to pee
• Problems with your sight, such as seeing zigzag lines or flashing lights
• Numbness or a tingling that feels like pins and needles
• Feeling dizzy
• Difficulty speaking

Migraine with aura

Migraine with aura often starts with visual effects such as flashing lights, zig‑zag lines or blind spots. Some people also notice tingling (pins and needles) or have trouble speaking. These symptoms usually build over 

minutes and fade within an hour, followed by the typical migraine headache.

Migraine without aura

A migraine without aura is the most common form of migraine. The headache begins without any preceding neurological warning signs, although you may notice throbbing or pulsating pain - often on one side of the head - along with nausea, sensitivity to light or sound and difficulty concentrating. The symptoms can last from a few hours to several days and tend to worsen with physical activity.

Chronic migraine

A diagnosis of chronic migraine usually means that you get headaches on 15 or more days every month for at least three months; and eight of those 15 days have migraine symptoms, including severe pain.

Vestibular migraine

With this type of migraine, dizziness is the dominant symptom as the brain’s balance symptoms are affected. Instead of (or alongside) head pain, you may experience episodes of vertigo, unsteadiness or motion sensitivity. These episodes can last from minutes to hours and may be accompanied by typical migraine features such as light or sound sensitivity, nausea or visual disturbances.

Hemiplegic migraine

This is a rare type of migraine, where you experience temporary weakness or paralysis on one side of the body. This can affect the face, arm or leg and often appears alongside other aura symptoms such as visual changes, speech difficulties or numbness. The weakness can last from minutes to several hours, or occasionally longer, before fully resolving.

Although the symptoms can resemble a stroke, they are reversible and part of the migraine process.

Menstrual migraine

A menstrual migraine occurs around the time of your period, typically triggered by the natural drop in oestrogen. The headache itself feels like a typical migraine, but the timing is what defines it. These attacks often happen in the two days before bleeding starts or during the first few days of the period, and they can be more intense or longer‑lasting than migraines at other times of the month.

A headache is:

• Usually mild to moderate – and rarely disabling
• Likely to occur on both sides of the head
• A pressing or tightening pain, but not throbbing
• Not made worse by movement or routine activity
• Likely to last for minutes to days
• Not usually accompanied by any other symptoms

A migraine is:

• Moderate to severe, and may be disabling
• Often (but not always) on one side of the head
• Accompanied by a throbbing pain
• Made worse when you move your head, or with routine activity
• Likely to last hours to days
• Usually accompanied by other symptoms such as sickness or sensitivity to light or sound

There’s currently no cure for migraine, but there are many ways to manage it, including a range of treatment options.

Acute medicines

These reduce or stop the symptoms of a migraine attack as it happens. Treatments include over-the-counter painkillers such as aspirin, ibuprofen and paracetamol, or anti-sickness medication.

If simple painkillers alone don’t help, your clinician might recommend triptans (such as sumatriptan) alone or in combination with simple painkillers and/or anti-sickness medications.

If the first triptan you try doesn’t help, your clinician may recommend different types or formulations of triptans.

If you’ve tried at least two triptans and these haven’t helped your migraine, or you can’t tolerate triptans, your clinician may prescribe Rimegepant.

Preventative medicine

These aim to reduce the number or severity of attacks over time. You may be prescribed preventatives if:

• You have attacks more than four days per month
• Migraine is severely impacting your life
• Acute medications aren’t helping

Preventatives include propranolol, topiramate, amitriptyline or candesartan pizotifen. You’ll need to try each for at least three months, unless you’re unable to tolerate them – in which case your clinician will try another type.

Your clinician will gradually increase the dose, according to what you can tolerate and how well it’s working for you.

Specialist treatments

If acute and preventative medicine aren’t helping your migraine, your clinician may recommend a specialist treatment.

Greater Occipital Nerve (GON) block

This is an injection into the back of your head to help prevent migraine attacks. It includes a small amount of local anaesthetic, sometimes combined with a steroid.

The injection is given to the back of your head (on one or both sides) where the greater occipital nerves are. These nerves run up each side of the back of your head and are linked to migraine pain signals.

Calcitonin Gene-Related Peptide (CGRP)

This injection consists of three subcutaneous drugs (injected under your skin) and one intravenous drug (injected into the bloodstream) either monthly or quarterly.

Gepants

Gepants are a newer class of migraine medicines that block the CGRP pathway, offering both acute relief and, for some options, preventive benefits.

There are two gepants currently licensed for management of migraine. Your clinician can discuss which drug may be more appropriate for you.

Botox® for migraine

Botox® for migraine is used as a preventative treatment in chronic migraine. Rather than stop your migraines once they’ve started, Botox® for migraines aims to reduce the number of days on which you get headaches and improve your quality of life.

Botulinum toxin type A, also known as Botox®, is a natural protein that’s 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”: in other words, it’s the part of the medicine that does the work, and it can be helpful in medical conditions such as chronic migraine.

This protein is the active ingredient – the part of the medicine that does the work – and it’s thought that Botox® helps migraines by blocking the chemicals (neurotransmitters) that carry pain signals before they reach the nerve endings. This indirectly blocks the development of a migraine.

All eligible adults over the age of 18 can access this treatment.

Starting a new course of migraine treatment is a major step. So, before recommending treatment your doctor will have checked that it is a suitable treatment for you. As a guide, you should not receive the treatment if:

• you have had a bad reaction to botulinum toxin type A treatment in the past
• you have an infection at or around any of the areas to be injected
• you are pregnant or breast feeding

There are specific qualification criteria in order to access Botox treatment for chronic migraine and these will be discussed with your doctor.

Starting a new course of Botox® for migraine treatment is a major step. So, before recommending treatment your Consultant will have checked that it’s a suitable treatment for you. As a guide, you shouldn’t have Botox for migraine treatment if:

• You’ve had a bad reaction to botulinum toxin type A treatment in the past
• You have an infection at or around any of the areas to be injected
• You’re pregnant or breastfeeding

Before you start your Botox® for headaches treatment, your Consultant will discuss what the treatment involves and what you can expect, including any side effects. Once your treatment has started, if you notice any side effects then you should tell your doctor straight away.

You should continue with your migraine diary, noting down:

• How many times you get headaches or migraines each month
• How long they last
• How severe they are

An anaesthetic is not required for your treatment.

Your treatment consists of a set of injections that you will have in the outpatient’s department of the hospital. You’ll only need to have this treatment once every 12 weeks.

Your Consultant will inject tiny amounts of botulinum toxin type A into the muscles around your head, neck and shoulders. Each session will need 31 injections and will take about 15 minutes.

If you don’t like needles, or you’re anxious or worried about your treatment, please speak to your medical team. They’ll be able to reassure you and answer any questions you may have – and tell you what we can do to help you relax during your treatment.

Please refer to the Patient Information Leaflet provided with the treatment for more information.

As with any type of injection, you may experience some discomfort during your treatment session, but this shouldn’t last for long.

Your Consultant or nurse may ask you to stay at the clinic for a short while, to check that you’re comfortable following your treatment and to arrange your next appointment, if needed.

You may get some bumps on the skin at the places where you were injected, but these should disappear within a few hours. Try not to rub the places where you have been injected for 24 hours after you receive your injections, to allow your treatment to work properly.

No. This Botox® treatment results in no change of appearance. You may get some bumps on the skin at the places where you were injected, but these should disappear within a few hours.

Like all medicines, Botox® for migraine can cause side effects, although not everybody gets them. In general, side effects occur within the first few days following the injection and last only for a short time. In rare cases, they may last for several months or longer.

A detailed list of side effects can be obtained from the Patient Information Leaflet. Please ask your medical team for a copy.

Your doctor or nurse will ask you to stay at the clinic for a short while, to check that you are comfortable following your treatment.

As with all procedures, you may experience some common side effects. Very rarely there is some pain around where the injection was given. The majority of patients do not experience pain or tightness.

No specific follow up appointment is required however, you may need or choose to have this treatment once every 12 weeks approximately depending of consultation with your prescribing doctor.

You can book a self-pay consultation with our Consultant Neurologist, who will assess your needs and recommend the most appropriate treatment.

You’ll need a referral from your NHS GP or one of our Private GPs before we can book the appointment.

Please call our Private Patient team on 01580 363158, request a callback by completing our online enquiry form or get in touch via Livechat.