Headache neurology · London
Botox for chronic migraine, by a headache neurologist.
The licensed PREEMPT protocol under NICE TA260 for adults with 15 or more headache days a month, delivered by a consultant neurologist with a headache subspecialty, in a clinic that also offers CGRP mAbs, gepants and nerve blocks if Botox is not the right first step.
Why patients choose us
- 01
A headache neurologist, not a cosmetic injector
A named consultant neurologist trained in the PREEMPT protocol, with a high case volume in chronic migraine, in a headache clinic that meets British Association for the Study of Headache standards.
- 02
The right treatment for your headache pattern
Botox is licensed for chronic migraine only. If your pattern is episodic migraine, medication overuse headache or cluster, we recommend CGRP mAbs, gepants or occipital nerve blocks before you commit.
- 03
Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Indicative pricing
What a private Botox cycle for chronic migraine costs in the UK.
Indicative ranges across our headache-clinic partners. Send the diary and we quote firm figures across two or three options, including CGRP mAb alternatives.
In short
A single PREEMPT cycle in our London network: £450–£1,600, home the same hour.
| Procedure | Indicative range | Typical duration | Turnaround |
|---|---|---|---|
| Neurology consultation and eligibility review | £300–£450 | 45–60 min | Same visit |
| Botox for chronic migraine, injection alone (155 units) | £450–£850 | 10 min | Same visit |
| Botox with consultant assessment, full cycle | £800–£1,600 | 60 min | Same visit |
| CGRP monoclonal antibody, monthly (indicative) | £350–£500 | 15 min | Same visit |
| Occipital or greater occipital nerve block | £250–£450 | 15 min | Same visit |
| Second-opinion review of headache diary | £250–£450 | 30 min | 48 hours |
Prices vary by clinic, by which consultant delivers the injection, and by whether a full neurology assessment is bundled. NHS access exists via headache clinics under NICE TA260; going private is usually a matter of speed.
The journey
From headache diary to cycle two - what happens, in order.
One team from first message to the 12-week response review that decides whether cycle three goes ahead.
- 01
Before
You send us the headache diary
A short, confidential form. Headache days and migraine days per month, previous preventatives tried and stopped, current acute medication use.
- 02
Before
We come back with a recommendation
Within one working day: whether NICE TA260 eligibility is met, whether a CGRP mAb or gepant is the better first call, and an indicative price. An honest read either way.
- 03
Before
We arrange the consultation
Usually within one to two weeks. A full neurology assessment, PREEMPT protocol consent and diary review before the first injection cycle.
- 04
On the day
Arrival at the headache clinic
A short chat with the consultant, marking of the 31 injection sites across seven muscle groups, and a topical cool pack if you prefer.
- 05
On the day
The PREEMPT injections themselves
5 to 10 minutes. 155 to 195 units of onabotulinumtoxinA delivered across 31 fixed sites: corrugator, procerus, frontalis, temporalis, occipitalis, cervical paraspinal and trapezius.
- 06
On the day
Home straight after
No sedation, no downtime. Written aftercare, a headache diary for the next 12 weeks, and a booked review at cycle two.
- 07
After
Response review at 12 weeks
A second cycle at 12 weeks. Response is judged after two cycles per NICE TA260: a 50% reduction in headache days continues treatment; no response means Botox is stopped.
Typical end-to-end: 1–2 weeks to first cycle. Peak effect: 4–6 weeks. Review: 12 weeks.
When it helps
When Botox is the right step - and when it is not.
The patterns we see most, plus the situations where a CGRP mAb, a gepant, a nerve block or urgent imaging is the safer first move.
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Chronic migraine, 15+ headache days a month
The licensed indication under NICE TA260: 15 or more headache days per month, with at least 8 that are migrainous, for at least three months.
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Failed at least three oral preventatives
Propranolol, topiramate, amitriptyline, candesartan or others tried and stopped for lack of effect, side effects or contraindication.
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Medication overuse headache addressed
Overuse of triptans, codeine or combination analgesics needs withdrawal before Botox is judged. A muddled picture gives a muddled response.
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Transformed migraine from episodic
A pattern that started episodic and has slowly transformed into chronic, often on the back of frequent triptan or opioid use.
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CGRP mAb non-responder or intolerant
Erenumab, fremanezumab, galcanezumab or eptinezumab tried and stopped. Botox and CGRP are not usually funded together on the NHS.
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Not: episodic migraine under 15 days a month
Not licensed and not funded. Consider CGRP mAbs, gepants (rimegepant, atogepant) or greater occipital nerve blocks instead.
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Not: cluster or trigeminal autonomic headache
Botox has no role. Verapamil, high-flow oxygen, sumatriptan and greater occipital nerve blocks are the standard steps.
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Red flag: new headache, focal signs, over 50
Sudden thunderclap headache, focal neurology, new headache over the age of 50 or systemic symptoms need urgent imaging, not an injection.
Treatment options
Botox sits inside a family of migraine preventatives.
The PREEMPT protocol is the standard. CGRP mAbs, gepants and nerve blocks sit alongside it. We help you pick, and switch, without a fresh referral each time.
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PREEMPT protocol, 155 units at 31 sites
The standard licensed protocol. Fixed-site injections across corrugator, procerus, frontalis, temporalis, occipitalis, cervical paraspinal and trapezius muscles, both sides.
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Follow-the-pain, up to 195 units
An additional 40 units in the temporalis, occipitalis or trapezius, targeted to where your pain sits. Used at the consultant’s discretion within licence.
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CGRP monoclonal antibody alternative
Erenumab, fremanezumab, galcanezumab or eptinezumab. Monthly or quarterly injections. Often first-line under newer NICE guidance if Botox not preferred.
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Gepants: rimegepant and atogepant
Oral small-molecule CGRP receptor antagonists. Rimegepant doubles as acute and preventive; atogepant is preventive only.
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Greater occipital nerve block
A local anaesthetic and steroid injection at the greater occipital nerve. Fast onset, short duration, useful as a bridge before Botox reaches steady state.
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Nerve conduction studies and EMG
Rarely needed, but useful when a cervicogenic or occipital neuralgia picture overlaps with migraine and the injection plan is unclear.
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Combination therapy (specialist)
In selected patients, Botox plus a CGRP mAb is prescribed privately when either alone is insufficient. NHS commissioning rules usually preclude combining them.
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Second-opinion review
A specialist review of your headache diary, previous preventatives and imaging. Sometimes the answer is a different diagnosis, not another injection.
Our vetted London network
A small panel of headache neurologists, we picked them.
Introductions are made privately once we understand your case. Providers our patients see include the National Migraine Centre, HCA The Wellington Headache Clinic, London Neurology and Neurosurgery Centre, Cleveland Clinic London and Imperial Private at Charing Cross.
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Consultant neurologists with a headache subspecialty and PREEMPT training, not general neurology lists
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Headache clinics meeting British Association for the Study of Headache standards
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CGRP mAb, gepant and nerve-block pathways available if Botox is not the right first step
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MDT input with pain medicine and clinical psychology when a chronic pain picture is layered on top
Safety and expectations
What to expect afterwards - honestly.
PREEMPT Botox is a common, well-established preventative. There is no downtime. The things worth planning are the neck weakness window, the 12-week cycle rhythm, and the stop rule at cycle two.
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Injection-site pain and pinprick bleeding
Brief, common, settles within minutes. A cool pack helps. Paracetamol is fine afterwards; avoid NSAIDs on the day if you bruise easily.
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Neck weakness, 5–10%
Mild neck weakness or heaviness after cervical paraspinal and trapezius injections. Settles over 4–6 weeks. Modifiable at cycle two by adjusting technique.
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Ptosis and brow droop, 2–5%
Occasional drooping of the upper eyelid or brow after frontal injections. Usually mild, resolves in 4–8 weeks. Apraclonidine eye drops help in the meantime.
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Muscle stiffness or tenderness
Transient soreness across the shoulder girdle, most noticeable at week one. Gentle movement, not rest, is the right response.
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Not licensed in pregnancy
OnabotulinumtoxinA is not used in pregnancy or while breastfeeding. If pregnancy is planned, we discuss timing at the consultation.
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Repeat every 12 weeks
Effect peaks at 4–6 weeks and wears off by week 10–12. Earlier retreatment is not supported by evidence and increases immunogenicity risk.
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Stop after two cycles if no response
Per NICE TA260, Botox is stopped after two cycles if headache days have not fallen by at least 30%, and after a year if response cannot be maintained without it.
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Immunogenicity is rare
Neutralising antibodies to onabotulinumtoxinA are uncommon at licensed doses and 12-week intervals. Loss of response after early success prompts a review.
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Red flags after discharge
Difficulty swallowing, breathing, speech change or drooping over both eyelids is very rare but needs same-day medical review.
Reading your Botox record
Your cycle note in four parts. Read the last one first.
Whichever consultant delivers it, the note you get afterwards keeps to the same shape.
- 01 Header
Diagnosis, headache days and preventatives
Confirmation of chronic migraine, current headache and migraine days per month, and every preventative previously tried, dosed and stopped.
- 02 Technique
Dose, sites and pattern of injection
Total units delivered (155 or up to 195), the PREEMPT sites covered, any follow-the-pain additions, and the batch number of the vial used.
- 03 Findings
Immediate tolerance and side effects
How you tolerated the injections, any vasovagal reaction, and observations at 15 minutes before you left the clinic.
- 04 Impression
Response plan and next cycle
Read this first: your booked review date, the headache-diary target for a 50% response, and the stop rule at two cycles if the target is not met.
Recognised by major UK insurers
Cover for PREEMPT Botox varies by insurer and is usually funded once NICE TA260 criteria are met. We confirm cover before booking.
Frequently asked
Everything we get asked about Botox for chronic migraine.
Quick answers on eligibility, cost, response rates, CGRP mAbs and when to stop.
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Am I eligible for Botox for chronic migraine under NICE TA260?
You need chronic migraine: 15 or more headache days per month for at least three months, with at least 8 of those days migrainous. You must have failed three or more oral preventatives, and medication overuse headache must have been addressed. If any of those are missing, a CGRP mAb, a gepant or a nerve block is usually the better next step.
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How much does Botox for migraine cost privately in the UK?
Roughly £450–£850 per cycle for the injection alone if you already have a headache specialist looking after you. £800–£1,600 per cycle with a full consultant assessment. Add £300–£450 for the initial neurology consultation. A second-opinion review of your headache diary is £250–£450. We confirm a firm figure within one working day.
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Is Botox for chronic migraine available on the NHS?
Yes. NICE TA260 recommends onabotulinumtoxinA for chronic migraine as an option for adults whose headache has not responded to at least three prior oral preventatives, delivered through NHS headache clinics. Waits vary regionally; going private is usually a matter of speed, not access.
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How well does Botox work for chronic migraine?
The PREEMPT trials showed roughly 50–60% of patients get a 50% reduction in headache days by cycle two, with continued gain out to cycle five. It is not a cure. Many patients still need acute treatment and a preventative plan around the injections.
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What is the difference between Botox and a CGRP monoclonal antibody?
Botox blocks acetylcholine release at nerve endings around the head and neck; CGRP mAbs (erenumab, fremanezumab, galcanezumab, eptinezumab) block calcitonin gene-related peptide signalling. CGRP mAbs work in both episodic and chronic migraine, are self-injected monthly or every three months at home, and have a different side-effect profile. Both are legitimate first calls in chronic migraine; we help you choose.
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When should Botox be stopped for chronic migraine?
Per NICE TA260, Botox is stopped after two cycles if the patient has not experienced at least a 30% reduction in headache days per month, and after a year if the chronic migraine has changed to episodic migraine (fewer than 15 headache days per month) that could be maintained on other treatment.
Ready when you are
Send your headache diary. We match you to a consultant within a working day.
No pressure, no automated funnels. A neurologist reviews your diary and comes back with a plan - Botox, CGRP mAb, gepant or nerve block - with firm private figures and NHS pathway options.
Related
Looking for something else?
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Migraine
The condition guide: types, triggers and treatment.
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CGRP monoclonal antibodies
Erenumab, fremanezumab, galcanezumab and eptinezumab.
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Occipital nerve block
Local anaesthetic and steroid block for headache.
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Greater occipital nerve block
Bridging treatment for chronic migraine and cluster.
Learn more -
Nerve conduction and EMG
When cervicogenic or neuralgic overlap complicates the picture.
Learn more