Concierge neurology · London
Migraine and headache treatment, by a consultant neurologist.
A NICE NG150-aligned pathway - acute rescue, proper prophylaxis, MOH prevention, and the interventional options (CGRP mAbs, PREEMPT Botox, occipital blocks, IV Vyepti) when they are the right next step.
Why patients choose us
- 01
A consultant neurologist, not a GP triage line
A named headache-specialist neurologist reviews your diary, your red flags and your medication history - then builds the plan.
- 02
NICE NG150 and BASH, followed properly
Stepped acute + preventive care, MOH prevention, CGRP mAbs (NICE TA764/TA765) and Botox for chronic migraine (TA260) when you meet criteria.
- 03
Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Indicative pricing
What private headache and migraine care costs in London.
Indicative ranges across our partner clinics. Send the details and we quote firm figures across two or three neurologists.
In short
A first consultant-neurologist consultation: £250–£450, with a full written stepped-care plan.
| Service | Indicative range | Typical duration | Turnaround |
|---|---|---|---|
| Neurology consultation (initial) | £250–£450 | 45–60 min | Written plan same week |
| Follow-up neurology review | £180–£300 | 30 min | Same visit |
| MRI brain (to exclude secondary cause) | £350–£700 | 25 min | 24–72 hours |
| Occipital nerve block (bilateral) | £350–£650 | 20 min | Same visit |
| PREEMPT Botox for chronic migraine | £600–£1,200 | 30 min | Every 12 weeks |
| CGRP monoclonal antibody (monthly) | £400–£600/month | SC injection | Monthly or quarterly |
| Vyepti (eptinezumab) IV infusion | £900–£1,500 | 30 min IV | Every 12 weeks |
Prices vary by clinic, by neurologist, and by whether you need imaging, an interventional procedure, or a specialist biologic. Under the NHS, first-line care is free; the pathway above is for those choosing private care or specialist access outside NHS waits.
The problem
The right diagnosis, the right ladder, the right specialist step.
Headache is under-diagnosed and over-medicated in equal measure. A rushed prescription of stronger painkillers usually makes it worse. A proper NG150 pathway, and knowing when to escalate, is what actually helps.
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Painkillers making it worse?
Medication overuse headache is the commonest missed diagnosis. Withdrawal, done properly, lifts a daily headache in weeks.
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Preventives not working?
Most have not been tried at target dose for long enough. We audit what you have had, and finish the ladder before escalating.
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Ready for a biologic?
CGRP monoclonal antibodies and PREEMPT Botox change lives for chronic migraine - when you meet NICE criteria. We tell you if you do.
The journey
From first enquiry to a stepped plan - what happens, in order.
One neurologist from first message to review - including the interventional step if you need it.
Phase 1 · Before the consultation
Concierge, off-stage for you
Phase 2 · In clinic
Assessment and plan
Phase 3 · After
Titration and review
- 01
Before
You tell us what is going on
A short, confidential form: headache pattern, frequency, current medications, what has failed, and any red flags.
- 02
Before
We come back with a recommendation
Within one working day: the right neurologist, whether imaging is needed, indicative price, and whether CGRP-mAb or Botox might apply.
- 03
Before
Headache diary and workup
A 4-week diary, plus MRI brain if red flags or diagnostic uncertainty. Bloods where indicated (TFTs, ESR/CRP over 50).
- 04
In clinic
Neurology consultation
A full 45–60 minute assessment. Diagnosis (migraine ± aura, tension-type, cluster, secondary), MOH screen, and a written plan.
- 05
In clinic
Acute + preventive plan started
Acute rescue prescribed (triptan, gepant, or oxygen for cluster). Prophylaxis started if ≥4 disabling days/month.
- 06
After
Specialist interventions if needed
Occipital nerve blocks, PREEMPT Botox, CGRP-mAb (erenumab, fremanezumab, galcanezumab), or IV eptinezumab (Vyepti) as indicated.
- 07
After
Review at 8–12 weeks
Diary reviewed, response measured, dose titrated. Preventives given 8–12 weeks at target dose before deciding they have failed.
Typical end-to-end: 1–2 weeks to first appointment. Response to preventives assessed at 8–12 weeks.
When it helps
The headache patterns we treat - and the one that means A&E.
Migraine (episodic and chronic), cluster, tension-type, medication overuse and the specialist-referral situations - plus the red-flag pattern that is emergency, not clinic.
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Migraine with or without aura
Throbbing, one-sided, nausea, light and sound sensitivity - with or without visual, sensory or speech aura before the headache.
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Chronic migraine (≥15 days/month)
Headache on 15 or more days a month for over 3 months, at least 8 of them migrainous - a specialist pathway, and CGRP/Botox territory.
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Tension-type headache
Bilateral, pressing, mild-to-moderate, no nausea - often stress, posture and sleep-driven, and usually managed in primary care.
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Cluster headache
Severe unilateral orbital pain with tearing, congestion, ptosis; attacks in bouts. High-flow oxygen and SC sumatriptan are first-line.
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Medication overuse headache (MOH)
Triptans or opioids on ≥10 days/month, or simple analgesia on ≥15 days/month, driving a daily headache - the fix is withdrawal.
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Failed ≥3 prophylactics
Propranolol, topiramate, amitriptyline, candesartan tried at target dose for 8–12 weeks each - time to consider CGRP-mAb or Botox.
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Pregnancy planning with migraine
Sodium valproate is contraindicated. Topiramate needs Pregnancy Prevention Programme review. A specialist plan matters.
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Red flag: thunderclap or new focal
Sudden worst-ever headache, new headache over 50, progressive, positional, worse on cough, focal neurology, fever, immunocompromise - A&E, not clinic.
Treatment options
Acute rescue, prevention, and specialist interventions.
What NICE NG150 and BASH actually recommend, in the order we escalate - from a simple painkiller-plus-triptan ladder to CGRP monoclonal antibodies and PREEMPT Botox.
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Acute treatment - migraine
Paracetamol + NSAID first; triptan (sumatriptan, rizatriptan, zolmitriptan, eletriptan) second; anti-emetic (metoclopramide, prochlorperazine) added. Avoid opioids - they drive MOH.
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Gepants and ditans
Rimegepant, ubrogepant (CGRP-receptor antagonists) and lasmiditan (ditan) - newer NICE-approved options when triptans fail, are contraindicated, or cardiovascular risk applies.
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Acute treatment - cluster
High-flow oxygen 12–15 L/min via non-rebreather mask (NG150 first-line, 70% response by 15 min) plus subcutaneous or nasal sumatriptan. Verapamil or lithium prophylaxis by specialist.
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Oral prophylaxis
First-line: propranolol, topiramate, amitriptyline, candesartan. Second-line: sodium valproate (not in women of childbearing potential without PPP), pizotifen, flunarizine.
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CGRP monoclonal antibodies
Erenumab (NICE TA764), fremanezumab (TA765), galcanezumab (TA764) - chronic migraine after ≥3 failed prophylactics. Monthly or quarterly SC injection, specialist-initiated.
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PREEMPT Botox for chronic migraine
NICE TA260: 155–195 units across 31–39 sites every 12 weeks. For chronic migraine that has failed ≥3 preventives. Specialist neurology only.
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Interventional headache procedures
Occipital nerve block (LA + steroid) for cervicogenic and chronic migraine; sphenopalatine ganglion block for chronic cluster; nerve stimulation (occipital, vagal, Cefaly) for the refractory.
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IV eptinezumab (Vyepti)
Quarterly IV infusion - a same-day rescue for chronic migraine when SC CGRP-mAbs have not worked. See our dedicated Vyepti page.
Our vetted London network
A small panel of headache neurologists, we picked them.
Consultant neurologists with a headache-specialist interest, tertiary access for Botox and biologics, and a proper stepped-care philosophy - introductions are made privately, once we understand your case.
Selection criteria
How we choose every neurologist in our network.
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Consultant neurologists with a headache subspecialty interest
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Tertiary-centre access for Botox, CGRP-mAb approval, and refractory cases
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Same-week MRI brain when red flags need excluding
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Written stepped-care plan aligned with NICE NG150 and BASH guidance
Safety and eligibility
What to plan for - honestly.
The traps (MOH, triptan cautions, teratogenicity), the disciplines (target dose, 8–12 weeks) and the red flags that mean imaging or A&E now, not a review appointment.
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Medication overuse headache is the trap
Triptans and opioids on 10 or more days a month - or simple analgesia on 15 or more - turn episodic migraine into daily headache. Limits matter more than potency.
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Triptans and cardiovascular risk
Triptans are vasoconstrictors - a full cardiovascular history is taken first. Uncontrolled hypertension, ischaemic heart disease and prior stroke rule them out.
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Topiramate needs counselling
Cognitive slowing, weight loss, kidney stones and - importantly - high teratogenic risk. Pregnancy Prevention Programme in women of childbearing potential.
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Sodium valproate is a last resort
Absolutely contraindicated in women of childbearing potential without a Pregnancy Prevention Programme. We rarely start it, and never lightly.
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Preventives need 8–12 weeks at target dose
A prophylactic has not failed until it has been titrated to the target dose and given a proper 8–12-week trial. Otherwise we chase our tails.
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Cluster headache: oxygen first
A non-rebreather mask at 12–15 L/min aborts around 70% of cluster attacks within 15 minutes. It is the most underused first-line treatment in headache.
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CGRP-mAbs are game-changing but not universal
Around half of chronic migraine patients get a ≥50% reduction. Response is assessed at 3 months. Cost-effective under NICE only after ≥3 failed preventives.
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Red flags mean imaging, not reassurance
Thunderclap onset, progressive daily headache, new headache over 50, focal neurology, positional pattern, cough-worsened, fever or weight loss - MRI now.
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A headache diary earns its keep
Four weeks of days, triggers, medications and severity turns a foggy story into a diagnosis and a treatment plan. Bring it to every review.
Your written headache plan
Your plan in four parts. Read the last one first.
Whichever pathway you end up on, the plan the neurologist writes for you keeps to the same shape.
A quiet reminder
A headache plan is a ladder, not a single prescription - expect to iterate.
If you would like us to talk you through the plan before your review, just ask.
- 01 Diagnosis
Headache type and any red-flag work-up
Migraine with/without aura, tension-type, cluster, or a secondary cause - with the MRI or bloods that ruled out anything sinister.
- 02 Acute plan
What to take, when, and the ceiling
Your acute rescue (triptan, gepant, oxygen) and the strict day-count limits that stop medication overuse headache.
- 03 Prevention
Prophylactic ladder and eligibility flags
Which preventives to try in what order, target doses, review timing - and whether you meet criteria for Botox or a CGRP-mAb.
- 04 Follow-up
Diary, review timing and safety-net
Read this first: how to track response, when to review, and the symptoms that mean you contact us or A&E straight away.
Recognised by major UK insurers
Cover for neurology consultations, imaging, Botox and CGRP-mAbs varies by insurer and by indication - usually funded when medically indicated and NICE criteria are met. We confirm cover before booking.
Frequently asked
Everything we get asked about migraine and headache treatment.
Quick answers on when to see a neurologist, what NICE recommends, CGRP mAbs, Botox and medication overuse headache.
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When should I see a neurologist rather than my GP for headaches?
If you have red flags (thunderclap, new headache over 50, progressive or positional pattern, focal neurology, fever), if three prophylactics have failed at target dose for 8–12 weeks each, if you have chronic migraine (≥15 headache days a month), suspected medication overuse headache, cluster headache, or you are planning pregnancy on preventives. Everything else can start in primary care.
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What is the first-line treatment for a migraine attack?
NICE NG150 recommends paracetamol plus an NSAID as first-line, adding an anti-emetic (metoclopramide or prochlorperazine) for nausea. A triptan (sumatriptan, rizatriptan, zolmitriptan or eletriptan) is second-line, taken at the earliest sign of pain. Opioids are avoided - they drive medication overuse headache.
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What are CGRP monoclonal antibodies and do I qualify?
Erenumab, fremanezumab and galcanezumab are monthly (or quarterly) subcutaneous injections that block calcitonin gene-related peptide, a key driver of migraine. Under NICE TA764/TA765 they are funded for chronic migraine after three failed oral preventives. Private cost is £400–£600 per month; response is reviewed at 3 months.
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Does Botox work for migraine?
Yes - for chronic migraine (≥15 headache days a month, ≥8 migrainous) that has failed three preventives. NICE TA260 approves the PREEMPT protocol: 155–195 units across 31–39 sites every 12 weeks. Private cost is £600–£1,200 per session. It does not help episodic migraine.
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What is cluster headache treated with?
Acute attacks respond to high-flow oxygen at 12–15 L/min via a non-rebreather mask (aborts around 70% within 15 minutes) and subcutaneous or nasal sumatriptan. Prophylaxis is verapamil (with ECG monitoring) or, for chronic cluster, lithium - both specialist-initiated.
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How do I avoid medication overuse headache?
Keep acute treatments to a hard limit: triptans and opioids on no more than 10 days a month, simple analgesia on no more than 15 days a month. If you are already using more, the treatment is a supervised withdrawal - the daily headache lifts within 4–8 weeks in most people.
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Do I need a brain scan for my headaches?
Most primary headaches (migraine, tension, cluster) need no imaging - the diagnosis is clinical. An MRI brain is warranted for red flags: thunderclap onset, new headache over 50, progressive daily worsening, positional or cough-worsened pattern, focal neurology, immunocompromise, fever or unexplained weight loss.
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What non-drug treatments actually help?
Trigger identification via a diary, sleep hygiene, hydration, regular meals, moderated caffeine, aerobic exercise, stress management or CBT, and - with NICE support - acupuncture for prophylaxis of migraine and tension-type headache. Weight management helps if BMI is above 27. Physiotherapy helps neck-associated headache.
Related pages
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All tests and procedures
Every test and procedure we arrange.
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