Chronic migraine, specifically
Chronic migraine is not simply frequent headaches. It has a definition — headache on fifteen or more days a month for at least three months, with migraine features on at least eight of them — and that definition matters, because it determines what treatments are indicated and what insurers will cover.
By the time somebody reaches that threshold, they have usually reorganised a good deal of their life around it: work missed, plans cancelled, a permanent calculation about how far they are from a dark room.
The examination includes your neck
The upper cervical spine refers pain into the head convincingly. Cervicogenic headache — pain arising from the joints, muscles and nerves of the neck — typically starts at the base of the skull and spreads forward, tends to be one-sided and consistent about which side, and is provoked by sustained neck positions rather than by the classic migraine triggers.
It is commonly mistaken for migraine and treated as migraine for years. Conversely, plenty of genuine migraine sufferers also have a contributing neck problem that, treated, reduces their headache burden.
So the neck is examined here — range of movement, the upper cervical joints, the muscles that refer into the head — as part of the headache assessment rather than as a separate appointment. A physician board-certified in Physical Medicine & Rehabilitation is well placed to make that distinction.
Botox for chronic migraine
For patients who meet the criteria, onabotulinumtoxinA is an established preventive treatment. It is given as a series of small injections at defined sites across the forehead, temples, back of the head, neck and shoulders, following a standard protocol, and repeated every twelve weeks.
What to expect, honestly:
- It is preventive. It does nothing for a migraine you already have.
- The goal is fewer headache days per month, not their abolition.
- The benefit usually builds from the first cycle to the second, so assessment is made after two rounds rather than one.
- The appointment takes about fifteen minutes and you return to normal activity straight away.
What else is covered
Trigger point injections where muscles in the neck and shoulders are contributing. Identification of medication overuse headache, which is a genuinely common reason that headaches have become daily and which no injection will fix while it continues. A discussion of triggers, sleep and the practical patterns in your own headache diary.
If your history suggests something that needs a neurologist, you will be told and referred rather than treated here.