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Muscle Relaxant Injections for Migraine

Chronic migraine treatment with PREEMPT 31-point botulinum toxin protocol. Performed by GMC Specialist Register plastic surgeons. From £995 per session. CQC-regulated Baker Street clinic.

Muscle Relaxant Injections for Chronic Migraine at Centre for Surgery, London

Migraine injection treatment in summary: Botulinum toxin injection therapy delivered using the established PREEMPT 31-point protocol — the only UK-licensed botulinum toxin treatment for chronic migraine. Performed exclusively by GMC Specialist Register plastic surgeons at Centre for Surgery. Treatment is delivered every 12 weeks; effects develop over 4–6 weeks, with full benefit best assessed after 2 complete cycles (24 weeks). Suitable for adults with chronic migraine (15+ headache days per month including 8+ migraine days) who haven’t responded adequately to at least 3 oral preventive medications. From £995 per session. CQC-regulated clinic, 0% APR finance available subject to status.

This is a clinical treatment, not a cosmetic one. Botulinum toxin for chronic migraine is licensed in the UK by the MHRA (specifically for chronic migraine) and supported by NICE Technology Appraisal guidance TA260. The injection protocol is fundamentally different from cosmetic anti wrinkle treatment — it involves 31 small injections across 7 anatomical sites (corrugator, procerus, frontalis, temporalis, occipitalis, cervical paraspinal, trapezius). Many patients we treat have been referred by GPs or neurology teams; others self-refer with documented migraine diagnosis from prior assessment.

Plastic surgeon-led care. The PREEMPT protocol involves precise placement at 31 anatomical sites including muscles in the back of the neck and shoulders that aren’t part of cosmetic injection practice. Plastic surgeons train in detailed head, neck, and shoulder anatomy throughout their decade of specialist training. The same anatomical knowledge that informs surgical work — facelift, brow lift, neck lift — directly informs accurate injection placement for the migraine protocol.

What we’ll tell you honestly: This treatment helps approximately 50% of chronic migraine patients achieve a 50% reduction in headache days. It doesn’t help everyone. We commit to 2 full cycles (24 weeks, 2 sessions) to fairly assess your response, and we will tell you directly if the treatment isn’t working for you and recommend alternative approaches via your headache specialist.

Related content at Centre for Surgery:

What is Chronic Migraine?

Chronic migraine has a precise clinical definition that determines whether botulinum toxin treatment is appropriate. Understanding this matters because the licensed indication is specifically chronic migraine — not episodic migraine, not tension-type headache, and not other primary headache disorders.

According to International Classification of Headache Disorders (ICHD-3) criteria, chronic migraine requires:

Diagnosis is clinical, based on a careful headache history — your GP, neurologist, or headache specialist takes a detailed history of headache pattern, associated symptoms, triggers, family history, and previous treatments. A headache diary is the most useful tool for diagnosis and is essential before starting any preventive treatment.

We will not deliver this treatment unless we are confident your headache pattern is chronic migraine — because the treatment doesn’t work for the other primary headache disorders, and using it incorrectly delays you accessing the right management. At consultation we’ll review:

If your pattern doesn’t fit chronic migraine, we will recommend headache specialist referral before treatment.

How Botulinum Toxin Treats Chronic Migraine

The exact mechanism by which botulinum toxin reduces migraine frequency isn’t fully understood — but several validated clinical observations explain why it works for many patients with chronic migraine.

Unlike toxin’s effect on muscle (which appears within 3–7 days), the migraine-prevention effect develops more gradually. Patients typically see meaningful change at weeks 2–4 of the first cycle, with peak effect at weeks 4–6. The cumulative benefit builds across multiple cycles — many patients respond best after 2–3 cycles, suggesting a slow modulation of pain pathways.

The PREEMPT protocol was developed in two large clinical trials and uses a fixed pattern of injections at sites that are anatomically associated with the trigeminal and cervical nerve distributions involved in migraine pain. The protocol distributes treatment across:

Total: 31 injections delivering 155 units of botulinum toxin. Patients with pain that concentrates at specific additional sites can receive "follow-the-pain" injections taking total dose up to 195 units.

Who is Suitable for Migraine Injection Treatment?

Migraine injection treatment is appropriate for a specific group of patients — those with chronic migraine who haven’t responded adequately to oral preventive medications. Suitability is confirmed at consultation with the plastic surgeon, with reference to your headache history and previous treatment.

A face-to-face consultation with the plastic surgeon is required. We’re happy to communicate with your GP, neurologist, or headache specialist if you have an existing care team.

Preparing for Migraine Injection Treatment

Preparation for migraine injection treatment is similar to other botulinum toxin treatments but with some clinical-specific considerations.

The Migraine Injection Procedure

The PREEMPT protocol takes 15–20 minutes for the 31 injections. Allow 45–60 minutes total for the appointment including consultation review, photographs, and aftercare advice.

The standard distribution of injections:

Total: 31 injections, 155 units of botulinum toxin.

For patients whose pain consistently concentrates at specific additional sites (e.g. one temple more than the other, or a particular occipital area), additional injections of 5 units each can be added at those sites — up to a maximum total of 195 units. These additional injections are tailored to your specific pain pattern.

Each injection is a brief pinprick. The forehead and temple injections feel similar to cosmetic anti wrinkle treatment. The neck and shoulder injections involve a slightly deeper needle but most patients describe these as more uncomfortable than painful. Most patients rate the overall discomfort 3–5 out of 10 — manageable without topical numbing for most patients.

After your first session, the next is booked for 12 weeks later. The pattern continues every 12 weeks. We ask you to maintain your headache diary throughout — this is essential for objectively assessing response.

Aftercare After Migraine Injection Treatment

Recovery in summary: Minimal downtime. Resume work and most normal activities the same day. Avoid lying flat, heavy exercise, and head/neck massage for 4 hours. Avoid alcohol for 24 hours. Some patients experience mild transient headache for 24 hours after the first session. Effects build over 4–6 weeks; full benefit best assessed after 2 cycles (24 weeks).

After 2 complete cycles (2 sessions of treatment), we review:

NICE recommends continuation of treatment if there has been a 30% reduction in headache days. Patients who haven’t responded by 24 weeks are unlikely to respond, and we recommend exploring alternative preventive options (CGRP antagonists, different oral preventives) with your GP or headache specialist. We will be honest with you if treatment isn’t working.

For responders, treatment continues every 12 weeks indefinitely. Some patients eventually space treatment further apart (16–20 weeks) if their migraine pattern improves significantly. A small number can stop treatment after a sustained period of improvement with their migraines remaining controlled.

Contact us on if you experience:

How Botulinum Toxin Compares to Other Migraine Preventives

Botulinum toxin is one of several preventive treatments for chronic migraine. Understanding where it fits in the treatment ladder helps set expectations and inform decision-making.

We are most often seeing patients who have:

We work within the established UK treatment pathway. We don’t recommend bypassing first-line oral preventives without appropriate trial and assessment. If your migraine has not been formally assessed by a headache specialist, we will discuss whether referral first is the right approach.

Most patients continue their existing oral preventive medication when they start botulinum toxin. The two work via different mechanisms and aren’t in direct competition. Decisions about reducing or stopping oral preventives are made with your GP or neurologist after observing response to botulinum toxin over several cycles.

Risks and Side Effects of Migraine Injection Treatment

Botulinum toxin for chronic migraine is well-established and considered low-risk when delivered using the PREEMPT protocol by appropriately trained clinicians. The treatment has decades of safety data both for the licensed migraine indication and for cosmetic and other clinical uses of the same product.

Many chronic migraine patients are on this treatment for years. Long-term safety data is reassuring — there’s no signal for cumulative toxicity, antibody resistance, or systemic effects from regular 12-weekly treatment. Some patients develop reduced response over time (potentially due to immunological tolerance), and switching to a different botulinum toxin formulation can sometimes restore effect. We will discuss this if it becomes relevant for you.

The treatment is not appropriate for:

The PREEMPT protocol’s safety profile depends substantially on accurate placement. Plastic surgeons train in the detailed anatomy of:

This anatomical depth is the same training that informs surgical work on facelift, brow lift, and neck lift — and directly informs migraine injection placement.

Migraine Injection Cost in London — Plastic Surgeon-Led Pricing

Migraine injection treatment at Centre for Surgery is £995 per session using the standard PREEMPT 31-point protocol. Treatment is delivered every 12 weeks. Pricing reflects the GMC Specialist Register plastic surgeon credential and the use of full PREEMPT protocol dosing (155 units per session).

Every quote at Centre for Surgery includes:

There are no hidden charges. The price quoted at consultation is the price you pay.

The PREEMPT protocol requires 155 units of botulinum toxin — significantly more than cosmetic anti wrinkle treatment (typically 20–40 units) or jaw slimming (typically 50–80 units). The unit cost of toxin is the main driver of our pricing. Some clinics offer "migraine toxin" treatment at lower prices but with reduced injection numbers or under-dosing — this is not the validated PREEMPT protocol and may not deliver clinical benefit. We deliver full protocol dosing as established in the clinical trials and supported by NICE TA260 guidance.

Like all our injectable treatments, migraine treatment is delivered exclusively by GMC Specialist Register plastic surgeons. The PREEMPT protocol involves precise injection at 31 sites across the head, neck, and shoulders — accurate placement at the correct depth is the primary safety mitigation, particularly for neck and shoulder injections that aren’t part of cosmetic injection practice.

We recommend exploring NHS provision via your GP first if the cost is a concern, and considering private treatment through us if NHS waiting times are not workable for your circumstances.

For patients committing to multiple cycles, Chrysalis Finance offers payment plans across the treatment year. 0% APR options are available subject to status, with longer terms at variable rates.

Indicative monthly costs at 0% APR over 12 months:

We recommend committing to at least 2 cycles (2 sessions, 24 weeks) to fairly assess response before judging effectiveness — this is what NICE recommends and is consistent with the published clinical trial evidence.

Full finance details are on our , or speak to a patient coordinator on .

Why Choose Centre for Surgery for Migraine Injection Treatment

Migraine injection treatment is a clinical, not cosmetic, procedure. The patients we see are typically people whose lives have been significantly affected by chronic migraine over years — not aesthetic patients. Our approach reflects this clinical context.

Every injectable treatment at Centre for Surgery is performed by a plastic surgeon on the GMC Specialist Register. The PREEMPT protocol involves 31 precise injections across head, neck, and shoulder anatomy — significantly broader than cosmetic injection practice. Plastic surgeons train in detailed anatomy of all these regions throughout their decade of specialist training. This level of credential is uncommon for migraine injection treatment outside NHS headache clinics.

We deliver the complete PREEMPT 31-point, 155-unit protocol established in the clinical trials and supported by NICE TA260. We don’t offer abbreviated or under-dosed "migraine toxin" treatment that hasn’t been shown to work. If a patient needs follow-the-pain additional injections, these are added — taking total dose up to 195 units as specified in the published evidence.

We commit to 2 cycles (24 weeks) of treatment to fairly assess response, in line with NICE guidance. We ask all patients to maintain a headache diary throughout. At the 24-week point we objectively review response — and if treatment isn’t working, we say so directly and recommend alternative options via your headache specialist. We don’t continue treatment that isn’t delivering clinical benefit just because the patient is paying.

Centre for Surgery is a private clinic on Baker Street, London. The same clinical governance standards required of any private hospital apply at our clinic.

Most chronic migraine patients have an existing GP, neurologist, or headache specialist. We’re happy to communicate with your team — sharing assessment letters, response data, and treatment plans. We don’t position ourselves as replacing your headache specialist; we work alongside them. We will also recommend referral to a headache specialist if your case suggests this would be appropriate, particularly if your diagnosis is unclear or if other preventive options haven’t been adequately explored.

We will not deliver this treatment unless your headache pattern fits chronic migraine. If consultation suggests episodic migraine, tension-type headache, medication-overuse headache, or another primary headache disorder, we recommend appropriate management for that condition rather than starting toxin treatment that won’t help.

For patients with documented chronic migraine who have already had specialist assessment and tried multiple oral preventives, our service provides direct access to PREEMPT protocol treatment without lengthy NHS waiting times. Many of our patients have been on NHS waiting lists for months or years and choose private treatment for faster access.

The clinic is at 95–97 Baker Street, Marylebone, London W1U 6RN, a short walk from Baker Street tube station (Jubilee, Metropolitan, Circle, Hammersmith & City, and Bakerloo lines).

A face-to-face consultation with the plastic surgeon is required before any treatment.

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Address: 95–97 Baker Street, Marylebone, London W1U 6RN

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Finance options are available from , including 0% APR, subject to status.

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If you're considering plastic or cosmetic surgery in London, Centre for Surgery offers a level of clinical excellence that few clinics can match.



All procedures at Centre for Surgery are performed exclusively by GMC specialist-registered consultant plastic surgeons — the highest qualification available in the UK. Our surgeons hold positions on the GMC Specialist Register and are members of BAPRAS and ISAPS, ensuring you receive care from fully credentialled specialists, not cosmetic doctors.



Our purpose-built private hospital at Baker Street, Marylebone is independently regulated and inspected by the Care Quality Commission (CQC), which awarded us a Good rating — a standard very few cosmetic surgery facilities in the UK achieve. We use TIVA (Total Intravenous Anaesthesia) as standard, the safest and most advanced form of anaesthesia available for day case surgery.



We offer the full range of surgical and non-surgical treatments under one roof, with in-depth consultations directly with your surgeon — never a sales consultant. Flexible 0% APR finance is available through Chrysalis Finance, and our comprehensive aftercare programme includes 24/7 nursing support.

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Centre for Surgery is a CQC-regulated private hospital on London’s Baker Street, delivering plastic and cosmetic surgery through GMC-registered specialist surgeons. Our expertise spans facial procedures including and , , for men, and body contouring procedures such as and . Patient safety, surgical excellence and natural-looking results sit at the heart of everything we do.

Centre for Surgery is a CQC-regulated private hospital on London’s iconic , offering plastic and cosmetic surgery led by GMC-registered consultant surgeons.

Marylebone

London

W1U 6RN

Mon – Sat, 9am – 6pm

Saturday consultations available