Headaches
Most people have suffered from headaches and one in twenty people suffer from chronic severe headaches, yet few receive a correct diagnosis and even fewer receive appropriate therapies to treat their headache. Migraine is the commonest cause of severe headaches and treatment may require a combination of lifestyle changes, acute medications and preventative measures. Only a minority of migraine p
What it is
Primary headaches (migraine, tension-type, cluster, hemicrania continua, new daily persistent headache) account for the great majority of presentations. Secondary headaches — from medication overuse, raised intracranial pressure, temporal arteritis, sinus disease and (rarely) more serious causes — are identified by red-flag screening at every consultation.
Symptoms and signs
- Recurrent throbbing, often one-sided headaches with nausea, light or sound sensitivity (migraine).
- A pressing, band-like all-day headache without aggravation by activity (tension-type).
- Severe, strictly one-sided eye pain with watering or nasal blockage, in short attacks (cluster).
- Headache that has changed pattern, woken you from sleep, or is associated with vision change, weakness or fever — needs prompt assessment.
- Daily-use of over-the-counter analgesia driving rebound headache — increasingly common and reversible.
How we investigate
Structured history with a 4-week headache diary, neurological examination and red-flag screen. MRI brain via partner imaging centres where indicated. Bloods include ESR (older patients, suspected GCA), thyroid, B12 and inflammatory markers. We will not order an MRI unnecessarily — overinvestigation of clear migraine is itself a problem.
Treatment options at The Vesey
- Migraine acute therapy — triptans, gepants (ubrogepant/rimegepant), NSAIDs and antiemetics, with explicit limits to prevent medication-overuse headache.
- Migraine prevention — beta-blockers, candesartan, topiramate, amitriptyline, and CGRP-targeted monoclonal antibodies (erenumab, fremanezumab, galcanezumab) for refractory cases.
- Botulinum toxin (BoNT-A) PREEMPT protocol — for chronic migraine (≥ 15 headache days/month) failing two preventatives. Performed in clinic; insured cover available with BUPA, Vitality and AXA.
- Cluster headache — high-flow oxygen, sumatriptan SC, verapamil, occipital nerve block as bridging therapy.
- Medication-overuse withdrawal pathway — supported with a clear schedule, preventative cover and follow-up.
What is medication-overuse headache and how is it treated? +
Medication-overuse headache (MOH) develops when painkillers — including paracetamol, ibuprofen and triptans — are used on 10 or more days per month. The treatment is a supported withdrawal of the overused medication, covered by a preventative. Most patients see significant improvement within 6–8 weeks.
What is the PREEMPT botulinum toxin protocol for chronic migraine? +
The PREEMPT protocol involves 31 injections of botulinum toxin A across 7 muscle groups of the head and neck, repeated every 12 weeks. It is licensed and NICE-approved for chronic migraine (≥15 headache days/month) that has failed at least two oral preventatives. Insured cover is available with BUPA, Vitality and AXA.
Do I need an MRI for my headaches? +
Most migraines and tension-type headaches do not require an MRI. We arrange brain imaging where there is a change in headache character, new neurological symptoms, onset after age 50, exertional headache, or features that could indicate raised pressure. Unnecessary MRI can cause anxiety without benefit.
What CGRP treatments are available for migraine prevention? +
Monoclonal antibodies targeting CGRP — erenumab (Aimovig), fremanezumab (Ajovy) and galcanezumab (Emgality) — are highly effective for both episodic and chronic migraine and are administered by monthly or quarterly injection. They are available at The Vesey for self-pay and are covered by some insurers following prior authorisation.
Pricing at a glance
Initial neurology consultation £290 (60 minutes). Follow-up reviews £190. BoNT-A PREEMPT injection cycle from £540 (drug additional, insured cover available). MRI brain via partner from £450. Insurance accepted: BUPA, Vitality, AXA, WPA, Cigna, Aviva, Healix.
Book an appointment
When to see a specialist
Book if your headaches occur on 8 or more days a month, if you are using acute medication on 10 or more days a month, if your usual headache has changed character, or if you have been told "it's just migraine" without a structured prevention plan.
Cost and pathway
Initial neurology consultation £290 (60 minutes). Follow-up reviews £190. BoNT-A PREEMPT injection cycle from £540 (drug additional, insured cover available). MRI brain via partner from £450.
- Open 7 days including Sundays — 8am to 8pm, no weekend surcharge
- No GP referral required — book directly with our consultant neurology team
- Sutton Coldfield location — serving Birmingham, Walsall, Tamworth, Lichfield and the West Midlands
- CQC-regulated — rated 4.87/5 on Doctify from 700+ verified reviews
Sutton Coldfield · Birmingham · Walsall · Tamworth · Lichfield · West Midlands · Open 7 days 8am–8pm
Open 7 days · 8am–8pm · 0121 387 3727