For many people, yes. In the trials behind the UK licence, and in ten years of real-world data since, botulinum toxin type A cut headache days by roughly 30 to 50% in people who responded: someone with 20 headache days a month might drop to 10 to 14. Some people improve more, and some not at all, which is why the treatment is judged after two sessions and stopped if it has not helped. It can also make the remaining attacks milder.

It is not fully understood. Botulinum toxin type A blocks the release of chemical messengers from nerve endings, and the current view is that it reduces the pain signals from the nerves around the head and neck that feed into a migraine, rather than working by relaxing muscles alone.

At 31 fixed points: the forehead and between the eyebrows, both temples, the back of the head, the back of the neck and the top of the shoulders. Up to 8 more can be added where your pain usually sits, so a session is 31 to 39 injections. The pattern is the standard one used in UK headache clinics.

Most people describe it as uncomfortable rather than painful: a very fine needle and a quick sting at each point, with the back of the head and neck the most noticeable. No anaesthetic is needed and the whole session takes 15 to 20 minutes. The injected areas can ache for a day or two afterwards.

The licensed dose for chronic migraine is 155 units, 5 units at each of the 31 fixed points, and up to 195 units when the extra points are added. That is several times the amount used in a cosmetic anti-wrinkle treatment, spread over the head, neck and shoulders rather than the face.

Most people notice a change two to three weeks after a session. The effect lasts about three months, which is why sessions are every 12 weeks. The benefit often grows with the second and third sessions, so the decision on whether it is working is made after two.

You can drive home, go back to work and shower the same day. For the rest of that day we advise not rubbing or massaging the injected areas, staying upright for about four hours, and skipping hard exercise, saunas and very hot showers. Leave a hairdresser’s appointment, hair dye or a head and neck massage for a day or two, so nothing presses on the injection points.

The common ones are neck pain or stiffness, muscle aches or weakness in the neck and shoulders, soreness or a rash where the needle went in, and a drooping eyelid or heavy brow. Some people have a worse headache for a few days at first. They are usually mild and wear off within days to weeks. Very rarely the medicine spreads beyond where it was injected and causes difficulty swallowing, speaking or breathing: that needs urgent medical help.

Studies following people for several years of repeated sessions have not found new problems over time, and the side effects stay the same as in the first year. Neck weakness can be more noticeable in the first sessions. We review you at every session and stop the treatment once your migraine has been episodic (under 15 headache days a month) for three months in a row.

Nothing sudden: there is no withdrawal effect. The medicine wears off over about three months, as it does between sessions, and for some people migraine days slowly creep back while for others they stay down. We plan a trial without treatment once your migraine has been episodic for three months, keep the diary going, and restart if the headache days return.

At OneMedicine the consultation is £95 and each treatment session is £395, which includes the medicine and the injections. At four sessions a year that is £1580 a year, plus the first consultation. Independent clinics in the UK charge roughly £335 to £950 a session.

Yes, if you meet the NICE criteria: chronic migraine, at least three preventive medicines tried without success, and medication overuse dealt with. Your GP refers you to a neurologist or specialist headache clinic, and the wait in the West Midlands can be many months. People come to us to start sooner or to avoid a gap in treatment; we write to your GP with your consent.

No. You can book the consultation directly. Bring any letters from a neurologist or headache clinic, and your diary. If anything suggests a cause other than migraine, we will refer you on rather than treat.

The treatment is licensed only for chronic migraine. Trials in tension-type headache and in episodic migraine (fewer than 15 headache days a month) did not show a worthwhile benefit, so we do not offer it for them. For episodic migraine, preventive tablets or a CGRP-targeting medicine are the better routes, and a GP appointment is the place to start.

It is the same family of medicine but a different treatment: a higher total dose, more injection sites including the back of the head, neck and shoulders, and a strict pattern that follows the nerves involved in migraine. The Migraine Trust advises having it only from someone trained in the migraine protocol, not as a cosmetic treatment.

A little, and only for as long as the treatment lasts. Because some injections go into the forehead, lines there usually soften and frowning is harder. A few people notice a heavy or lowered brow, or a slightly drooping eyelid, for a few weeks. The injection pattern is set for migraine, not for appearance, and everything wears off over about three months.

It is not recommended, because there is too little information on its safety in pregnancy and breastfeeding. Tell us if you are pregnant, planning a pregnancy or breastfeeding, and we will discuss migraine treatments that are safer at this time.

Yes. Most people carry on with their preventive tablets and their usual treatment for attacks, at least at first. Once the injections are working, some reduce or stop a tablet with their doctor. We will also look at how often you use painkillers, because cutting back helps the injections work.