Chronic Migraine – GPs’ and Neurologists’ Different Approaches to Treatment

Not all prophylactic medications work for all migraine patients, and it can take some time to find the right one. Took me 13 years.
GPs know squat about treating migraines; they really are only allowed to go through a standard long list of prophylactics, which may or may not work. Typically, you are titrated up to a therapeutic dose and then kept on it for a minimum of three months. If by that time it hasn’t helped, they titrate you back down and move on to the next one. Common drugs prescribed by GPs include propanolol, amitriptyline, topiramate and dosulepine
If you’ve been seen by a neurologist who specializes in migraine, he and your GP can work together and try a larger variety of prophylactic meds on you. GPs are only allowed to prescribe a limited number of types of migraine meds because it’s technically outside their specialty. The neurologist can authorize the use of different meds or treatments, such as Tegretol, VerapamilBotox or sodium valproate – the drug I have been on since 2012  – You don’t get near any of those unless your migraines haven’t responded to the list of meds that your GP has already tried on you. 
Estrogen can be a very common migraine trigger, so if you have them frequently it might be worth switching to a progesterone-only pill (POP). They try to stay away from estrogen pills for migraine patients, but a GP might not pick up on that – a contraceptive specialist nurse, however, would.
Although my periods were never a migraine trigger, I’m on the POP because my periods were always extremely painful.


More information on Botox for chronic migraine in adultsThe Migraine Trust
Botox Treatment for Chronic Migraine – Salford Royal Hospital NHS Trust*

*Salford Royal is where I get my Botox done every 12 weeks, done by a specialist nurse, Siobhan Jones, under the care of Mr Adam Zermansky, consultant neurologist. Nurse Jones might be able to direct you to an NHS Trust in your area that offers Botox as a treatment option.