"Just take paracetamol and lie down in a dark room.", what you've probably been told
Migraine
NHS guideline CG150 sets the diagnostic pathway for migraine and lists the preventive treatments that should be tried (propranolol, topiramate, amitriptyline, and candesartan as an off-label option). Once a patient has failed at least three preventives, separate NHS Technology Appraisals cover CGRP monoclonal antibody injections (TA682 erenumab, TA659 galcanezumab, TA764 fremanezumab, TA871 eptinezumab); TA260 covers Botox for chronic migraine.
The wait: Most patients fail 2–3 preventives before anyone mentions CGRP injections.
What GPs miss
GPs often stop at one or two preventives and never document the failure trail that unlocks CGRP injections or Botox. Candesartan as an off-label preventive is frequently forgotten. Medication-overuse headache from daily triptans or codeine is also routinely missed, and patients are rarely told that CGRP injections are NHS-funded under specific NHS Technology Appraisals once the preventive ladder is exhausted.
The letter asks for
- A CG150-aligned diagnosis (migraine with/without aura, chronic migraine, medication-overuse headache)
- A documented preventive trial history, with dose and duration for each preventive offered
- Neurology referral where ≥3 preventives have been tried without benefit, citing the CGRP TA criteria (TA682, TA659, TA764, TA871)
- Consideration of Botox for chronic migraine under TA260 where criteria are met
- A medication-overuse headache review where acute treatments are used on ≥10–15 days per month
Ready to act on what you just read?
Get a formal Migraine letter to your GP, drafted, cited, and sent in minutes.
Frequently asked questions
Can my GP prescribe CGRP injections?
No. CGRP monoclonal antibodies are specialist-initiated under the relevant NHS Technology Appraisals. The letter asks the GP to refer to neurology once the documented preventive trail meets the TA criteria.
What counts as a failed preventive?
Generally an adequate dose for at least 3 months without meaningful benefit, or stopped due to intolerable side effects. The letter asks for that history to be written down so the neurology referral isn't bounced.
What you hear vs. what CG150 says
What's usually said in the room
"Just take paracetamol and lie down in a dark room."
What the guideline actually says
GPs often stop at one or two preventives and never document the failure trail that unlocks CGRP injections or Botox. Candesartan as an off-label preventive is frequently forgotten. Medication-overuse headache from daily triptans or codeine is also routinely missed, and patients are rarely told that CGRP injections are NHS-funded under specific NHS Technology Appraisals once the preventive ladder is exhausted.
Source: Headaches in over 12s: diagnosis and management (CG150)
Benefits and rights for Migraine
Outcomes from people with Migraine
One short email each Sunday, anonymised stories from people who got their GP to take them seriously.