Focused Clinical Interest

Headache & Migraine
Dr. Mit Ankur Raval

Focused headache medicine including migraine, chronic migraine, cluster headache, medication-overuse headache and complex headache presentations.

Understanding headache

Not every headache is migraine—and not every migraine looks the same.

The clinical pattern matters: frequency, duration, associated symptoms, triggers, medication use, disability and neurological examination.

Migraine

Recurrent neurological attacks that may include headache, nausea, vomiting, light/sound sensitivity and aura in some patients.

Chronic migraine

Frequent headache requiring structured diagnosis and preventive treatment planning.

Cluster headache

Severe recurrent attacks with characteristic cranial autonomic symptoms.

Medication-overuse headache

Frequent acute medication use can contribute to persistent headache in susceptible patients.

Secondary headache

Some headaches are caused by another underlying condition and require appropriate investigation.

Headache diary

Frequency, duration, associated symptoms, medication use and treatment response help make consultations more productive.

Treatment planning

Four questions guide most headache treatment plans.

What is the diagnosis?

Migraine, cluster headache, medication-overuse headache and secondary headache have different pathways.

How frequent is the headache?

Headache-day frequency helps determine whether preventive treatment should be considered.

What has been tried?

Previous acute and preventive therapies, response and side effects guide the next step.

Are there warning features?

Sudden severe onset, new neurological deficits or a major change in pattern may require urgent evaluation.

Botulinum toxin

A specialist treatment for selected neurological conditions.

Chronic migraine

OnabotulinumtoxinA is an established preventive option for appropriately diagnosed chronic migraine.

Dystonia

Targeted botulinum toxin is commonly used for selected focal and segmental dystonias.

Focal spasticity

Selected post-stroke or other focal spasticity may benefit from targeted treatment.

Individualised decision

Suitability depends on diagnosis, phenotype, functional goals and previous treatment response.

Patient questions

Common questions about headache

When is a headache an emergency?
Sudden severe headache, new focal neurological deficit, seizure, loss of consciousness or severe confusion requires urgent assessment.
Do all headaches need an MRI?
No. Imaging is guided by the clinical history and neurological examination.
Can chronic migraine be treated with botulinum toxin?
Yes, in appropriately diagnosed chronic migraine after specialist assessment.
What should I bring?
A headache diary, medication list, previous preventive trials and relevant reports are useful.
Selected references: International Classification of Headache Disorders (ICHD-3) and current American Headache Society clinical guidance.
Appointments

Book a neurological consultation.

Clinic and appointment details will be updated here.

Important: This website provides general information and is not a substitute for an in-person medical consultation. In an emergency, seek immediate medical care.
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