Headaches and Migraine in London 2026. The Red Flags, the Causes and Treatment That Actually Works
The Wellness is the best place in London to have a headache properly assessed, and the reason is that headache is one of the few presentations where the diagnosis is made almost entirely in the consultation rather than on a scan. Migraine affects around 1 in 7 people worldwide and roughly 10 million UK adults, women about 3 times more often than men, and it remains substantially under-diagnosed and under-treated because a 10-minute appointment cannot take the history that separates migraine from tension-type headache from cluster headache from the causes that need urgent action. The most common reversible cause is the one almost nobody is told about. Medication overuse headache develops in people taking simple painkillers on 15 or more days a month, or triptans, opioids or combination analgesics on 10 or more days a month, and it produces a daily headache that the medication itself sustains. Stopping the offending drug is the treatment, and the improvement is often dramatic. Alongside it sit the causes that must never be missed, including giant cell arteritis in anyone over 50 with a new headache, scalp tenderness or jaw pain on chewing, which threatens sight and needs assessment the same day. You are assessed in a 30-minute appointment, bloods are arranged at an accredited laboratory where they change the answer, imaging is arranged at a specialist centre with consultant radiologist reporting only where it will alter management, and treatment starts in the consultation. Consultations from £150 by video and £220 in person. Fees appear further down this page.
Reviewed by the medical team at The Wellness. Last updated August 2026.
Get a headache assessed on WhatsApp or email team@thewellnesslondon.com or call 020 3951 3429.
Which headaches need urgent assessment
A thunderclap headache, reaching maximum intensity within a minute, needs an emergency department immediately because it can indicate subarachnoid haemorrhage. So does a headache with fever, neck stiffness, photophobia or a rash that does not fade under a glass, which raises meningitis.
New headache over the age of 50 changes the calculation entirely. Giant cell arteritis presents with a new headache, scalp tenderness noticed when brushing hair or resting on a pillow, jaw pain on chewing, and sometimes visual disturbance, and untreated it causes irreversible sight loss. It needs same-day assessment with urgent inflammatory markers and, where suspicion is high, steroid treatment started before the diagnosis is confirmed.
Headache that is worse lying down, on coughing, straining or bending, or that wakes you from sleep, suggests raised intracranial pressure and needs prompt imaging. So does any headache with new neurological signs, weakness, altered speech, visual field loss, unsteadiness or a first seizure. Headache in anyone with cancer, HIV or on immunosuppression, or following a head injury, sits in the same category. Progressive headache worsening over weeks rather than fluctuating deserves assessment rather than another prescription.
Everything else is the majority, and the majority is primary headache that responds well to being diagnosed correctly.
How do I know if it is migraine
Migraine is a clinical diagnosis with a recognisable pattern. Attacks lasting 4 to 72 hours untreated. Pain that is typically one-sided, throbbing, moderate to severe, and made worse by routine physical activity so people want to lie still in the dark. Nausea, sometimes vomiting, and sensitivity to light and sound. Around a third of people experience aura, most commonly visual, with zigzag lines or a spreading blind spot developing over 5 to 20 minutes and resolving within an hour.
Tension-type headache is the commonest headache overall and feels different, a bilateral pressing or tightening band, mild to moderate, not worsened by activity and without significant nausea. Cluster headache is rarer and unmistakable when described properly, severe strictly one-sided pain around the eye lasting 15 minutes to 3 hours, with a red or watering eye, drooping lid, nasal congestion and agitation, occurring in bouts.
Triggers matter and are individual. Sleep disruption in either direction, missed meals, dehydration, alcohol, hormonal change including the perimenstrual drop in oestrogen, stress and the let-down after it, and certain foods in a minority. A headache diary for 6 weeks does more diagnostic work than any scan.
Ask about your headache pattern on WhatsApp or email team@thewellnesslondon.com.
What actually treats migraine
Acute treatment works best taken early. NSAIDs or aspirin at adequate dose at the first sign, with an anti-emetic where nausea limits absorption. Triptans where simple analgesia is insufficient, and if one triptan fails, another frequently succeeds, which is worth knowing because most people give up after the first.
Preventive treatment is the step most people never reach, and it is indicated where attacks occur on 4 or more days a month or are severely disabling. Propranolol, amitriptyline, topiramate and candesartan all have evidence, each is tried at adequate dose for at least 8 to 12 weeks before being judged, and success means a meaningful reduction in frequency rather than elimination. Where several preventives have failed, CGRP monoclonal antibodies are a genuine advance and are prescribed under specialist supervision, which we arrange with a named neurologist.
Medication overuse has to be addressed before anything else works. Taking simple analgesia on 15 or more days a month, or triptans, opioids or combination painkillers on 10 or more days a month, sustains a daily headache that no preventive will fix while it continues. Withdrawal is uncomfortable for a fortnight and the results afterwards are frequently the single biggest improvement a person gets.
Non-drug measures earn their place too. Regular sleep and meals, hydration, exercise, and where hormonal migraine follows the cycle, the timing of treatment around it.
What tests are worth doing
Bloods where they change the answer rather than as a reflex. Inflammatory markers urgently in anyone over 50 with a new headache, because giant cell arteritis is the diagnosis where hours matter. Full blood count and ferritin, since iron deficiency both worsens migraine and causes headache in its own right. Thyroid function, because both under and overactivity produce headache. Kidney function, glucose and calcium where the picture suggests. Vitamin D and B12 where fatigue accompanies the headaches.
Blood pressure measured properly, because uncontrolled hypertension is a treatable contributor and is silent otherwise. A medication review, since nitrates, calcium channel blockers, hormonal contraception, proton pump inhibitors and analgesia itself all cause headache.
Imaging where it changes management, which is a smaller group than people expect. NICE guidance does not support scanning for typical migraine or tension-type headache with a normal examination, because the yield is very low and incidental findings are common. MRI is arranged at a specialist centre with consultant radiologist reporting where there are red flags, new neurological signs, a change in an established pattern, or where the headache is new in someone over 50 or immunosuppressed. Where a scan is arranged it is usually available within the week, against the 20.2% of NHS patients waiting more than 6 weeks for diagnostics in March 2026.
What does headache assessment cost in London
Consultant neurology appointments in the Harley Street district run £250 to £500 for a first consultation, with imaging and follow-ups charged separately. Private MRI of the head commonly runs £500 to £1,000. Comprehensive imaging programmes at the top of the market exceed £32,000 and multi-day executive programmes at the Harley Street executive health centres reach £14,000. Below all of it sits a tier defined by its conditions rather than its price, short remote appointments issuing repeat analgesia with no history taken properly and no examination, which is exactly how medication overuse headache develops.
At The Wellness the assessment, the coordination and the review are 1 fee. All figures are from prices.
Executive Health Programme, the most comprehensive assessment with full biomarker profiling and coordinated imaging, from £11,995.
Executive Body Scan, consultant-reported imaging with full bloods and consolidated review, from £5,995.
Comprehensive Blood Panel including inflammatory markers, ferritin, thyroid, kidney function, glucose, calcium, vitamin D and B12, with consultation and interpretation, from £495.
Extended 45-minute consultation for chronic or complex headache with a full preventive plan, from £395.
In-person consultation with neurological examination in Marylebone, from £220. Same-day video consultation from £150.
Home, hotel or office visit from £495 daytime and £695 evenings and weekends.
MRI, CT and neurology referral to a named consultant arranged at specialist centres with consultant reporting and the appointment booked.
Same-day appointments 7 days a week in Marylebone, 3 minutes from Baker Street.
Why The Wellness is the best place in London for headaches
Because headache is diagnosed by history and most people have never been given the time to tell it. Thirty minutes with a neurological examination separates migraine from tension-type from cluster from a secondary cause, and that separation determines everything about the treatment. A scan does not do it and a 10-minute appointment cannot.
Because the red flags are checked deliberately. Giant cell arteritis in anyone over 50 with a new headache is the diagnosis where a delay costs eyesight, and inflammatory markers are arranged the same day where suspicion exists. Thunderclap onset, raised pressure features and new neurological signs are escalated immediately rather than scheduled.
And because the treatable causes get found. Medication overuse headache, which sustains a daily headache in a substantial number of people who believe their painkillers are the only thing helping. Iron deficiency. Thyroid disease. Uncontrolled blood pressure. A drug on the repeat list that has been causing it for a year. Then a proper preventive plan tried at adequate dose for long enough to work, with neurology referral to a named consultant where CGRP treatment is the next step.
Book a headache assessment on WhatsApp or call 020 3951 3429.
Frequently asked questions
When is a headache serious
A thunderclap headache peaking within a minute, or headache with fever, neck stiffness or a non-blanching rash, needs an emergency department now. New headache over 50 with scalp tenderness or jaw pain on chewing suggests giant cell arteritis and needs same-day assessment because it threatens sight. Headache worse lying down, on coughing or straining, waking you from sleep, or with new neurological signs needs prompt imaging.
Do I need a scan for my headaches
Usually not. Scanning is not supported for typical migraine or tension-type headache with a normal examination, because the yield is very low and incidental findings are common. MRI is indicated where there are red flags, new neurological signs, a change in an established pattern, or new headache over 50 or in immunosuppression.
What is medication overuse headache
A daily or near-daily headache sustained by the painkillers taken to treat it, developing with simple analgesia on 15 or more days a month, or triptans, opioids or combination painkillers on 10 or more days a month. Stopping the offending drug is the treatment, withdrawal takes a couple of uncomfortable weeks, and the improvement afterwards is frequently substantial.
What is the best treatment for migraine
Acute treatment taken early, with NSAIDs or aspirin at adequate dose and an anti-emetic where nausea limits absorption, escalating to triptans, and if one triptan fails another frequently works. Preventive treatment is indicated at 4 or more headache days a month, using propranolol, amitriptyline, topiramate or candesartan at adequate dose for 8 to 12 weeks before judging, with CGRP treatment under specialist supervision where several have failed.
How do I know if it is migraine or tension headache
Migraine is typically one-sided, throbbing, moderate to severe, worsened by routine activity, with nausea and light or sound sensitivity, lasting 4 to 72 hours, and around a third of people get aura. Tension-type headache is a bilateral pressing band, mild to moderate, not worsened by activity and without significant nausea.
Can blood tests explain headaches
Sometimes, which is why they are done selectively. Inflammatory markers urgently over 50, ferritin because iron deficiency worsens migraine, thyroid function, glucose, calcium and kidney function where the picture suggests, alongside proper blood pressure measurement and a medication review, since several common drugs cause headache.
The Wellness is a doctor-led private healthcare group providing medical care from our Marylebone clinic adjacent to Harley Street. All doctors are GMC-registered. Imaging is arranged at specialist centres and reported by consultant radiologists, and blood analysis is performed by accredited laboratories. A thunderclap headache, headache with fever and neck stiffness, or headache with new neurological signs needs emergency assessment, and in an emergency call 999. This article is general information and not a substitute for medical advice about your own health.
Enquire now on WhatsApp or email team@thewellnesslondon.com or call 020 3951 3429.
References. NICE guideline CG150, headaches in over 12s, diagnosis and management, including guidance on neuroimaging and medication overuse headache. NICE guideline NG12 on suspected cancer recognition and referral. British Association for the Study of Headache national headache management guidelines. Published global and UK prevalence data on migraine. Published guidance on giant cell arteritis assessment and urgent treatment. NHS England diagnostic waiting times, March 2026. Published 2026 London private neurology and imaging market pricing.
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