Shaping the future of headache care
Antoinette is the first headache nurse specialist at Charing Cross Hospital and believed to be the youngest non-medical prescriber in the Filipino nursing community. Here she shares her inspiring nursing journey and passionately advocates for why younger professionals should aspire to leadership positions.
What inspired you to pursue a career in nursing and headache care?
My mum is my biggest inspiration. She’s an incredible nurse and a real trailblazer in headache care – she helped set up some of the first nurse-led procedure clinics for headache in the UK. But what really inspired me wasn’t just her accomplishments, it was her genuine love for nursing and caring for people.
I also live with migraines myself, so I know first-hand how important this care is – and how much of an impact specialist headache nurses can have. I wanted to support others the way I have been supported.
Tell us a bit more about your role.
I am part of the Headache Service at Charing Cross Hospital, which is led by Dr. Sam Dahdaleh. I work closely with Dr. Sam Dahdaleh, Dr. Kalladka and our physiotherapist Davina Richardson who co-runs the Botox clinics with us. It’s a privilege to be part of a team that’s so passionate about making a real impact.
No two days are never the same, which is something I really enjoy. When I’m running nurse-led clinics, my day starts with checking and responding to patient queries, usually about changes in their condition or medications. I then review headache diaries and PROMs (Patient-Reported Outcome Measures) to prepare for the clinic.
In Botox clinics, I typically see 8-10 patients per session alongside those booked for nerve blocks. For the CGRP clinic, a type of preventative medicine for migraine, I run telephone reviews to assess patients’ responses to treatment, manage any side effects, and support them with ongoing care.
For face-to-face clinics, I work alongside my consultant colleagues, where I carry out follow-ups to assess treatment effectiveness, adjust medications, and offer education around treatment options, including advanced therapies. I also teach injection techniques for CGRP monoclonal antibodies, and help patients optimise both acute and preventive treatments.
In addition to clinical care, I complete and maintain databases for audits, fill out Blueteq forms for high-cost drug approvals, and prescribe medications as an independent prescriber. I usually meet with Dr. Dahdaleh during the day to review patient queries and agree on treatment plans. I then finish by writing clinic letters, liaising with GPs, and working with the wider multidisciplinary team to ensure coordinated, high-quality care for patients.
Why was there a need for a dedicated specialist headache nurse?
Headache is a highly prevalent and often disabling condition, and the need for specialist care is only growing. We already had an excellent team in place, but with the introduction of advanced treatments like Botox, CGRP monoclonal antibodies, and Gepants, it became clear that having a dedicated headache nurse would make a big difference.
My role helps us run these services more efficiently and, importantly, increases access to treatment for more patients. It also allows us to offer more consistent follow-up, education, and support which are key to helping people manage their condition and improve their quality of life.
Antoinette Lagrata"Headache is a highly prevalent and often disabling condition, and the need for specialist care is only growing."
How does it feel to be the first headache nurse specialist at Charing Cross?
It’s an honour and so exciting to help shape the future of headache care here.
One of the most rewarding parts has been seeing the tangible impact the role has had, like helping to launch our CGRP service. Because of my role, patients in our patch now have access to this new, migraine-specific treatment, which wasn’t previously available. We’ve also significantly improved access to Botox treatment which can help to reduce how often patients have migraines and how bad they are.
When I started, the waiting list was up to a year. Now it’s down to 3-4 months, and more importantly, patients are able to receive their Botox on time every 3 months, as recommended, without delays which lead to better outcomes and a more positive experience for our patients.
But it’s not just about treatments. I also support patients through education and self-management strategies, helping them become more confident and informed in managing their own condition. This kind of empowerment is a big part of the NHS 10-Year Plan, and it makes a real difference to long-term outcomes and quality of life.
I’m also incredibly grateful to work alongside and be supported by such brilliant consultants. Dr. Dahdaleh and Dr. Kalladka have been amazing mentors; their guidance has been key in helping me grow into this role.
Antoinette Lagrata"I hope and strive to be a good role model by showing that with compassion, teamwork, and a genuine love for what we do, we can create a more positive and inclusive environment for everyone in healthcare."
You’re believed to be the youngest non-medical prescriber in the Filipino nursing community – how does this feel?
Honestly, this was a complete surprise – I didn’t know until it was mentioned! I was 26 when I completed my training.
Professionally, it’s a big responsibility, but also a real privilege. Being an independent prescriber means I can offer more complete, timely care for my patients, and contribute more actively to their treatment plan and help ease the burden for my colleagues. I hope it also inspires other young nurses to aim high, we do belong in these advanced roles, and we have so much to bring.
I am very proud of my Filipino heritage and of my profession. Each of us has our own journey and challenges – whether you're a nurse trained here or abroad – but at the end of the day, we all have the same one goal: to provide high-quality care and improve our patients’ lives. That’s why I believe so strongly in supporting one another, and in leading with kindness and respect.
In a demanding profession like nursing, these values go a long way, not just for our patients, but also for each other. I hope and strive to be a good role model by showing that with compassion, teamwork, and a genuine love for what we do, we can create a more positive and inclusive environment for everyone in healthcare.
Finally, what would you bring to a potluck lunch?
I would bring a Filipino dessert called a Mango float. This is a form of an icebox cake made with layers graham crackers, whipped cream with sweetened condensed milk, and chopped mangoes. It is best served chilled.
