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What options do I have to manage my migraines?
Each patient needs two basic strategies in management of Migraine and other headache disorders.
- Immediate action: Treatment individually optimised to subdue your acute attack when it happens, to reduce the impact on your daily activities.There are 7 established ‘Triptan’ medicines that help many migraines by acting on ‘5 HT’, an important neurotransmitter. Recent neurophysiology has focused on another, known as ‘CGRP’, in migraine, and new drugs have emerged to block this pathway. The 2 categories are of monthly self-administered injections, and of tablet formulations to control attacks. These last groups are currently expensive and have variable NHS availability.
- Prevention: strategy or treatment to diminish the frequency, severity and duration of your attacks overall.
For immediate action, there are specific painkillers, together with muscle relaxants and anti-nausea medications, that may be tailored to controlling the acute attack in an individual.
For overall prevention, there are also medical options, with muscle relaxants and a number of licensed medications found to be useful in migraine and neuropathic pain. Virtually every agent known to affect nerve pathways has been tried in migraine, and some drugs have been found to be useful, as they stabilise nerve pathways or connections in migraine – though their original design was for other purposes, e.g. in epilepsy, mood control or even heart rate control.
Some general medications can provoke headache, and (painkiller) Medication Overuse Headache is an increasingly recognised problem. At the Norfolk Migraine Clinic, we re-evaluate the impact of any medications you may already be taking as part of your initial assessment.
Medical interventions
- Botox
Botox now has well established benefit in chronic migraine control. A standard evidence based protocol of widespread scalp and neck injections is helpful in cases who have failed to benefit from other medication pathways. Treatments are repeated every 3 months.
- Greater Occipital Nerve Block
This has been quite widely practised for a number of years, and currently finds favour in the management of Cluster Headache in leading headache centres. The way in which GON Blocking helps is not proven; and unfortunately its effects have not been shown to be sustained in a number of studies. However, it is inevitable in applying this technique that a key muscle attachment involved in the potential areas of problem in the neck is being treated: a muscle attachment that benefits the mechanisms affecting the trigeminal nuclei.
- Muscle dynamics options: Suboccipital Vector Therapy – a special interest of this clinic
At the Norfolk Migraine Clinic, an extended systematic treatment of relevant neck muscles has been found to promote much longer-term benefits as malfunctioning muscles are rehabilitated as a set, strengthening and correcting them in order to relieve the background stress which provokes the nuclei which generate migraine.
- Whiplash
Neck injuries commonly give rise to persistent pain and movement symptoms. The anatomy is complex, with potential problems arising from muscle, ligament, bone, and nerve or spinal cord in the most severe cases. Muscle damage is the most frequent issue and often associated with headache. These territories are a main focus for therapy in this clinic.
- TMJ Treatment
Temporomandibular Joint problems may arise from tooth clenching ('bruxism'), or originate from the joint itself. They may cause independent trouble, or contribute significantly to Headache.
In the Norfolk Migraine Clinic we offer treatment with Botox to the relevant muscle groups, and also use a new specific steroid injection treatment to a small ligament of the joint which has been found to be a significant pain generator.
- Facial Pain
Facial pain may be a feature of headache or an independent condition. If no diagnostic cause is evident it is referred to as 'PIFP' (Persistent Idiopathic Facial Pain). This is the medical profession's leap forward from 'AFP' (Atypical Facial Pain)! Some cases involve referred pain in the cervicotrigeminal pathway, and benefit from the Suboccipital Injection system.
For your personal treatment plan, please book an appointment on 01603 836 744
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