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Norfolk Migraine ClinicSpecialists in the diagnosis and treatment of migraine, and variants of head, neck and facial pain

Could we help you? Read some of our FAQs to find out more about what we can treat...

Might I have something more serious?
The Norfolk Migraine Clinic is orientated towards people who have long-established patterns of pain: of at least six months. Some patients who come to see us have had pain for many years. The main alarm features of more serious causes for headache would include acute severe first headache or ‘Thunderclap’ headache, headache associated with fever and generalised acute illness (e.g. Meningitis), headaches associated with neurological problems (such as seizures, or deficits of power, coordination or sensation), and significant change of headache characteristics in a patient with preceding stable headaches. If there is concern on any of these levels, you should seek advice from your GP as soon as possible.

Do I have to have a headache at the time of my consultation?
No. Our assessment evaluates the pain pathways of your headache whether your pain is active or not.

What do injection treatments for neck muscle problems involve?
Injection treatments have been commonly used in pain clinics for forty years, to treat pain in various territories of the body. Treatment focuses on sources of pain and blocking these with standard injections of anti-inflammatory steroid and local anaesthetic in nerve pathways, joints, muscle attachments, and bursas. The Norfolk Migraine Clinic undertakes a set of injection treatments in the Upper Neck directed at muscle attachments just under the skin. These are not at a Spinal Cord or nerve root level. The purpose of the local anaesthetic component is to dilute a very small amount of anti-inflammatory steroid and to act as a marker in relieving pain or headache at the time of the treatment. The purpose of the steroid is to provide slow-acting reduction of inflammation in the source of pain.

Is this a quick fix? Will the injections wear off?
Injections work by breaking a cycle of maintained pain in the muscle dysfunction over a short number of weeks. During the time of action of the injections, the muscles are able to regain their natural function which is then promoted by regular, specific exercises. This means that, when the injections do wear off, the eventual benefit is designed to be long-term. It is difficult to break a long-established pattern of pain with a single treatment, so some patients may need to return for further treatment sessions, depending on the individual.

Is it the same as Botox?
No. Botox is used in many different ways in the UK. The benefit of Botox in headache was found incidentally in patients being treated for cosmetic purposes, that of forehead wrinkles. A subsequent clinical trial has established benefits in a particular group of patients with Chronic Migraine (migraine on more than 15 days a month). The pattern of Botox injections involves thirty-one injection sites in the scalp and upper neck. It is not currently licensed for other forms of headache. Botox is also available at the Norfolk Migraine Clinic, as it may be useful in certain cases. However, our system of anti-inflammatory steroid injections is targeted at a choice of specific muscle attachments in each individual: there are up to six areas which can be sources of pain on each side of the neck, so a maximum of twelve injection sites in all. It would be unusual to need more than five injections in any session of treatment.

Is it the same as Greater Occipital Nerve Block (GON)?
Again – no. In Greater Occipital Nerve Blockade, the nerve itself is the notional target of the treatment, though there is inevitably some distribution of anti-inflammatory steroid into the local muscle tissue. In this clinic, it is not intended to treat the nerve: we focus on the muscle attachment through which it passes, but do not target the nerve itself. One primary target area of injection in our clinic is the important muscle attachment at each Occiput, which is the, often tender, bump at the back of the skull on each side, but other relevant local muscle attachments are also treated. The benefits of GON Block on its own have always been shown to be temporary. The benefits of our treatment are designed to be longer-term, in treating the wider complex of muscle problems causing the headache, through rehabilitation of the muscle dynamics.

Are there any side effects?
There is a very low incidence of side effects, which are the same as from injections of anti-inflammatory steroid anywhere else in the body. These may include: minor bruising at an injection site; a facial flush for up to 36 hours, in about 5% of patients, irrespective of injection site; and a slight variation in the blood sugar of diabetics for 2-3 days afterwards.
Is it the same as Acupuncture?
No. Acupuncture is either a ‘Traditional Chinese’ treatment setting needles in points of meridians e.g. at the wrist, which may not appear to relate to the pain in straight anatomical terms, or else the ‘Western’ variety of acupuncture, which uses skin needles over trigger points more clearly relevant to the pain. Some of these points do overlap with anatomical targets used in the Norfolk Migraine Clinic - but there is a major difference at the level of treatment with injections of anti-inflammatory steroid and local anaesthetic.

Is the Treatment painful?
Any injection involves some discomfort, however the volumes are small and local anaesthetic comprises part of the medication. The treatments are in muscle attachments just under the skin, and not near brain or spinal tissue. The local anaesthetic works in 30-60 seconds and lasts about 45 minutes. It may be possible to reduce or clear a Migraine or other Headache if present at the time of a treatment.

What are the Outcomes after Treatment?
Firstly, this is not a ‘Quick Fix’. Anti-inflammatory steroid injections appear to break patterns of pain by reducing inflammation at the treatment site, thus enabling muscle function to rehabilitate. After initial benefit there is often headache in the 2nd week which should then subside progressively. A single Treatment session may not suffice for established severe patterns of pain. However, in an audit of 430 consecutive clinic patients, 68 – 70% of individuals showed a sustained symptom improvement of 75% or more. Each patient may benefit from further specific advice on managing the acute attack, managing painkiller intake, and preventative medication.

For your personal treatment plan, please book an appointment on 01603 81 22 66.


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