What Is A Migraine?
Migraines come in many forms. For some the headache is the worst part, while for others it may be the nausea, or the dislike of bright light, or the brain fog that stops them thinking clearly, so when we try and answer this we have to look at the common processes, and not necessarily the detailed symptoms you experience.
Indeed Professor Peter Goadsby, an acknowledged expert in migraines at Kings College Hospital in London, describes them as a problem that affects the entire brain (different parts for different people). He considers them more as a sensory information processing disorder. Think of the brain as having a fire alarm panel. When the alarm goes off you have a headache that wants you to lie down and hide away till you get better. This is good if you’re ill, but if the detectors are too sensitive or there’s a fault on the panel, the alarm is set off when there is no fire. The brain is very much more complicated than an alarm panel so the fault can be in the sensory nerves that take information from outside to the brains stem at the base of the brain. In effect it is a telephone exchange that processes this raw information and sends more information to higher control circuits in the thalamus in the middle of the brain, and the limbic system which also control your mood. These in turn send information outwards to many places, including the many pain endings in the coverings (meninges) of the brain where you experience much of the pain of a migraine.
This is of course a simplified description. The brain is far more complicated than this, so you can also look at the control processes as a balance of excitable and calming influences. In migraines the brain becomes hyper-excitable. Sensory information from the nerves outside the brain, that would be nothing to ordinary people, can start a chain reaction that sets the fire alarm panel off far too easily. Fortunately this hyperexcitability is self-limiting and the attack eventually subsides, but for some it doesn’t do so completely and some people hardly ever have a day when they have no symptoms
As a doctor, my aim is to calm the hyperexcitability down so that you don’t reach the level that triggers an attack. At the very least I want to calm the brain down to reduce the severity of the attacks. I want you to be in charge of your migraines and not them in charge of you. Ideally, of course, I want to banish the symptoms completely. This is often possible with Botox injected in the correct places. Indeed, in my opinion it is one of the best treatments available. Unlike the preventative drugs that have traditionally been given (propranolol, amitriptyline and topiramate and which often either don’t work or have unpleasant side effects), Botox has virtually no side effects. When given in very focused infections it calms some very specific parts of the brain stem. This keeps the cost down, and improves the benefit compared to the PREEMPT protocol usually given on the NHS.
Another treatment that I am researching is Daith Ear Piercing. It is not yet a generally recognised treatment by neurologists because they feel there is not enough evidence to say that it does. However, apart from my work, no doctors are researching it. Absence of evidence is not the same as evidence of absence, and my aim is to convince my colleagues that it is time that more research is done. It appears to work by stimulating a small branch of the Vagus Nerve in the ear. Vagus Nerve stimulation is already a recognised treatment for both migraines and epilepsy. Like the commonly used drugs mentioned above, it certainly doesn’t work for everybody and Botox is more guaranteed to have an effect. Far more research into Daith Piercing is still needed….
As part of the treatment, Dr Blatchley offers a detailed consultation to discuss what will be the best approach to reducing your migraines.
This website is here to give you a guide to:-
- The latest theories of how migraines start
- All about Botox for migraines
- The best drug treatments, both for attacks and how to prevent them
- How to deal with Medication Overuse Headaches, and how to avoid them ever starting
- Other sites giving excellent general advice on migraines
The London Migraine Clinic is run by Dr Chris Blatchley MB BChir, a registered doctor who trained at Cambridge and has a particular interest in migraines which developed from his other specialist work using Botox for aesthetic procedures. Quite simply, we aim to give you the best medical care of your migraines, using Botox along with other well-established medical treatments when they are not controlling the attacks effectively. We offer the opportunity for a consultation with him before any treatment, so that you can be sure of what is right for you. For more details click here.
