Migraine Treatment

A migraine is a moderate to severe headache that is usually felt as a throbbing pain predominantly on one side of the head. It may be accompanied by feeling nauseous, vomiting, or having an increased sensitivity to noise and light; hence why sufferers often retreat to lay down in a darkened room or try to sleep.

Migraine comes in different types:

• Migraine with aura – a migraine that comes with a pre-warning before it begins which often alerts the sufferer to an impending attack, this may be flashing lights,
• Migraine without aura – a migraine that happens without any pre-warning, often the most common type, and,
  a silent migraine or
• Migraine with aura but without headache – whereby the pre-warning migraine symptoms occur but a headache never develops.

The exact causes of migraine are still relatively unknown but are thought to be related to short-lived changes in the interactions between blood vessels, nerves, and chemicals within the brain. They are often hereditary, which could imply a genetic link, but can also be triggered by outside influences related to diet, stress, hormonal changes, or tiredness.

Frequency of migraine attacks, as well as their severity is the trigger to seek medical help for what may be a chronic condition, especially if over-the-counter pain medication has become ineffective or you risk overdosing and taking them too regularly.

Migraines can severely affect quality of life, ability to function, and if frequent, impact on your ability to get on with your life and do normal, daily activities, especially if you are confined to bed for several days.

The National Institute for Health and Clinical Excellence (NICE) estimates that there are 190,000 migraine attacks experienced every day in England, and 6 million people suffering from migraine in the UK. They note that prevalence has been reported to be 5-25% in women and 2-10% in men. The NHS also quote 1 in 5 women and 1 in 15 men, making it a very common health condition that usually begins in early adulthood.

At Blemish Clinic, we can discuss the treatment options available to address chronic migraine and find the right solution for you.

With no cure for migraines, much of what is available are treatments to reduce or relieve the symptoms, or the use of medicines and lifestyle changes to aim to prevent the triggers that cause a migraine.

Many people start by avoiding known migraine triggers, such as certain foods or tiredness, and treat their migraines themselves with over-the-counter painkillers like ibuprofen and paracetamol. But, when this does not work, and there is a risk of taking too many pain medication tablets, this often results in a visit to the GP and a diagnosis of migraine headaches – the frequency, type, and severity of which determines if it is a chronic condition.

Other treatment options, which may be offered via a referral from your GP practice include a group of medicines called triptans or serotonin receptor agonists that interfere with the chemical signals in the brain, particularly one chemical called serotonin to help quieten down overactive pain signalling nerves that can cause a migraine. If you experience nausea or vomiting alongside migraine, you may be given another type of medicines call anti-emetics. Your GP will usually advise you on avoiding triggers, maintaining a healthy lifestyle with diet and exercise, avoiding, or limiting caffeine and alcohol, and getting enough sleep.

If you have chronic, frequent, and severe migraines, your next route is often more targeted medication such as anti-seizure medicine likes topiramate and medicines used to treat high blood pressure like propranolol.

At Blemish Clinic, we can also discuss an alternative treatment option with you during a consultation with our medical practitioner which uses the prescription medicine botulinum toxin to temporarily reduce the occurrence of migraine headaches. In the UK, Botox® (botulinum toxin type A) is a licensed medicine for the ‘prophylaxis of headaches in adults with chronic migraine (headaches on at least 15 days per month of which at least 8 days are with migraine)’. The aim is to reduce the frequency and severity of migraine attacks.

The National Institute for Health and Clinical Excellence (NICE) recommends that Botox is used for people with chronic migraine who have failed to respond to at least 3 preventative migraine treatments and/or have been appropriately managed for medication overuse headache (caused by frequent use and overuse of painkillers and headache medications to relieve migraine attacks).

The full range of treatment options for chronic migraine will be discussed during a consultation, which may result in our doctor prescribing botulinum toxin to treat your headaches.

Botulinum toxin is a prescription only medicine that is one of the options available for treating chronic migraine headaches. It is available under the brand name Botox® and can be prescribed by a medical professional with prescribing privileges, like our doctor.

Botox is injected into specific areas at the front, side and back of the head, usually with multiple injections in a grid-like pattern. The exact mechanisms of why it works are still being studied, and its discovery is often credited as a happy accident when it offered headache relief to patients having treatment with botulinum toxin for the cosmetic relaxation of lines and wrinkles in the upper face. Scientists believe that it works by blocking the chemicals or neurotransmitters that carry pain signals from the brain before the signals reach the nerve endings around the head and neck, thus, the development of a migraine is indirectly blocked leading to a significant reduction in the number and frequency of headaches, bringing relief to migraine sufferers.

The effect is temporary, wearing off after 3 months, so does require repeat treatment; however, for many the relief in severity or the number of headache days is worth it due to the improvements in their quality of life.

The manufacturers of Botox report that no efficacy has been shown for the treatment in the prophylaxis of headaches in patients with episodic migraine, i.e., headaches on fewer than 15 days per month, or tension-type headache or cluster headache.

Your suitability for a variety of treatment options for chronic migraine headaches, including botulinum toxin or Botox injections will be discussed during a consultation with our medical practitioner. If after taking a full medical history, discussing any underlying medical conditions, medications, and allergies, understanding your experience with migraine headaches (frequency and severity), and a physical examination, they believe you would be a suitable candidate for treatment, you can be prescribed the medication and have it administered to reduce your migraines.

If you suffer from a neurological condition that causes muscle weakness – myasthenia gravis – you will not be suitable for treatment with botulinum toxin.

If you are pregnant or breast feeding, you will also not be suitable for migraine treatment using botulinum toxin, however we can discuss other options for use during this time to relieve your symptoms.

The injections into the forehead, back and sides of the head are generally well tolerated with little discomfort due to the use of thin, small needles so there is no requirement for anaesthesia.

The use of Botox (botulinum toxin) to treat migraine headaches is now well researched with multiple published, independent clinical studies reporting that treatment is safe with few side effects.

There will be relatively no downtime following treatment, other than some slight redness, swelling, or bruising at the injection points that will fade within 24-48 hours.

In clinical trials for Botox treatment of chronic migraine, the incidence of any side effect was 26% with the first treatment and this declined to 11% with a second treatment, commonly being pain at the injection sites, eyelid ptosis (drooping), rash, neck pain and stiffness, muscle pain, tightness, or weakness, and the triggering of a headache or migraine. All such side effects are temporary and wear off over time.

Rarely you may experience a worsening of headache or migraine within the first month after treatment, but clinical trial results show that the incidence of this declines with repeated treatments.

All potential and rare side effects will be fully discussed during your consultation.

Treatment with Botox for migraine headaches does not cause an immediate result as the botulinum toxin will take up to 2 weeks to take effect, reducing the nerve impulses and consequently reducing the frequency and severity of headaches after a week or two.

According to the makers of Botox, data used for licensing for the treatment of chronic migraine suggests that typically migraine headache frequency can be reduced by 30-50%.

Many patients try a minimum of two cycles of treatment to determine if this is an effective option for them, due to the impact of some side effects experienced after the first treatment which diminish with repeated treatment.

Treatment with Botox for chronic migraine will last around 12 weeks as shown in trials by the medicine manufacturer before you will need a repeat treatment; therefore, you will require treatment approximately 4 times per year.

We believe in being transparent with our prices and want you to be fully aware and comfortable with the cost of your treatment. A full list of our prices can be found here. We will always agree a final price with you though before treatment commences.