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.
How Migraines Work
Hyper-excitability
The brain becomes overly sensitive to sensory input. Signals that a healthy brain would process silently instead trigger a cascade of activity that can culminate in a full migraine attack.
Sensory Overload
Normal stimuli such as light, sound, and smell trigger extreme discomfort. The threshold for these sensations is dramatically lowered during and before a migraine.
Brain Fog
Difficulty thinking clearly during attacks is common. The higher cognitive centres are affected as the brain diverts resources to managing the sensory overload.
Pain Response
Pain originates in the meninges — the membranes covering the brain — rather than in the brain tissue itself. This is why lying still in a dark, quiet room often provides some relief.
The Brain's Fire Alarm
Sensory Processing 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 brain 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 controls your mood.
Self-Limiting Attacks 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.
Dr Blatchley's Approach 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.
About This Guide
This website is here to give you a guide to the latest treatments and understanding of 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.
Treatments Available
Dr Blatchley offers several treatment approaches at the London Migraine Clinic:
- Botox — one of the best treatments available. Unlike preventative drugs (propranolol, amitriptyline, topiramate) which often don't work or have unpleasant side effects, Botox has virtually no side effects. When given in very focused injections it calms some very specific parts of the brain stem.
- Daith Ear Piercing — 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.
- Detailed consultation — to discuss what will be the best approach to reducing your migraines, so that you can be sure of what is right for you.
- The latest theories of how migraines start and 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.