At Home with Chris Jessen 2018 - 69
MEET THE EXPERT
DO I HAVE A
There is excellent evidence to show
that if someone presents to a doctor
with migraine, the chances of them
having a brain tumour is 0.045%.
Therefore, investigation is not
indicated, not least because
there is a 1-2% chance of picking
up an incidental intracranial
abnormality that could cause anxiety
or even have an adverse influence
on life insurance applications.
Imaging should be reserved for
cases where clinical assessment
suggests there is a much higher
possibility of finding an underlying
abnormality. Examples include
finding abnormal neurological
signs on examination; headaches
associated with new-onset
seizures; significant alterations
in consciousness, memory or
co-ordination; or headaches in
patients with a history of cancer
elsewhere in the body. In such
cases, MRI is the scan of choice.
THERE IS ALWAYS
CAN BE DONE...
PhD, FRCP, FRCP
at Cambridge and
pursued a career
as a medical
historian for six
years. He trained in neurology at
Oxford, Nottingham, Preston and
Manchester, before an interest in
headache took him to the National
Hospital for Neurology and
Neurosurgery in London.
For the past 10 years, Dr Weatherall has
been a consultant neurologist
at the Charing Cross and Ealing
Hospitals in London. In 2018, he will
take up a new post as a consultant
neurologist at Buckinghamshire
Healthcare NHS Trust.
Dr Weatherall has served as a
trustee of the Migraine Trust and and
is Vice-Chair of the British Association
for the Study of Headache.
with a person's work, school or social
life. If drugs fail, interventions such
as greater occipital nerve blocks or
Botox can be tried. New non-invasive
neurostimulation techniques such as
transcranial magnetic stimulation (TMS)
and vagal nerve stimulation (VNS)
may also be helpful.
These are exciting times for the
treatment of migraine. New options
will become available over the next year
or two, most notably the preventive
CGRP antibodies. In the meantime,
existing medicines and techniques offer
plenty of possibilities for clinicians and
patients to work together to improve
the lives of people with migraine.
FOR MORE INFORMATION
The Medical Chambers Kensington
Call 020 7244 4200
BMI The Chiltern Hospital,
Call 01494 890890
These may include fatigue or abnormal
bursts of energy, stiffness in the neck,
yawning and frequent urination.
Migraine likes people to be a bit
boring! A regular regimen of set meal
times, good hydration, plenty of sleep
and minimal stress is helpful in reducing
the onset of migraine. Recognising
this is straightforward, but making the
requisite lifestyle changes in the modern
busy world can be more difficult.
Some form of painkiller is usually
needed. If simple over-the-counter
painkillers, such as paracetamol, aspirin
or ibuprofen are not effective, then
triptans should be tried - these are
specific migraine drugs, such as
sumatriptan (Imigran). Opiates,
such as codeine, tramadol and so
on, must be avoided.
Preventive treatment is prescribed
when migraines significantly interfere