Kate Burgess

The Times

Gerry Gajadharsingh writes:

“Out of the many pain syndromes that we see in clinical practice, Headache and Migraine (yes, they are different) can sometimes be the most debilitating for many patients, in the UK approximately 10 million migraine suffers. In my experience the cause of the symptom (similar to many complex chronic problems) tends to be multifactorial and are often different for many patients.

 Various hypotheses for the actual mechanism of the pain are proposed including, inflammatory, vascular, muscular, nervous system hypersensitivity etc. Triggers are numerous from stress, neck strain, chemical triggers such as caffeine, citrus and chocolate, glucose dysregulation, dehydration, strong smells and strong tastes etc

 Like a lot of diagnosis, detective work is necessary from both the patient and the clinician to help decide what actually can be treated. The article below refers to asking patients to keep a diary of their pain, I am surprised that this is only now being flagged up in the NHS, as its been used by many patients and clinicians for years. Understanding the chronology of symptoms can help us understand the cause.

 For many patients they rely on medication, initially on OTC remedies and prescribed drugs such as NSAIDS, Paracetamol, Codeine, combinations of these drugs, Beta Blockers and Triptans, to try and gain some symptom relief. The downside is that many of these medications, if overused, ironically will cause rebound pain.

 Adopting a more holistic approach can often be very helpful, so find a clinician who is experienced in adopting a more holistic approach. From a mechanical and muscular perspective, working on the upper neck can really be helpful. Pain diaries to find out the likely triggers, dietary change to balance blood sugar and down regulate inflammation, better hydration and reducing caffeine, breathing re-education as part of stress management can also be a very useful part of managing these chronic problems.”

Britain’s ten million migraine sufferers will be told to keep “headache diaries” to chart their attacks while GPs will have hotlines to access specialist advice and cut down on hospital visits, the NHS has said.

The number of emergency hospital admissions for headaches and migraines has increased by 14 per cent over the past five years, from 95,548 in 2014-15 to 108,711 in 2018-19, according to figures from NHS Digital. Data also shows that 2.5 million GP appointments are linked to serious headaches, with about 100,000 referred on for hospital assessment. Health chiefs have said that migraines cost the NHS £150 million per year while headaches cost £250 million.

In order to reduce this burden and speed up diagnosis and treatment for sufferers, the health service is rolling out a plan of action for GPs and patients called the NHS RightCare Headache and Migraine Toolkit. It is hoped that it will prevent 16,500 emergency admissions per year.

The advice will also warn patients against overusing medication. The NHS said the “practical steps” such as the diaries and hotlines would lead to fewer unnecessary visits to GPs and hospitals and improved quality of life for patients.

Hugh McCaughey, NHS national director for improvement, said: “Headaches and migraines can place a heavy burden on sufferers, the NHS and the wider economy, but we know that there are local health services which are doing really well in meeting people’s needs early in the community, and therefore reducing the need for hospital care.”

He said the initiative “will provide all local NHS leaders with the information and proven ideas they need”.