Migraine and Headache Treatment in Marylebone, London

A migraine attack is typically one-sided, throbbing, moderate to severe, and made worse by movement. Nausea and sensitivity to light and sound are common. Around a third of people get an aura first, usually visual, in the twenty minutes to hour before the pain. An attack can last from four hours to three days, and the day after often costs you as well.

Attacks begin in a cortex that is more excitable than average, so the threshold at which an attack starts is lower. In aura, a slow wave of altered neural activity spreads across the cortex. The pain itself comes from activation of the trigeminovascular system. Where attacks are frequent, the nervous system sensitises further, which is why episodic migraine can drift into chronic migraine over years.

Chronic migraine means fifteen or more headache days a month over three months, with at least eight of them migraine days. Two things commonly hide inside that picture. One is medication-overuse headache, caused by frequent use of acute painkillers or triptans, which is common and treatable. The other is neck or jaw pain referring into the head. Both are worth finding before anyone stimulates anything.

Magnetic stimulation is aimed at cortical excitability, which is the reason it is of interest in migraine prevention. Being straight about the evidence: it is more limited here than in depression, and studies have used several different targets, including motor cortex, prefrontal and occipital sites, so there is no single agreed protocol to quote at you. Single-pulse devices marketed for acute attacks are a different technology from the rTMS delivered here, and we do not claim their evidence or their regulatory status.

One firm rule. If your headaches are new, have changed in character, wake you from sleep, or come with weakness, speech difficulty or visual loss, you need a neurological assessment rather than a treatment plan from us, and we will tell you that at the free consultation.