Anglim Private Health is a private GP surgery based in Bury St Edmunds. We look to support our small group of patients with individualised personalised care which takes account of illness and the impact they have on people’s lives.
Migraine is a really good example of an illness which has to be placed in context. It is often dismissed as a temporary, short term headache; something which you can be expected to just get over with a bit of rest. But for those who suffer from migraines it can be severely debilitating and affect our lives in many different ways. Worldwide, it is second only to back pain as a cause of disability, and is the most disabling illness amongst young women.
A broad range of symptoms
Migraine also covers a really wide range of presentations. Some will have very mild symptoms; perhaps a mild headache and vision problems lasting 30 minutes a couple of times a year. But others will experience severe headache, nausea and neurological symptoms, lasting days at a time, recurring several times every month. There are many migraine sufferers who have no idea that migraine is their diagnosis. Classical migraines can be straight forward to diagnose, but there is a large range of people experiencing episodic headaches with or without a range of other symptoms, who are truly dealing with migraines and are never given that as a diagnosis. There is such a broad range of symptoms which can be considered as a migraine that the diagnosis is often significantly delayed or totally missed.
A huge impact on wellbeing
The effects of migraine can go further than just the symptoms as they occur. The uncertainty of when they might occur has huge effects on people’s lives. Can you take a job with tight and extremely important deadlines if you might, without warning, suddenly need 4 days off work to recover from a migraine? And when that happens does it affect your job and future career prospects? Away from work, can you commit to taking your child to far flung hockey matches, if a migraine might suddenly strike 3 hours from home? Can you commit to an exercise plan or sporting challenge, when dehydration is one of your migraine triggers? The effects of the unpredictable nature of migraines means it can have effects on wellbeing which are broader and more significant than the symptoms when they occur.
Treatments
But help is at hand and over recent years the choices of treatment for migraines have been expanding. Before reaching for the prescription pad however, it is always important to consider how other interventions can help migraines.
- Look for known or common triggers and try to treat those, like stress, lack of sleep or dehydration.
- Regular exercise and maintaining a healthy weight have been shown to reduce migraines.
- Look for other illnesses which can be triggering migraine, undiagnosed sleep apnoea is a good example.
Sometimes supplements can be effective at reducing the frequency and severity of migraines. Riboflavin (vitamin B2), magnesium and co-enzyme Q10 are the supplements with the most evidence behind them. The doses needed are specific for migraine and you should speak to a doctor who really understands these treatments if you are using them for migraine.
Then with traditional medications there are two parts to the treatment. Treatments to end or reduce a migraine once it has started include simple pain killers like aspirin, ibuprofen or paracetamol, often taken with an anti sickness medication. Triptans are the most common specialist medication for migraines, they are effective and the majority of people (but certainly not all) tolerate them very well. They are quite effective as a tablet, but in some patients can be much more effective when given as a nasal spray or self administered mini-injection and those treatment choices are often underutilised.
Then there are medications which are taken to prevent or reduce the frequency and severity of migraines. These unfortunately do have some side effects for most people and part of the judgement in these instances is to work out if we feel the side effects are easier or more difficult than the underlying illness. Propranolol, topiramate, amitriptyline or candesartan are the most commonly used preventative drugs and the key is to take the time to discuss with your private GP which of those we feel would have the best benefit with fewest side effects.
Newer treatments
For many years the treatment for migraines had been the same with us limited to the armoury outlined above. But over recent years two new medication classes have become available for the treatment of migraine. These can be expensive treatments, which means they are often restricted significantly by the NHS; but for many patients the benefits can be life-changing and most clinicians, even within the NHS, believe the restrictions are significant and unfair.
Aquipta can be used to prevent migraine, and Vydura can be used both to treat each episode of migraine, but also taken regularly to reduce the frequency and severity of the migraines. Both of these tablets are significantly restricted through the NHS, but might be available through your Private GP if it was felt appropriate.
Finally monoclonal antibodies are a new injectable type of treatment which can be effective at reducing the frequency and severity of migraines. It would be necessary to see a specialist to access those treatments.
Summary
Migraine is a significant disabling illness and the effect of the uncertainty around migraines amplifies any of the significant symptoms experienced by patients. Diagnoses can be delayed as patients attend with a range of symptoms which could be migraine. There have been moderately effective treatments available for many years, but the best treatments can face restrictions because they are expensive to provide.
But by taking account of the whole situation, your private GP from Anglim Private Health can agree with you a more comprehensive treatment plan which includes lifestyle changes, supplements and medications when needed. Through your private GP you can access some of the newer treatments for migraines and/ or get supported with a specialist referral if some of the most complex treatments are required.
You can find more information about migraine on the Migraine Trust website.
If you would like to see how a private GP might improve your health and wellbeing, please contact us at Anglim Private Health. Dr Anglim would love to welcome you for a no obligation discussion regarding our membership options.