What are migraine treatment options?

At Queen Square, we have what is called a tertiary referral centre. We look after patients with complex headaches. And in fact, we look after the whole range of patients with anywhere from very simple and straightforward headaches to the very complex end. And in terms of treatments, we'll certainly offer patients lifestyle advice, but besides lifestyle advice, we'll talk in terms of painkillers, how to optimise the use of the painkillers, which painkillers to take, and how and when to take them. We will also start patients on preventive treatments. Preventive treatments are treatments that reduce the number of headache attacks that patients have. And there are a whole host of preventive treatments that can be tried out. In the vast majority, we use drugs but in some patients we use injectable treatments such as acupuncture and Botox injections. Then, there is a group of people in home, we use electrical treatments. There are stimulators that are available that are non-invasive, that are hand-held devices that patients use. So, examples of these are something called transcranial magnetic stimulation or something called vagal nerve stimulation. And those are generally not available, but we certainly have them available at the Queen Square Private Consulting Rooms. Then for patients who fail to respond to all of those treatments, there are invasive treatments. There are operations that can be done. And there are a number of operations that we offer. There is something called occipital nerve stimulation which involves putting electrodes at the back of the head with a battery that's inserted often over the chest, and patients get electrical stimulation on a continuous basis. And it's shown to be effective in a number of headache disorders. But besides that, we have also pioneered an operation called sphenopalatine ganglion stimulation. We're the first group to have done it in the UK. And we have also been doing something called deep brain stimulation where what we do is we insert an electrode in the brain and have stimulation going in through that electrode on a continuous basis. And for patients who have highly intractable headaches, highly disabling headaches, all of these very invasive treatments can be used. And we're one of the foremost groups in the UK in offering patients these treatments. There is also a fourth group of treatments that we offer. These are what we call injectable treatments, or infusions. When patients have very severe headaches and you're trying to get on top of the headaches as quickly as possible, then there are injections you can do. There are examples of those being greater occipital nerve blocks or multiple cranial nerve blocks. And we can also give infusions as something called dihydroergotamine that can be given as an infusion. Lignocaine can also be given as an infusion. And those are kind of examples we have of the treatments that we offer at Queen Square.