The last-ditch cure for migraine: A jab in the back of the head



23:12 GMT, 27 August 2012

'I would lie in a dark, quiet room and cry from the pain,' said Ilana Fox

'I would lie in a dark, quiet room and cry from the pain,' said Ilana Fox

Three months ago I woke up with a migraine.

It was the usual horrific pain — my left eye throbbed, my whole head felt as though it was in a vice, and I could barely move.

As I opened my eyes, I was overcome with nausea.

I managed to make it to the bathroom just in time.

As I stumbled back into bed, I felt a
dark cloud of depression consume me.

I knew the migraine would stick
around for at least four days.

the past ten years I’ve suffered from a migraine every couple of
months, but in the past year this increased to two a week, and I was
spending 85 per cent of my time in bed, unable to function.

affect 15 per cent of the population, but do so in different ways —
some people get auras (visual or sensory disturbances), most people get
sensitivity to light and sound, and nearly everyone suffers from the
head pain.

Doctors aren’t entirely sure what causes them; they only know it’s a life-long condition with no known cure.

I can be fairly stoic about most ailments, but my migraines are excruciating.

not just little headaches — they consist of pounding pain where the
tiniest noise feels like a knife slicing through my head.

I would lie in a dark, quiet room and cry from the pain.

My GP couldn’t explain why my migraines had become more frequent (‘Are you stressed’ she asked unhelpfully), prescribing various painkillers and triptans (pills that narrow the blood vessels, which dilate during a migraine).

Even though they didn’t take the edge off the pain, she insisted I persist with them. I was too exhausted to argue.

My previously energetic life quickly dwindled into nothing.

I declined all social invitations, and attempting to prevent the attacks became a lonely, all-consuming obsession.

I tried supplements such as Feverfew and magnesium, said to reduce the attacks. I stopped drinking alcohol and reluctantly gave up cheese and chocolate — all to no avail.

I left my house only to see a cranial osteopath and an acupuncturist (neither provided any relief), and I became such a frequent visitor to my local pharmacy that the woman behind the counter implied I was a drug addict.

My breaking point came when I phoned my father and mumbled something about killing myself.

As I sobbed in my GP’s office, she finally admitted defeat — but she wouldn’t refer me to see a neurologist, as she felt insulted that I didn’t trust her to treat me. I changed doctors immediately.

With the help of my health insurer, I was referred to Dr Guy Leschziner, a consultant neurologist at The London Bridge Hospital.

Doctors aren't entirely sure what causes migraines

Doctors aren't entirely sure what causes migraines

He sees around 300 patients a year with ‘migraine or severe headache’, which is classified as occurring more than two or three times a month.

He worked with me to see if preventative drugs could help — the aim is to stop all migraine attacks, but more typically there is an improvement rather than complete abolition.

The first course of action was amitriptyline, an antidepressant that has been shown to prevent migraines.

I’ve never taken daily medicine before — I’m so sensitive to drugs that even the Pill makes me extremely ill, so I’ve always avoided having to take anything.

However, by this point I was so desperate I was willing to try anything.

Needless to say, the tiniest dose of amitriptyine knocked me out, and I lay comatose on my sofa.

I tried propranolol (a beta-blocker that blocks the transmission of certain nerve impulses that cause migraine), which made me faint and dizzy, and pizotifen, a medicine that knocked me out for 20 hours a day.

It’s believed that serotonin is released at the start of a migraine attack, and pizotifen blocks the serotonin receptors in the brain, which then prevents the migraine.

These drugs have helped countless people with migraine attacks, but the side-effects they gave me were intolerable.

The choice for me was stark: I could have twice-weekly migraines, or I could be unable to leave my house because I was so spaced out from the drugs.

Topiramate, an anti-epilepsy drug that can ease migraines, was my last attempt. Dr Leschziner put me on a tiny dose, but I would spend the night feeling as if there were ants crawling under my skin.

I began to have daily upset stomachs and couldn’t stop vomiting. It was time to bring out the big guns.

In previous consultations with Dr Leschziner, he’d mentioned the possibility of having injections in my head.

I had a choice: greater occipital nerve block injections (which work for only up to 60 per cent of sufferers) or Botox (which NICE approved last May and work for 50  per cent of people).

I chose the nerve block injections — I’ve never liked the idea of Botox for cosmetic purposes, and I couldn’t get my head around the idea of using it for migraines.

In nerve block treatment, the greater occipital nerve — which runs over the back of the head to supply the scalp — has local anaesthetic, sometimes with a steroid, injected next to it to block impulses.

These run from the top of the neck over the head and to the eyes. It’s thought sometimes impulses from nerves in the head and neck drive migraine.

Dr Leschziner only suggests this treatment in one or two patients per year, usually pregnant women who want to avoid oral medication, or people who can’t tolerate any other medication.

‘First, there is limited evidence for the injections in migraine, and since there are a variety of drugs available with good evidence for their efficacy and safety, these are seen as the better option,’ he says.

‘Second, it is a specialised procedure and not available everywhere.

Third, the duration of relief is variable, and some people need repeated injections.’

One study showed 60 per cent of people experienced benefits a month after the treatment, and Dr Leschziner said there were few drawbacks if it worked — I would only feel some tenderness in the back of the head after treatment.

The procedure was brutal, though: I was taken into an operating theatre where, face down, I had several injections of anesthetic in the back of my head, and then the consultant used ultrasound and X-ray to target the nerve endings.

I’d been adamant I didn’t want sedating, but the pain was so intense I begged for more through my tears.

When I came to, my neck was covered in dried blood, and my head was numb.

I was allowed home as soon as the sedatives began to wear off — but the numbness in my head lasted for several days, and I was left with a headache no painkiller could shift.

I spent two days in bed sobbing, not believing the nerve block injections had worked.

But, gradually, the pain disappeared — and it hasn’t come back. I’ve had one migraine in five weeks, and it went away so quickly after I took a triptan that I was astonished.

And while I’m still nervous about making social plans, I’m getting back to where I was.

I recently managed to spend a weekend away with friends — and was delighted when I didn’t get a migraine.

The greater occipital nerve block injections are available on the NHS, but Dr Leschziner thinks they should be reserved for people like me who can’t use conventional treatments.

During my darkest days, I thought my life was over.

If it wasn’t for those jabs, I have no doubt I’d be in bed, in darkness and in considerable pain.

There’s no question that the injections are horrible, but I’ll take the discomfort of them over months of debilitating migraines any day.

All That Glitters by Ilana Fox is available as an Orion Ebook (1.99) out now.