Managing migraines and the new treatments available

Written by: Dr Stefan Schumacher
Published:
Edited by: Bronwen Griffiths

Migraines are more than just your average headache, and can be debilitating to those who suffer them. Hence, finding a way to manage the pain and preventing them is key to treating those who have them. Dr Stefan Schumacher, a leading neurologist, explains how patients can manage their migraines, from controlling their diet, to medications, to new treatments being used.

How can I manage my migraines?

The management of migraines can be very different and with every patient it is very individual. A lot of our patients watch their diet, which makes sense as a healthy diet does help. Patients, for instance, with gluten or other intolerances to food have to watch their diet very carefully because if they don’t follow the guidelines with their diet then that also triggers migraines. Daily stress in work or other stresses including stress from bereavement, for instance, also induces migraines.

Additionally, the daily management of migraines means taking medication. Patients who suffer from migraines must go and see their specialist or GP who you should have good contact with so that they can keep a watchful eye on you and ensuring you are leading a normal, healthy life. What does that mean though? That means that you sleep enough, at least six hours per night, that you have a regular pattern of sleep, that you preferably do not smoke, that you do not take any drugs and that you don’t drink too much alcohol.

What medications are there for migraines?

We have different treatment strategies for migraines. The first one is tackling the acute pain and the best medication for this are the so-called triptans. We use, for instance, sumatriptan (the brand name is Imigran) in a dosage of fifty or one hundred milligrams, either as tablets, as nasal spray or as a subcutaneous injection into the skin which the patient can administer themselves.

Then we use so-called preventative drugs, which are established drugs used for other conditions such as depression and epilepsy. These preventative medications include beta blockers, amitriptyline, topiramate, zonisamide, gabapentin and others. These drugs are given in a daily dosage and patients need to take them for at least eight to twelve weeks to see if they are effective. Sometimes patients find it a bit irritating taking these drugs because they also have to take them when they haven’t got headaches, but it is very important and they are often very beneficial.

What new medication is available for treating migraines?

An interesting and relatively new drug being used just for treating chronic migraines is Botox. Botox A (this is the proper brand name) is a medication which consists of a certain protein coming from a bacteria and there is a special chemical way to transform this protein which we then administer in injections. Since 2012 Botox has been licensed by NICE (National Institute of Clinical Excellence) guidelines here in the UK and in many other countries by their own authorities. There are a good number of patients suffering from chronic migraines who benefit from Botox injections. When neurologists are administering these treatments, we inject the Botox with a very fine needle into the head in two sessions within three months. This might sound frightening – thirty-one injections into the head – however, it is a very fine needle, like an insulin syringe and it is normally tolerated very well.

My personal experience with this drug is that it works very well for many patients. The criteria are that patients have to have at least fifteen headaches per month, nine of them migraines, and they must have tried or treated with three different preventative drugs, not being effective. Hence, the criteria are quite strict and a number of our patients who we treat for migraines do not fulfil the criteria, but these patients who have chronic migraine often find Botox injections enormously helpful and I am very happy that we have this new treatment and hopefully we shall move forward with Botox as a treatment for chronic migraine.

 

If you suffer from migraines, make an appointment with an expert to discuss your treatment options.

By Dr Stefan Schumacher
Neurology

Dr Stefan Schumacher is a leading consultant neurologist based in Greater Manchester, who specialises in multiple sclerosis (MS), Parkinson’s disease, headaches and migraines.

Dr Schumacher was born and educated in Germany and moved to the UK in 2007 where he worked as a consultant neurologist in Salford Royal Hospital and Royal Bolton Hospital. He currently works in the private sector at the Spire Manchester Hospital and BMI Alexandra Hospital.

Dr Schumacher studied medicine in Florence, Italy and Saarbruecken and Freiburg, Germany. In Germany he worked in a number of medical centres, including Neurosurgery University Hospital, Giessen and a specialised centre for MS and Parkinson’s disease in Bad Laasphe.

For nine years Dr Schumacher was a consultant and the Medical Director of the Wicker Clinic in Bad Wildungen. His department was one of the first in hospitals in Germany to be certified by the German Society for MS. He participated in MS research and was in charge of phase 3 trials with MS medication.

Dr Schumacher was the German Deputy for medical exchange with several Arab countries such as the United Arab Emirates, Qatar, Oman and Egypt. He was a lecturer at the University Hospital Marburg and a teacher and an examiner for medical students at Marburg University.

As a passionate long-distance runner, he holds a special interest in sport-related health issues in neurology. Dr Schumacher is a member of the committee 2.5 Neurology and Sport of the German Society of Neurology and has presented in the past on scientific conferences for this committee.

Dr. Schumacher was born and educated in Germany. He is a son of a German father and English mother from Windsor/Berkshire, he was brought up bilingual.

He studied medicine in Florence, Italy and Saarbruecken and Freiburg, Germany. After graduation he worked in different medical centres in Germany incl. neurosurgery university hospital in Giessen and a specialised centre for Multiple Sclerosis and Parkinsons Disease in Bad Laasphe.
During his time in neurosurgery Dr Schumacher had a special interest in intense care medicine and was one the responsible physicians of the ITU in University Hospital Giessen/Germany which was managed by neurosurgeons and neurologists.

For 9 years Dr Schumacher was consultant and medical director of the Wicker Clinic Bad Wildungen. His special interest at that time was Multiple Sclerosis (MS) and Parkinsons Disease (PD). Dr Schumacher's department was one of the first hospitals in Germany which were certified by the German Society for MS
(" Deutsche Multiple Sklerose Gesellschaft"). Dr Schumacher participated in MS research and also was in charge of Phase 3-trials with MS medication.

Dr Schumacher is member of 3 national neurological societies: ABN (Association of British Neurologists), DGN (Deutsche Gesellschaft fuer Neurologie ) and AAN (American Academy of Neurology).

Dr. Schumacher was German deputee for medical exchange with several Arab countries such as Emirates, Qatar, Oman and Egypt.
He was a lecturer at the University Hospital , Marburg (Prof. Oertel, Neurology) and a teacher and examiner for medical students in Marburg/ University.

Dr Schumacher and his family moved to UK in 2007 and worked as a consultant neurologist in Salford Royal Hospital (prior known as Hope Hospital) and Royal Bolton Hospital. Since 1.4.2016 Dr Schumacher works part time in NHS at Salford Royal Hospital.
Dr Schumacher works 4 days weekly in 2 private hospitals in Manchester : Spire Hospital in Didsbury and Alexandra Hospital in Cheadle.

Being himself a passionate long-distance runner, Dr Schumacher has since years a special interest in sport-related health issues in neurology. Dr Schumacher is member of the committee 2.5 "Neurology and Sport" of the German Society of Neurology (DGN) and has presented in past on scientific conferences for this committee.

Chronic migraine is a very common neurological problem and often patients find it very difficult coping with this condition. Dr Schumacher has a special interest in new treatments for this.. BOTOX (Botulinum toxin type A) is now recommended as an option for the prophylaxis of adults suffering from chronic migraine (NICE Guidance 2012). This is a very interesting new treatment for migraine sufferers and Dr Schumacher is planning  this treatment soon for private patients in BMI The Alexandra Hospital in Cheadle.

 

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