Headache management rests on two main pillars: acute and preventive medications. Acute Medications: These relieve symptoms during an attack. Examples include over-the-counter drugs like ibuprofen or paracetamol, prescription triptans (e.g., sumatriptan) for migraine, or oxygen therapy for cluster headaches. Preventive Medications: These reduce headache frequency and severity when taken regularly. Examples include beta-blockers (e.g., propranolol), anticonvulsants (e.g., topiramate), antidepressants (e.g., amitriptyline), melatonin, and flunarizine. Melatonin, a natural hormone, helps regulate sleep and may reduce migraine frequency, particularly in patients with sleep disturbances. Flunarizine, a calcium channel blocker, has specific evidence supporting its use in patients with vestibular migraine and those with migraine with aura, offering effective prevention by stabilizing neuronal activity. At London ENT Surgeons, we offer cutting-edge CGRP-based therapies targeting calcitonin gene-related peptide, a key migraine pathway component. These include: Oral CGRP inhibitors (e.g., rimegepant, atogepant) for convenient management. Subcutaneous CGRP injections (e.g., erenumab, fremanezumab) for long-term prevention. Intravenous CGRP therapy (e.g., eptinezumab) for rapid, sustained relief. For refractory migraine or TACs, we can arrange admissions for dihydroergotamine (DHE) treatment at the Guthrie Clinic, a specialized facility for complex cases. Our multidisciplinary team ensures comprehensive care, combining medication, lifestyle advice, vestibular rehabilitation, and advanced diagnostics to address your unique needs, includin g conditions like PPPD.

Headache Treatment London | London ENT Surgeons

Surgery & Treatment

Understanding Headaches

Broadly speaking, there are two main types of headaches: primary and secondary. Primary headaches, such as migraine, vestibular migraine, menstrual migraine, and trigeminal autonomic cephalalgias (TACs), occur independently and are not caused by another medical condition. Secondary headaches stem from underlying issues like infections, injuries, or other health conditions. At London ENT Surgeons, we specialize in diagnosing and treating a wide range of headache disorders, ensuring personalized care tailored to your needs through our multidisciplinary approach involving neurologists, ENT specialists, audiologists, and physiotherapists.

Migraine

Migraine is a neurological disorder characterized by recurrent migraine attacks or headaches, often presenting with throbbing pain, typically on one side of the head, though it can affect both sides. These attacks may be accompanied by nausea, vomiting, and sensitivity to light, sound, or smells. Migraine attacks can last from a few hours to several days, significantly impacting daily life. Common triggers include stress, certain foods, hormonal changes, or sleep disturbances. Approximately 1 in 7 people experience migraine, with women being three times more likely to be affected than men.

Pathophysiology (Why do I get headaches?)

In migraine patients, the brain becomes overly sensitive to certain triggers, like stress or hormonal changes. This sensitivity causes the brain to release chemicals that lead to pain and swelling of blood vessels around the brain although this does not seem to be the cause of the pain. These changes result in the throbbing pain, nausea, and other symptoms of a migraine attack. Key players in this process include a brain chemical called calcitonin gene-related peptide (CGRP), which contributes significantly to the pain.

Migraine with and without Aura

Some people experience migraine with aura, while others have migraine without aura. An aura is a set of warning signs that can occur before or during a migraine attack. These might include seeing flashing lights, zigzag lines, or blind spots in your vision, or feeling tingling in your hands or face. Auras typically last 20–60 minutes and serve as a signal that a migraine attack is coming. Not everyone gets auras—about 1 in 4 migraine sufferers do. Whether you have auras or not, the headache and other symptoms can be just as severe, and our team tailors treatment to your specific experience.

Vestibular Migraine

Vestibular migraine is a prevalent and important subtype of migraine that involves dizziness, vertigo, or balance disturbances, typically with a history of headache. Patients may experience spinning sensations, unsteadiness, or sensitivity to motion, often mistaken for inner ear disorders. These symptoms can be highly disruptive, affecting daily activities like driving or working. At London ENT Surgeons, our multidisciplinary team of neurologists, ENT specialists, audiologists, and physiotherapists excels in managing vestibular migraine with high standards, offering tailored treatment plans that address both headache and vestibular symptoms. We also treat related differential diagnoses, such as Persistent Postural-Perceptual Dizziness (PPPD), a chronic condition causing persistent dizziness and unsteadiness, with comprehensive rehabilitation strategies.

Menstrual Migraine

Menstrual migraine is linked to hormonal fluctuations during the menstrual cycle, typically occurring just before, during, or after menstruation due to a drop in oestrogen levels. It shares symptoms with migraine, such as throbbing pain and sensitivity to stimuli, but its predictable timing allows for targeted treatment. Women with menstrual migraine benefit from cycle tracking to anticipate and manage attacks effectively.

Trigeminal Autonomic Cephalalgias (TACs)

Trigeminal autonomic cephalalgias are rare but severe primary headaches, including cluster headaches, paroxysmal hemicrania, and SUNCT (Short-lasting Unilateral Neuralgiform headache attacks with Conjunctival injection and Tearing). TACs feature intense, one-sided pain around the eye or temple, accompanied by autonomic symptoms like tearing, nasal congestion, or eyelid swelling. Cluster headaches, known as “suicide headaches,” are particularly excruciating and occur in cyclical patterns. TACs require prompt diagnosis and specialized treatment due to their severity.

Other Headache Types

Beyond migraine and TACs, other primary headaches include tension-type headaches, which feel like a tight band around the head, and rare conditions like hemicrania continua. Secondary headaches may result from sinus infections, head trauma, or medication overuse. Accurate diagnosis is critical, as treatment varies by headache type and cause.

Treatment Approaches

Headache management rests on two main pillars: acute and preventive medications.

Acute Medications: These relieve symptoms during an attack. Examples include over-the-counter drugs like ibuprofen or paracetamol, prescription triptans (e.g., sumatriptan) for migraine, or oxygen therapy for cluster headaches.
Preventive Medications: These reduce headache frequency and severity when taken regularly. Examples include beta-blockers (e.g., propranolol), anticonvulsants (e.g., topiramate), antidepressants (e.g., amitriptyline), melatonin, and flunarizine. Melatonin, a natural hormone, helps regulate sleep and may reduce migraine frequency, particularly in patients with sleep disturbances. Flunarizine, a calcium channel blocker, has specific evidence supporting its use in patients with vestibular migraine and those with migraine with aura, offering effective prevention by stabilizing neuronal activity.

At London ENT Surgeons, we offer cutting-edge CGRP-based therapies targeting calcitonin gene-related peptide, a key migraine pathway component.

These include:

For refractory migraine or TACs, we can arrange admissions for dihydroergotamine (DHE) treatment at the Guthrie Clinic, a specialized facility for complex cases. Our multidisciplinary team ensures comprehensive care, combining medication, lifestyle advice, vestibular rehabilitation, and advanced diagnostics to address your unique needs, includin g conditions like PPPD.

Why Choose London ENT Surgeons?

Headache disorders, whether migraine, vestibular migraine, menstrual migraine, TACs, or related conditions like PPPD, can profoundly affect your quality of life. At London ENT Surgeons, our expert team delivers high-standard, multidisciplinary care, leveraging advanced CGRP therapies, specialized options like DHE, and targeted preventive medications such as flunarizine for vestibular migraine and migraine with aura. Contact us today to schedule a consultation and take the first step toward lasting relief.