S1 E8: Acute Treatment and Medication Overuse Headache

A National Migraine Centre Heads Up Podcast transcript

Acute treatment and medication overuse headache

Series 1, episode 8

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[00:00:01] Did you know that medication overuse headache is one of the most common chronic headache disorders and a public health problem worldwide? It’s important to know how much is too much. Welcome to the Head’s Up podcast brought to you by the National Migraine Centre, the only UK charity treating migraine and headache.


Dr Jessica Briscoe [00:00:27] Hello, I’m Dr. Jessica Briscoe and I’m joined by Dr. Katy Munro.


Dr Katy Munro [00:00:32] Hello.


Dr Jessica Briscoe [00:00:32] And we’re here today with your Heads Up podcast. We’re going to be talking about acute medication today. Essentially, we talked a little bit about medications that people can use to manage their migraine, but we wanted to talk about other medications. So we talked about triptans a few episodes ago. And today we wanted to talk about other things that you can do to take away the symptoms that you get with a migraine.


Dr Katy Munro [00:00:55] And also the problems that you can run into if you do that too often. So the simplest medications you can buy over-the-counter paracetamol, aspirin, ibuprofen and some of those are in combination with caffeine.


Dr Jessica Briscoe [00:01:08] Yes. I mean, generally speaking, we don’t advise to take combinations of medications. I prefer them to be sold or bought individually because you’re a bit more in control of how much of each of the medication you’ve got. And also, you have to be a little bit careful about caffeine.


Dr Katy Munro [00:01:26] Yes, caffeine can be a trigger if you take it too often. And so to make it useful as a co-analgesic, which is helping painkillers to work, you need to be sensitive to it. So watch out for caffeine.


Dr Jessica Briscoe [00:01:41] So initially, the way that I advise people to manage their migraine is to start off by thinking about which painkiller they like. Now, for me, aspirin is my- I don’t like to use the word favourite, but it’s my simple painkiller of choice. And I usually advise people to take high dose of whichever painkiller that they want. And usually in a formulation that’s more likely to be absorbed better, which is the other reason I prefer aspirin because you can get it in a soluble or dissolvable formulation.


Dr Katy Munro [00:02:12] You used to be able to get an effervescent form, which was quite handy and I think you can still, if you look on the shelves carefully, but it’s not so easily available as it used to be. So it’s soluble or effervescent aspirin dissolves very quickly and that helps it to be absorbed very quickly once it gets to the right place in your body. And that is the secret of success, isn’t it? Squashing your migraine very quickly with a high dose of something. So I usually recommend either 600 milligrams or 900 milligrams of soluble aspirin. If patients can’t take soluble aspirin because they’ve got gastritis or problems with indigestion, then they can take paracetamol. What do you think about paracetamol and migraine?


Dr Jessica Briscoe [00:02:57] My main problem with paracetamol is it’s not the right- it’s not strong enough usually to hit migraine. You can actually get paracetamol in a soluble or effervescent formulation, which can work a bit better. But I would usually avoid paracetamol.


Dr Katy Munro [00:03:13] It’s quite weak isn’t it. Most people say, well, I’ve tried it and it didn’t help, but if that’s your only option, it can be worth a try. And it works for some people a bit. It’s quite good in children, actually.


Dr Jessica Briscoe [00:03:23] Yeah, yeah, I agree with that. The other thing that- so you’ve talked about absorption actually of the medication, often alongside their painkiller, I advise them to take an anti sickness as well, but specifically one that will help to reverse the gastric statis that people get, so the bit where your stomach stops moving at the beginning of a migraine. So I usually get them to take metaclopramide or domperidone to help with that absorption process to.


Dr Katy Munro [00:03:47] Yeah, you need to get those on prescription from your GP, but they are quite useful so they help their stomach to move the contents on. And that has the benefit of speeding up absorption of the painkillers, but also reduces the nausea and vomiting, which is a nuisance. But you don’t have to wait to feel sick to take it. You can take it with your painkillers. And of course, the other painkillers commonly available- easily available are ibuprofen. And you can get that in lots of different formulations. So that can be quite useful and handy to carry with you if you don’t want to take aspirin, but you shouldn’t take the two together.


Dr Jessica Briscoe [00:04:25] No. And also you do often need to take it at a higher dose than you would usually take it. So again, with ibuprofen, if it works for you, I often advise around 600 to 800 milligrams actually, which is higher than it would stay on the packet and higher than people are used to taking. Again, as with aspirin, that can cause problems with gastritis and also the other thing people do worry about a little bit with long term nonsteroidal use is kidney problems.


Dr Katy Munro [00:04:54]  So be careful. And of course, we’re talking about adult doses. If you’re giving ibuprofen to children, you just need to be careful about the age specific dose for them. But the principle is basically higher dose quickly and then repeat the doses later in the day, if the headache is continuing because it’s much better to squash your migraine on day one than to partially treat it and have it come back again on day two and then take some more painkillers and maybe more on day three, because it hasn’t really gone. So if you keeping on doing that, then we have a much higher risk of developing medication overuse, which is what we’re going to come on to in a minute. Yeah, the other nonsteroidals that can be useful in migraine are naproxen. And we used to use diclofenac a lot, didn’t we?


Dr Jessica Briscoe [00:05:49] Yeah. And some people still find that they prefer it, usually because it’s available in other formulations so suppositories. So if people are feeling quite sick, they quite liked to take it and it was fast onset. But we have to be a little bit more cautious with diclofenac than we used to be just because of this- there’ve been some studies which show that it can cause problems with your heart.


Dr Katy Munro [00:06:14] That’s right. Yes. So we tend to use ibuprofen or naproxen in preference really and sometimes with something like omeprazole or lansoprazole just to protect the stomach from the gastritis, if you’re having to take it fairly frequently. But the, of course, the big no no from us and from all headache specialists really would be to take codeine or any opiates, because these can very rapidly cause a transformation of your headache from episodic into a background daily headache with episodes of migraine on top of that. And people run into all sorts of problems with codeine. It’s very addictive and it makes the gastric statis worse and so we do strongly advise people to avoid codeine and opiates, if at all possible.


Dr Jessica Briscoe [00:07:05] Also they actually do hit the wrong pain receptors. They don’t actually manage the right type of pain. They’re quite good for bone pain. They’re not good for headache pain.


Dr Katy Munro [00:07:14] And they make people sleepy. And that is why I think sometimes people think they work because they go off to sleep and then the headache does its thing and goes away. And they’re also very addictive so they become very difficult to come off. Going on then to medication overuse headache, Jess. This is something we see pretty much every week in clinic. So common. Do you want to just kind of explain the definition, what we think of?


Dr Jessica Briscoe [00:07:41] Essentially medication overuse headache is a slightly unusual phenomenon that occurs in people who are known to have headache problems, particularly migraine. And it’s where the very thing that you’re using to treat your migraine then causes further headache to occur. So it’s more of a sort of background headache where you’re getting- it’s usually chronic. So you’re having more than 15 headache days a month and then you can be getting exacerbations of your migraine in between. Different types of medication can- you’re allowed to use them for different amounts of time. So for things like what we call the simple painkillers so ibuprofen or paracetamol or aspirin type medications, if you’re taking more than 14 days, and it’s days that’s important, not doses, of those tablets in a month for three months or more, you are at risk of developing medication overuse. Different for triptans, that tends to be 8 to 10 days per month. And then for codeine and opiates, I mean, we say not at all, but it tends to be six days a month.


Dr Katy Munro [00:08:41] Yes, it is a problem. And I think the time to be talking to people about it is when we are starting them on medication and I think it’s not just doctors who should be talking about this it’s pharmacists as well, because if people don’t know that it’s a risk, then they don’t understand about counting the number of days. And we see some patients who’ve been taking triptans every single day or aspirin or paracetamol or ibuprofen every single day, and then they’ve got medication overuse.


Dr Jessica Briscoe [00:09:09] And I think that’s the problem. I think a lot of times people can feel that they’re being blamed, actually for the migraine when they have medication overuse. I never see it as the person’s fault. People are doing what they think is the right thing, but they haven’t been told or they’ve been misinformed. And I’ve seen people whose doctors have told them to take triptans every day to take painkillers every day. It’s never the person’s fault that has it, it’s a very unusual phenomenon. It doesn’t happen with other types of pain in the same way. There’s been quite a lot of studies, actually, and it’s only people who get migraine who seem to get medication overuse.


Dr Katy Munro [00:09:42] The other thing I think is it’s so understandable that if you’re getting frequent bad headaches, you will take frequent painkillers. And so it really is a question of spreading the word about how this is a thing that people need to watch out for. So, as you said, it’s totally not the fault of the person it’s happened to. And it does need us as doctors, I think, to really understand and support people through the process of getting through medication overuse and getting back into hopefully episodic migraine, because a problem with medication overuse is that things we normally use for episodes of migraines stop working, and it’s not just a question of switching from this to that and try this and try that. We have to detox the brain to get to a clear space where we can then start putting in effective medications again.


Dr Jessica Briscoe [00:10:31] Yeah, I think that’s a really important point. I mean, how do you usually identify medication overuse headache?


Dr Katy Munro [00:10:37] I think it’s just by listening and very often you get the clues in there in the story of people say, well, I used to get episodes and I used to have headaches that were easy to treat and then they got a little bit closer together and and now I’ve got a headache nearly every day. And I specifically ask about crystal clear head days so our definition of a crystal clear head is a day when somebody has not a trace of any symptoms because of course, it’s not just about headache, it’s sometimes brain fog, a feeling of pressure around your head or fullness or dizziness, all these other symptoms. But if they are having a day when they’re completely well, that’s a crystal clear head day and it’s worth counting those up because sometimes people look back and think, well, I can’t remember the last time I felt completely well. Because they’ve ignored the days when they had a mild headache or low grade symptoms. But they’re still there relentlessly in the background.


Dr Jessica Briscoe [00:11:33] Yeah. And I think the other thing that can be quite a give away is a symptom called allodynia. And that’s particular sensitivity to touch, usually around the area of the head pain around the face or the scalp. Some people have said it can be so bad that even a breeze blowing on their face can be quite painful for them. And studies have shown that that’s a very- that’s quite a key feature of medication overuse headache. So, I mean, it can exist in chronic migraine anyway with people who don’t have medication overuse. But I think something like that for me might sort of make me wonder if I’ve looked at someone’s diary, seen they’re taking a lot of painkillers, might start to wonder if that’s the thing that’s causing their daily headache or symptoms.


Dr Katy Munro [00:12:13] Yes. I think the other thing is sometimes it’s a diagnosis that we make looking back, because if we’ve had a suspicion that medication overuse might be part of the problem in somebody who’s developed chronic headaches, then once we’ve done that detoxing with them and help them through that period, if everything clears and they start to get lovely periods of time where they haven’t got headaches, then you can look back and say, well, actually, it was probably because you were taking that medication too often. And of course, it can then be something that we need to think about preventers, as we were talking about in a previous episode, preventative medication probably needs to be used a bit more frequently.


Dr Jessica Briscoe [00:12:53] Absolutely. So I think, in summary, we’ve talked a lot about different types of medications that you should use acutely, which ones you shouldn’t use and how often you should use them to avoid developing medication overuse.


Dr Katy Munro [00:13:07] And just to state again, it’s about the days you take things on, not the doses. So double dosing on day one, taking something in the morning and something later in the day is better than taking something on one day and then again the next day. So days not doses is what you’re counting.


Dr Jessica Briscoe [00:13:25] So now Katy is going to have a chat with one of our colleagues, Dr Naz, about medication overuse headache.


Dr Katy Munro [00:13:34] Now we’re going to talk about medication overuse headache with Dr Nazeli Manukyan and what we can do about it once somebody has got to the stage where their headaches are coming every single day and being relentless. So what would you do first? What would you advise somebody?


Dr Naz Manukyan [00:13:51] Yes, I would explain why a medication overuse occurred and the mechanism and the main treatment will be withdrawing the medication which brought to the duration of headaches.


Dr Katy Munro [00:14:04] So stopping the cause of the problem. But they can’t- do you think that cold turkey is a good idea? We know that sometimes people are advised to just stop everything for a number of weeks, something like about four weeks, and not take any of their triptans or painkillers or anything at all for four weeks to detoxify the brain. How effective do you think that is?


Dr Naz Manukyan [00:14:22] Yeah, it is possible to do cold turkey, but probably needs a bit longer duration than just four weeks. And there are some complex patients who will need some support during this time, not just on the cold turkey.


Dr Katy Munro [00:14:35] I think it’s quite challenging, too, isn’t it? Because one of the problems with going cold turkey is that often the brain kicks off a bit and you get really quite severe withdrawal headaches. And that’s a very daunting prospect, especially when a lot of our patients have children or jobs and they’re trying to keep functioning and to tell them that this persistent daily headache that they’ve got is going to get worse and they’re not allowed to take anything, that makes them really quite scared.


Dr Naz Manukyan [00:14:59] That’s right. And so many of them say so, OK, I’m happy to stop, but what do I take if I have a headache?


Dr Katy Munro [00:15:05] Yes, that’s true. Yeah. And also people who have taken codeine on a very regular basis, there’s also that worry about addiction and withdrawal from the codine, so I tend to have a long chat with people about the various different options, but cold turkey has been found in some studies to be very effective and give people quite good relief by the end of the period of time when they’ve withdrawn, they start to get days when they haven’t got headaches and everything’s looking a lot brighter.


Dr Naz Manukyan [00:15:32] That’s right. I think individual approach and just understanding patient’s individual story and how to help them to cope through that difficult time and offer some alternatives and support.


Dr Katy Munro [00:15:44] So what kind of support do you offer? I think what we call them is sort of bridging techniques. And what would be your first one to talk about with patients?


Dr Naz Manukyan [00:15:53] Yes. So they are bridging treatments or intermediate treatments. For example, offering naproxen as a choice taken regularly during a period when they withdraw all analgesics or triptans. So naproxen is an antiinflammatory painkiller. But if you take it in a smooth manner, for example, 500 milligrams twice a day or 250 three times a day and have a constant level of that in the body, this may work as a preventive during this withdrawal period.


Dr Katy Munro [00:16:21] Yeah, it can work quite nicely, can’t it? And there are some snags with Naproxen. So if people have gastric problems or indigestion, they might need to take a protector like omeprazole or one of those medications to help them through. What about the nausea and vomiting that comes with the headaches? What do you think?


Dr Naz Manukyan [00:16:39] Yes, frequently withdrawal symptoms can be accompanied by nausea or vomiting, so antiemetic can be taken safely. Any choice of anti sickness drugs like metoclopramide or domperidone or cyclizine, whatever their preference, may help just first few days.


Dr Katy Munro [00:16:55] And it does at least give people something to to try to get them through those difficult days. And I also say physical things like using icepacks, resting and perhaps even preparing your family or your work for the fact that you’re going to have to really look after yourself over the next few weeks as you do this detoxing process.


Dr Naz Manukyan [00:17:14] They may consider time of work or plan it, they may not necessarily have to do it the day after they leave our clinic, they can plan during their holidays, start at the weekend and ease off into that and see if it’s possible. But it’s important to have longer duration of abstaining up to six to eight weeks because some patients mentioned they stopped for five days. It didn’t go away. So, that’s not good enough.


Dr Katy Munro [00:17:36] Yeah, you do have to be patient with this. And I think that’s why we try here at the National Migraine Centre to talk to patients very thoroughly about this before they embark on it, because it is something that they’ve often heard about. They get very worried and anxious. What about steroids? Do you ever use steroids?


Dr Naz Manukyan [00:17:53] Yeah, another popular option is prednisolone. So you start with a high dose of prednisolone, it’s antiinflammatory and it abolishes headaches, but then you can’t continue on that high dose for long enough. So you have to reduce gradually and usually headaches come back a bit quicker. And I think this is a bit- it’s not that popular an option.


Dr Katy Munro [00:18:12] Yeah and it has side effects as well doesn’t it. And I think steroids in the long term are not something we want our patients to be on.


Dr Naz Manukyan [00:18:22] And not everyone can take them. They are a lot of contraindications for them.


Dr Katy Munro [00:18:24] What about injections? So we do offer some injections here and sometimes nerve blocks can be quite useful.


Dr Naz Manukyan [00:18:31] I find greater occipital nerve block is a very good option to offer. It’s an injection of a local anaesthetic and steroids at the back of the head and that usually kicks in within days and they find the headache has definitely settled with that, it’s very easy to stop medication. And in some patients it can last up to eight weeks or sometimes it could be shorter, up to three weeks.


Dr Katy Munro [00:18:55] But yes, nothing works for everybody does it. I think that’s one of the messages we always have to say to people, we can’t look at you and know which thing will work for you. But I’ve seen quite a number of patients benefit from a greater occipital nerve block and people don’t seem to mind it too much unless they are needle phobic or really worried about injections. And it can just give them that sort of quietening down of the irritability of the brain while they’re trying to reduce the medication or stop the medication to do this detoxing programme. So we also have some other options now, what do you think about the new medication, the CGRP injections that we’ve been hearing so much about? And even recently there’s been a NICE guidance and unfortunately, one of these has not been approved for the NHS, but we’ve been using aimovig here. Have you used that for helping people through medication overuse?


Dr Naz Manukyan [00:19:49] Yeah, it’s a good option when many other treatments failed and there is medication overuse, the studies show that patients who did overuse their painkillers, they noticed a reduction in their use of treatments and improvement in a number of headaches. And therefore, somehow medication overuse has been addressed when the CGRP injections work.


Dr Katy Munro [00:20:12] Yes, there’s another one called Ajovy, which has also got some study evidence, I think, to show that it can be useful, but these are expensive treatments, not easily available. And so people are very unlikely to get these on the NHS at the moment sadly.


Dr Naz Manukyan [00:20:27] We have a few other options. We do Botox injections. They have also shown in studies and in our experience to reduce the number of migraine days and therefore use of painkillers and also topiramate can be used.


Dr Katy Munro [00:20:41] Yeah. So some of the medications that we’re using with the injections while they’re improving people’s headaches, the result of that is that they stop taking their medication for their acute attacks. And that in itself helps things to improve, doesn’t it?


Dr Naz Manukyan [00:20:58] I also find offering any other prophylactic before they commit to withdrawing medication could be helpful, although we want also to try it completely detoxifying them, because about 50% of patients, after they address medication overuse, they don’t need preventive because migraine frequency significantly reduced.


Dr Katy Munro [00:21:19] So sometimes it’s just the medication overuse that’s driving the headaches. But other times there is a more frequent episode of migraine behind it. And so once hopefully we are getting people through to a clear patch where they’re getting some lovely, crystal clear head days where they’re not getting chronic migraine anymore, they’re getting episodes of migraine. And that can last for quite a period of time. But we do find that some people then relapse. So what do you think about the relapsing and the recurrence of medication overuse? It is a bit of a risk, isn’t it?


Dr Naz Manukyan [00:21:52] That’s right. So people who improved with such treatment and abandoning painkillers, sometimes towards the end of year, they gradually the frequency of painkiller creeps up because migraine is still there. We haven’t eliminated migraine. So to prevent that, it will be important to, again, be on the prophylactic or consider a regular course of naproxen when migraine starts to become frequent, or address whatever stress, certain triggers and lifestyle changes prevent getting back into that phase.


Dr Katy Munro [00:22:23] Because, of course, life changes and the stresses we’re under and the changes that are happening in our bodies and in the weather and all these other things that we’ve dealt with in previous episodes about triggers can kick off again. And if you have got this irritability of the brain, then unfortunately the migraine can ramp up. So we need to keep an eye on people basically, don’t we?


Dr Naz Manukyan [00:22:44] Yes. And also we may need to clarify why in the first place the medication overuse occurred, is there some underlying problem driving migraine? So there are stressors, mental health problems, depression, anxiety. Is there chronic insomnia and some form of sleep disorder like obstructive sleep apnoea and therefore headaches were frequent anyway to begin with?


Dr Katy Munro [00:23:09] Yeah, so looking more widely at the background other the conditions that might be present, I think in future episodes we’ll try and talk a bit more about some of these problems like insomnia, sleep and other chronic pain syndromes that might aggravate things. So, yeah, medication overuse headache is such a common thing. We see it every week here really, don’t we?


Dr Naz Manukyan [00:23:29] Yes. The majority of patients with bad migraines, have medication overuse.


Dr Katy Munro [00:23:35] An awful lot. And it is something to really gen up on and for us to be aware and be helping and supporting people through it.


Dr Naz Manukyan [00:23:42] But it’s very satisfying when they manage to come off medication and the improvement. I think this is the best treatment out of whatever drugs we can offer. Just abandoning medication helps.


Dr Katy Munro [00:23:54] Absolutely. We are hoping that you’re all enjoying this podcast and we are certainly enjoying making it, if you would like us to keep going. And we’re hoping to do a series 2, we would be very grateful if you would give us a donation. So if you go on to Virgin Giving and type in Heads Up podcast, it’s very easy to give us a pound or a tenner or £100 if you’re feeling generous. And that would be absolutely lovely and we might even manage to buy some better microphones. Thank you so much. Charlotte spoke to one of our patients. This is what they had to say.


Charlotte [00:24:31] Hi, Sue, thanks so much for joining us. I understand you’ve experienced medication overuse headache, so how did that sort of come about and how did you get through it in the end?


Sue [00:24:40] I’ve always suffered from migraines sporadically from when I was a child. I learnt really early on to what the triggers were for my headache, so I managed it really well. Then about three years ago, I discovered I had a tumour in my eye, went to the eye infirmary, they suspected a detached retina, but they said it was a tumour. So instantly I’m thinking it’s cancer. I had to wait three months for all the tests to go through to tell me it was a haemangioma. So basically it started leaking. I can’t see anything in that eye. And it was flickering and really light sensitive. So I had a constant headache for six months. I went to my GP and he prescribed sumatriptan to take twice a day, omeprazole for my stomach and amitriptyline to take at night. So I was taking this religiously for months. It didn’t stop my headache at all. It just took the edge off. I was off work, because I was doing an office job at the time. It was just horrendous. It literally- I used to just come home and go straight to bed, get up. I was just functioning and it was just so- my mental health was horrendous. And then Katy came down and we were just sat, having a chat on the sofa and she just said sumatriptan can cause headaches if you take it for more than seven days. And I was like, but I’ve been taking it for months. So she was like, oh my goodness. So she was only here for like ten minutes but in that ten minutes it was almost like i might actually see light at the end of the tunnel here. So later on that day, she she sent me a WhatsApp message saying, right OK, stop, basically stop taking the sumatriptan. She said you’ll probably have a headache, but she basically set me up with a plan. So she said to stop all the medication that I was on, almost go like cold turkey, but take naproxen. Then after two weeks to knock that down to two times a day, and then stop. Still take the omeprazole to protect my stomach and then the amitriptyline at night, literally within two weeks, I didn’t have a headache. I had had my eye treated just before that as well. So where my eye was flickering all the time and I couldn’t see anything out of it, that started to ease a bit as well. So not only did I not have the flickering, I also had that, but I think it was the fact that my headache had gone. I could get out and exercise more and it was literally just like a weight has been lifted. It was just absolutely crazy. So now I still do get headaches. And because I have to go back and have my eye treated every year and when it starts leaking my eye starts flickering more and that’s when my headaches start to come. So to manage that now, if it’s really bad, I do take amitriptyline at night, but I take it early on so I can get a really good night’s sleep. And I think sleep is also the key to go to bed on time to get up on time. And that’s always been the case with me. If I ever had a lay in my headaches would be almost immediately as soon as I woke up. But I think exercising and eating regularly and then obviously managing the tablets. But I had no idea that the tablets that my GP had prescribed would actually cause the headaches. And I think I was really upset, to be honest, because I’d been to the GP three times during that time. I’d practically broken down. And he said, well, if it continues we’ll refer you to a specialist. I really don’t like going to the doctors, you know, I’m a get on with it kind of person. So it was just, yeah, Katy was my god send.


Charlotte [00:28:23] How hard was it sort of going cold turkey for those two weeks?


Sue [00:28:27] You know, because I had a headache anyway, it really didn’t make a lot of difference. I was off anyway. I was off work because I just couldn’t function properly. So it’s not like I had to go to work and concentrate, but it wasn’t a lot of difference. In fact, after a few days, it was actually better.


Charlotte [00:28:47] Yeah, definitely worth it in the end anyway.


Sue [00:28:49] 100%. Yeah. And I think also the knowledge that actually this might stop, whether it’s you subconsciously thinking, because at that point I literally had a headache every day for six solid months and to have a little bit easier and to actually speak to somebody that knew what they were talking about.


Charlotte [00:29:11] It makes such a difference.


Sue [00:29:11] Yeah, it really did. And I did say at the time, you know, if only my GP was more clued up on migraine medication, I could have been headache free months previously.


Charlotte [00:29:23] Yeah, and not have to go through all that. Well, thanks so much for sharing your story.


Sue [00:29:28] You’re very welcome!


Dr Katy Munro [00:29:33] Thanks for listening to this week’s episode. In our next podcast we’ll be talking about a topic which is probably not as well recognised as it should be, and that’s vestibular migraine, a variant of migraine, which causes people a lot of distress with dizziness. And we’ve got some special guests on that episode so do listen in. But before I go, I just wanted to say a big thank you to our generous donors, including Elizabeth, Clare, Anita and Kelly, who have very kindly sponsored the podcast, along with some other people who have anonymously given us lovely donations ranging from small to large, every little helps. So thank you so much for that support. And we’ll keep doing this if you keep listening.


[00:30:19] You’ve been listening to the Heads Up podcast, if you want more information or have any comments, email us on info@NationalMigraineCentre.org.uk. Till next time.


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This transcript is based on a past episode of the Heads Up podcast and reflects information available at the time of broadcast – some facts may have changed or new treatments become available since.

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