S3 E10: Christmas Special 2

A National Migraine Centre Heads Up Podcast transcript

Christmas Special 2

Series 3, episode 10

Heads Up is the award-winning podcast series on all things headache, brought to you by the National Migraine Centre.  Produced by leading headache doctors, it’s the trusted source of information and support for all those affected by migraine and headache.

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[00:00:06] Welcome to the Head’s Up podcast brought to you by the National Migraine Centre, the only UK charity treating migraine and headache.


Dr Katy Munro [00:00:21] Hello and welcome to our festive edition of Head’s Up podcast, and this is our final episode of the podcast in Series three. If you haven’t managed to catch up with all of the other episodes, now’s your big chance as you’ll have nothing much to do over the next couple of weeks over the Christmas holiday. So sit down with a nice cup of tea and have a listen to all of our episodes on various topics. But today I’m joined by Dr Jessica Briscoe.


Dr Jessica Briscoe [00:00:48] Hello, Merry Christmas.


Dr Katy Munro [00:00:50] And Dr Nazeli Manukyan.


Dr Nazeli Manukyan [00:00:52] Hello. Happy Christmas, looking forward to catching up with all the episodes finally.


Dr Katy Munro [00:00:59] And Professor Paul Booton.


Prof. Paul Booton [00:01:02] Hello, Season’s Greetings.


Dr Katy Munro [00:01:04] And we are all headache specialists at the National Migraine Centre or have been over the last few years. So what we thought we would do is just to share with you some of the real achievements and challenges that we’ve had over the last year. And then later we’re going to be joined by a rather special patient who has a story to tell.


Dr Jessica Briscoe [00:01:27] Very exciting! So yeah I think first of all- we are also going to catch you up on our Christmas appeal, which you might have seen quite a lot about on social media. But we will talk- give you a little bit more information about that later on. So it’s been a really big year, I think 2020 will definitely go down in history for all of us. It’s quite nice to start off with a little bit about what we’ve been through this year and actually a lot of the positives that have come out of this year, I think. And so I mean, obviously we’re talking about coronavirus, COVID, and how it’s really changed the way that we all- the way we’ve all worked, interacted with each other, everybody’s general lives. And that’s obviously had a big impact on people’s migraine, positive or negative. Some people have found they’re better, and a lot of people have found that they’ve been worse. But I think the big change for us has been in the way we work, don’t you think, guys?


Dr Nazeli Manukyan [00:02:26] Yes, and the suddenness of change. So one week we were debating how safe it is to conduct online consultations and whether we should accept assessing patients just via video calls or telephone calls. And then suddenly, within a week, we setup remote connections and just without any break, just embarked on online consultations via phone and video links. That was impressive.


Dr Katy Munro [00:02:55] I think that’s been a really positive thing for a lot of the patients, I think, hasn’t it? Because, you know, where in the past we were having to see patients face to face for at least the first appointment. So they were often having to have a journey, maybe by train or car coming across London to our clinic. And I don’t know about you, but I often used to see people actually having a migraine from the journey, which was always a bit sad. So it’s been very good for a lot of people that, you know, because we’re seeing patients from all over the country. So we’ve actually gained a lot of new patients who wouldn’t have otherwise been able to come and see us.


Dr Nazeli Manukyan [00:03:35] Yeah, and some funny part, when you connect them via video link and they’re having their migraine and they just get off their screen and say, ‘Doctor, I can’t watch the screen, I have an attack’ so you can’t see them at all. But you’re still continuing professionally to complete the consultation.


Dr Jessica Briscoe [00:03:53] Yeah, I mean, I think that’s true. I think the fact that we’ve actually been able to continue to see people and we’d had this debate for ages about whether we- even with telephone calls, we were doing a few before. But I think the fact that we have all been able to- that we all had to suddenly set up our remote desktops, it kind of meant that we’ve been able to be a bit more flexible with the days as well. So I think we’ve all done days, you know, we’ve done maybe some people have done Saturday clinics, because that was something we were talking about setting up for ages to increase our- people who are working all the time. So I think that’s been a real eye opener having to deal with IP remotely, not being on site for that.


Dr Nazeli Manukyan [00:04:36] And we also cancelled our holiday. So we didn’t have any time off and were doing more days just to see lots of patients and help them.


Dr Katy Munro [00:04:48] I think there’s been some funny episodes where you suddenly realise that the patient is actually in a car or driving along. And I know we have had to draw the line at people actually driving because that’s not safe. But it does mean that people don’t have to take such a big chunk out of their day. They can just have a consultation and then get back to whatever they were doing before, which is really a benefit.


Dr Jessica Briscoe [00:05:13] I think the challenge for us has been the fact that we can’t always examine people as fully as we used to be able to and that’s been a big debate amongst all of the headache specialists, hasn’t it? The fact that I mean, it’s nice on video. You can see all of the big points that you usually would. But I think one of our sort of- the challenges for us has been, well, what if we think that somebody needs a full neurological examination? How would we do that? And it’s been coming up with little tips for how to examine somebody on video and things without having our fancy scopes and things like that, to look in the back of eyes and stuff. It’s been an interesting time.


Prof. Paul Booton [00:05:51] I think that’s true. But it’s also true that we’ve known for years that the research has shown that the history, the story of the patient’s illness is by far the most important thing in deciding what’s wrong with them and what we’re going to do about it. And they’ve worked out that it’s something like 80% of the information comes from the history and only about 10% from the examination. When you suddenly find yourself in a situation where you’re unable to do an examination, most of the time you simply don’t miss it. It’s simply not providing the information. And I always think there’s something magical about human communication skills is that just by talking to one another, a specialist talking to a patient, you discover so much, you discover things that a brain scan can’t tell you. It’s remarkable really.


Dr Nazeli Manukyan [00:06:40] It’s all about verbal and nonverbal cues, if you’re lucky to have a video consultation. Plus, it seems that our patients are very organised and they’re, sometimes, very well prepared with their diaries. They’re already seeing many other specialists, they’ve had scans, they’ve had examinations and they just need this one to one human connection just to clarify things and just reassure them and make a plan for the future.


Dr Katy Munro [00:07:07] Yeah, I think that’s really true. And as you were saying, Naz, I think a lot of people have been to other doctors before, by the time they get to us they may have had neurological examinations or scans, but they’ve also often been to the optician, haven’t they? So I’ve taken to saying, when did you last have your optician check? And if it’s fairly recent, you know, that they will have had a good examination of the back of the eye and a look at the optic nerves, which is really reassuring as well.


Dr Jessica Briscoe [00:07:34] That’s that’s been helpful. But I think the big thing that we’ve all missed is we actually just quite like seeing patients face to face. It is nice to meet people, but also being able to do injections and Naz has actually been able to do a few injection clinics. And it might be quite interesting to hear about the challenges and what’s been good about that from you, Naz.


Dr Nazeli Manukyan [00:07:56] Yes, it was great being able to offer procedures, which we did in July after lockdown eased off and we started planning the procedures. So we had a couple of days in the clinic. It was just lovely and nostalgic going back to the clinic and the patients were just so organised and looking forward to this appointment. So everything run very smoothly with long gaps between patients, wearing PPE and hopefully they benefited from it.


Dr Katy Munro [00:08:29] It’s been more tricky because, of course, with the impact of not being able to fundraise, we’ve been obliged to move out of our clinic premises. So that’s made doing the injection clinics much more difficult. And that’s partly because the only way we were able to afford the clinic as a charity was to have a couple of other charities joining us in the building. And, of course, they were impacted as well and so that has meant that Naz has been able to do a couple of sessions in her general practise area. So hopefully that is going to be something that we can continue to offer. What do you think, Naz, about that? Does that work out for you?


Dr Nazeli Manukyan [00:09:13] I think patients who came to my local GP surgery were quite happy to travel because most of them, they had to drive and it was just easy to get there compared to London, parking was easy and it was just an appropriate clinical room and building. They felt safe and secure to come and have a procedure and go home.


Dr Katy Munro [00:09:35] Obviously, if we do offer more injection clinics, one of the highest priorities has to be safety for everybody. And so, you know, we’re going to make sure that that happens if we get back to doing them more regularly next year. But the other injection therapies that were in the news are the anti-CGRP drugs, weren’t they, Jessica?


Dr Jessica Briscoe [00:09:58] Yay! Yeah, and we’ve talked a lot about this, but I never think you can talk enough about CGRP, if I’m honest because it is, you know, there and just before recording this episode, we got the news that Aimovig has been approved for use on the NHS in episodic and chronic migraine. Which means all three of the CGRP medications that are available in the UK will be available on the NHS. That is obviously pending local guidelines being written and decisions being made about the feasibility and the appropriateness of them being prescribed. So that’s something that’s really exciting about next year, but it’s definitely been changing. I think there have definitely people who from this year have been able to get Ajovy on the NHS as well, which is exciting because a lot of people who really had felt that they’d tried absolutely everything, including Botox, people who weren’t able to access Botox as well because of the- especially doing the first lockdown when clinics were really reduced. And this is something that’s available. And hopefully, well potentially, people be able to do their own injections at some point, again, depending on how different clinics have been set up? I think we found it’s been very useful for people who haven’t been able to go on site. We’ve been able to prescribe it to be given at home too.


Dr Nazeli Manukyan [00:11:21] The results, just because it’s very specific to migraine, the drug targeting migraine mechanism, the results are quite amazing. Those who benefit is just very surprising, the effect compared to prophylactic medication we use or the Botox, which just diminishes headaches and makes them function better. But this antibody injections seem just to clear after each injection, more and more clear days and much milder attacks. And some of them who are struggling for years just found a way of just getting out of the migraine pain.


Dr Katy Munro [00:12:02] It really seems to help the brain fog as well, doesn’t it? I think people are so delighted that they’re not just finding their headaches are reducing, but they’re also feeling clearer. I’ve had a number of people who’ve said, you know, I can exercise now, I’ve started to exercise. And all the benefits that ripple out onto families and friends as well. You’re able to go and do things with your family, but of course it doesn’t- none of these things work for everybody. And I do also have a couple of patients who haven’t found them particularly helpful and have had to go and look for other things. And there’s usually something else we can find and suggest that they haven’t tried. But yeah, I think it’s exciting news.


Dr Jessica Briscoe [00:12:43] It is exciting. I think it’s just as you said, it’s just nice to have something else in our arsenal, particularly for the people whose migraines their attacks are refractory to treatments, the ones that just don’t respond to treatment very well. And it’s nice to be able to try and target some of those attacks, those people who have those problems, with something else that might be more effective.


Dr Katy Munro [00:13:04] The other people I think it’s helped are the people who have been trying to manage their day to day lives by treating their migraines with triptans and having to take more and more triptans. And of course we know that gives medication overuse headache from the triptans. And so once they’re on something that’s really helping reduce the acute treatments they have to take, it’s a win win, isn’t it? Because they stop getting quite so many because their brain is settling down. So, yeah, exciting. We’ll have to see how it rolls out on the NHS. I know the NHS is particularly overloaded at the moment with COVID and with all the delays to outpatient clinics and a lot of neurologists at the beginning of lockdown were redeployed to acute medical wards to help look after COVID patients. And so it’s going to take a while for things to get back to any semblance of normal, I think, with that.


Dr Jessica Briscoe [00:13:57] Yeah, and I think also the other thing to say is that for any new medication has to go through committees and guidelines need to be written. And that happens at different paces in different areas, which can seem really unfair when you’re in one of the areas that’s taking a little bit longer but trying to be patient is really important in these situations.


Dr Nazeli Manukyan [00:14:20] We had a similar problem when Botox was first licenced for migraine. So it wasn’t available widely in every hospital and still there were some problems getting into that service. But hopefully with CGRP, it’s just within a year we had three drugs approved, three types of antibodies approved. So hopefully, as you know, months and year passes, there will be just probably access to it for every headache specialist. So we are just privileged to have access and experience the effects first hand.


Dr Jessica Briscoe [00:14:51] Yeah, the other thing that’s been new this year, which Paul was involved in as well was the expansion of our clinic. Because of the demand, because we were able to reach more people, there was a big demand on our appointments, which means we needed to hire some new doctors. And that was quite a big challenge because we weren’t able to meet people in the usual way. Obviously, you can put out a request, you know, job requests and things, but actually, how do you interview people and how do you decide who’s going to be right for the job? And we did have a few challenges around that, didn’t we?


Prof. Paul Booton [00:15:27] Yes. So we ended up interviewing people over Zoom calls and things, technology like that, which actually you feel a bit uncomfortable with it at first, but actually it worked surprisingly well. It is, in any case, a challenge finding new doctors for the clinic, because being a charity, we can’t afford to pay them very much. When I say we can’t afford to pay them very much. Nobody paid me very much. This has a sort of good side in that it’s only the doctors who are really keen on getting involved in this work who bother to apply in the first place. And I’m glad to say that we had some fantastic people apply for the jobs we offered and we’ve been able to recruit some of those now to start working with us.


Dr Jessica Briscoe [00:16:10] Yeah, which is exciting. Obviously, all of the issues with training people up via technology. But actually technology is quite impressive. Our patients have all been really amazing and sort of allowed us to have extra people in on video calls or telephone calls. So thank you all for that. And actually they’re both starting now, actually, aren’t they? They’re both doing clinics. And hopefully that means that even despite all of the restrictions with our clinic in lockdown or during the coronavirus pandemic situation and we’ve still been able to recruit, which means that bodes well for the future when hopefully we’ll keep expanding.


Dr Katy Munro [00:16:50] We’ve also, of course, we’ve got Dr. Richard Wood working with us, who is a headache specialist who’s been doing this work for lots and lots of years. And having him doing Saturday morning clinics is really nice as well, because it gives a bit of flexibility of appointments, as you were saying before, Jess. Yeah, a really great team.


Dr Jessica Briscoe [00:17:10] And also one of our clinicians moving as well because we’ve been able to actually carry on with telemedicine consultations, we didn’t have to lose a doctor. So Dr. Sara Miller has been able to stay with us, which is amazing.


Dr Nazeli Manukyan [00:17:25] Yes and though our waiting times are getting very long like in NHS neurology clinics but this changes every week and we’re offering more and more consultations now.


Dr Katy Munro [00:17:36] Yeah, I think that’s it. The increased demand, it’s hard to keep up with at the moment, but we are recruiting new doctors and hopefully that will mean that we can shorten those waiting lists. We’ll do our best. The other thing, of course, we have to change is the way that we do the podcast. So we were very happy sitting in our little office with our lovely microphones and making our sound quality as good as we could. And now we have to do it very much more spread out, Zoom and other sort of recording techniques. So apologies if the sound quality is sometimes a little bit less than you were used to in the first couple of series. But it still has enabled us to meet up with guests and do these episodes. And we’re hoping to do Series four next year, too.


Prof. Paul Booton [00:18:23] Even though two people live in North London.


Dr Katy Munro [00:18:29] North London is a very high tech place so, you know, we’re on it with the technology here.


Dr Jessica Briscoe [00:18:36] So I think this might be a good time as old listeners, old is a bad way of saying it, as established listeners to the podcast may be aware, we like to try and talk to a patient during our podcasts just to get their experience about life with migraine. So we actually have a special guest. It’s a chap called Nick. Nick Claus who’s in with us today. And he’s going to tell us a little bit about his experience of migraine. Hi, Nick. How are you?


Nick Claus [00:19:09] Yes, hello. Am I on?


Dr Jessica Briscoe [00:19:10] You’re on, you’re on! We’ve managed to get you nice and clear. I know you’re a bit far away.


Nick Claus [00:19:15] Jolly good. Well, I just happened to notice a sign on the roof, so I thought- I’ve got a blazing headache at the moment. So I thought I’d drop down the chimney pot and come and talk to you all.


Dr Jessica Briscoe [00:19:26] Oh, wonderful. Well, maybe if you could just start off by telling us your story, what problems you’ve been having with your headaches, and then hopefully we’ll be able to come up with some tips at the end. You’re getting three for one at the moment. You’ve got three headache specialists, so.


Nick Claus [00:19:42] Well, yeah, of course it’s always like this at this time of year. It’s fantastically busy. I’m run off my feet, working all hours and then, of course, it’s all over. And the day after you get this blazing headache, which takes days and days to settle.


Dr Katy Munro [00:19:56] So have you found that this is a seasonal thing?


Nick Claus [00:19:59] Oh, very much so. Very much so. Always, always at the tail end of the year.


Dr Katy Munro [00:20:04] So what have you found are particular triggers for you then, Nick?


Nick Claus [00:20:09] Well, I don’t know, it’s just when I’m so busy like this, really. And you’ve got all these elves, these so-called elves. These little work experience laddies who come along and they’re not a ha’p’orth of good really and you end up doing it all yourself anyway.


Dr Katy Munro [00:20:25] Oh my goodness, it sounds as if stress is quite a factor for you.


Nick Claus [00:20:29] Stress is the very word for it.


Dr Katy Munro [00:20:31] We hear that a lot. And actually sometimes it helps, you know, if you know that this headache always comes around the same time and after you’ve been particularly stressed, is to try and maybe pace yourself a little bit better in the run up to your busy periods, you know, maybe delegate more and possibly take some time to wind down in the evenings. Does your work involve any travel?


Nick Claus [00:20:57] Yes, a fair bit. I have to visit every house in the whole wide world.


Dr Jessica Briscoe [00:21:00] Goodness.


Nick Claus [00:21:01] Unless people haven’t been good.


Dr Jessica Briscoe [00:21:04] How long do you have to do this then, Nick?


Nick Claus [00:21:07] Pretty much you have to do it overnight.


Dr Jessica Briscoe [00:21:09] Goodness me. So that’s a lot of travel. How are you travelling around?


Nick Claus [00:21:14] Well, it’s old technology really. I’ve a standard flying sleigh.


Dr Jessica Briscoe [00:21:19] OK, that sounds like it’s quite bumpy. Does that make your headache worse at all when it’s jerking around and things?


Nick Claus [00:21:28] I think it does. If you happen to hit a pocket of air turbulence, it can be quite nasty.


Dr Nazeli Manukyan [00:21:33] Travel sickness can affect migraineurs as well. So I think the motion sickness, the flying itself and all the changes of air pressure can be well known triggers for migraine.


Nick Claus [00:21:46] Yes, when I was a very young Santa, I used to get a lot of travel sickness.


Dr Katy Munro [00:21:50] Well, we know that is a linked condition. Yes. A lot of children do get travel sickness and then later they get older and get migraine. And they also get a lot of tummy aches, which are more predominant in children than in adults rather than headache. And do you ever get any sort of nausea or queasiness with your migraines?


Nick Claus [00:22:11] Oh, very much so, yes. I get a lot of that. And I always thought it was just rattling around on the sleigh. But are you telling me otherwise?


Dr Katy Munro [00:22:18] Well, it is very much linked because we know the brain of a person with migraine affects the vagus nerve, which causes the stomach to stop emptying properly. And so it is very likely that you will feel a bit more nauseous. And if you have any painkillers and you try them, they don’t get absorbed very quickly. So it’s worth, if you’ve got a good GP, are there any good GP’s around you in the North Pole?


Nick Claus [00:22:45] Well, the facilities in the North Pole are fairly limited. Sometimes even have to resort to dropping down the chimney of a local pharmacy to pick up some co codamal or something like that. Do you think that’s a good suggestion?


Dr Jessica Briscoe [00:22:59] Generally not. We tend to advise to avoid codeine. Does it help your headache particularly?


Nick Claus [00:23:06] No, it just makes me sleepy.


Dr Katy Munro [00:23:10] Well, that’s not a very good idea.


Nick Claus [00:23:15] I turned left just past Nairobi last year and completely missed Dar es Salaam.


Dr Katy Munro [00:23:22] Oh gosh.


Dr Nazeli Manukyan [00:23:23] Most patients report that the painkillers, they have lots of them in their pockets and take them around everywhere. And they just take the edge off the attack and the pain or they just take it just in order to switch off and sleep, sleep off the attack. But I think the better opportunity will be using something like a triptan, which will just block the attack and abort all the symptoms rather than just making you groggy and you still lose a couple of days.


Nick Claus [00:23:53] Well I do take rather a lot of painkillers at this time of year so perhaps that’s a good idea.


Dr Jessica Briscoe [00:23:58] And if you’re driving or sorry, if you’re in control of your sleigh, codeine is not a great idea if it makes you sleepy, it sounds a bit of a health and safety hazard. It may be a good idea to try and change.


Nick Claus [00:24:12] There’s not a lot of other traffic around Christmas.


Dr Jessica Briscoe [00:24:15] How about eating? When do you get time to eat on these long travels?


Nick Claus [00:24:21] Well, you just have to sort of grab a sandwich when you can. You just sort of stop at a filling station and get a coffee and a sandwich and on your way again.


Dr Katy Munro [00:24:32] But didn’t I hear that sometimes when you’re visiting all these different houses in the whole wide world, you get left little offerings of thanks. Is that right? Sherry and mince pies? Do you partake of those?


Nick Claus [00:24:48] Well, yes. I mean, it’s something of an occupational hazard, I have to say, that having a glass of whisky at every house you pass over the course of one night in the whole wide world, it’s quite a lot of whisky, to be honest, and in fact, my GP has spoken to me about that.


Dr Katy Munro [00:25:05] Yes, we do know that is a trigger for migraine. So you might want to just, you know, maybe try and get a message out over social media or something suggesting that people leave a non-alcoholic beverage for you, you know, and possibly something more slow release energy foods that you could snack on to keep you going rather than very sugary treats, because we know the fluctuations of blood sugar can really aggravate migraines. And also make sure you do eat regularly, because if you leave it all night before having anything, you’re very likely to get a migraine the next day.


Nick Claus [00:25:40] Yes. Yes.


Dr Jessica Briscoe [00:25:42] And you mentioned the caffeine as well. You said about a coffee, it sounds like you’re having quite a lot when you’re on your job.


Nick Claus [00:25:50] This time of year, I drink nothing but coffee. Get up in the morning, strong espresso from a machine which didn’t get delivered the year before last so I live on nothing but coffee.


Dr Jessica Briscoe [00:26:00] We know that caffeine in people that are susceptible to it, that can act as a trigger in some people as well. So it may be quite a good idea to try and avoid caffeine, maybe switch to decaf, which does have a little bit of caffeine in it, and try and limit how much caffeine you’re having particularly at this time of year, because that might be making your headaches worse as well.


Nick Claus [00:26:23] Right. OK, so that’s quite a lot of things I’ve got to remember.


Dr Jessica Briscoe [00:26:27] There was one of the thing I wanted to ask actually. We forgot to mention it. Did you say something about- we mentioned about how the movement of the sleigh can bother you, can make you feel a bit sick but do the lights ever bother you? Because, you know, if you’re riding around at Christmas, you must be seeing lots of lovely illuminations.


Nick Claus [00:26:48] There’s lots of lovely illuminations and there’s Rudolph the Red Nosed Reindeer, of course. You know, that light bobbing up and down at the front of the sleigh all night. Drives you mad!


Dr Katy Munro [00:26:56] So maybe. I mean, I know it’s dark when you’re travelling in your work, but, you know, maybe some tinted lenses, some sunglasses or a hat with a visor so the sparkly lights aren’t aggravating your migraine. Any sort of flashing lights can do that, can’t they?


Nick Claus [00:27:13] So Santa wearing shades. I’ll bear that in mind.


Dr Katy Munro [00:27:16]  I think it would be a cool addition to your image probably. But what I wanted to ask you is, do you ever- we hear a lot from patients talking about feeling dizzy and getting ringing in their ears and that kind of symptom when they’re getting their migraines. Do you ever hear, you know, like jingling bells or anything like that?


Nick Claus [00:27:37] There’s a lot of jingling bells in my line of work, and I’ve always regarded it as something of an occupational hazard.


Dr Katy Munro [00:27:44] So people with migraine are often quite noise sensitive and dizziness is so common. And often people don’t even think of mentioning it because people have this feeling that migraine is just a headache. And of course, we know, as I’m sure you’ll all agree, that migraine is not just a headache. So anything you can do to reduce those kind of irritant sounds, noises or smells, I mean, what’s it like riding behind a whole load of reindeer? Sounds like it might be quite a smelly journey?


Nick Claus [00:28:18] Yes, it depends what tundra they’ve been browsing on over the couple of days beforehand.


Dr Nazeli Manukyan [00:28:24] But it sounds like you are so busy and everythings happening in one day. So perhaps you can, when you plan your travel, you could also pace yourself and plan your meal times and maybe make sure it’s not just a coffee and it’s not a huge difference between your waking up time and sleep time and perhaps you can plan taking your medication with you wherever you go. So you’re ready for the attack and you can prevent it. So a bit of a pacing and planning I think it helps the burnout.


Nick Claus [00:29:00] Well, I’ll bear that in mind certainly, Doctor. I’m not sure pacing is something that the International League of Santas is particularly good at. But certainly I can carry my medication with me in future.


Dr Nazeli Manukyan [00:29:12] Perhaps you can plan the year ahead.


Nick Claus [00:29:14] Right. Well, perhaps I’m going to have to push off now, but perhaps I can just summarise what you said to me. It seems to me you’ve given me seven tips for Santas! So I’m to eat regularly. Drink, not too much booze, much more water, not too much coffee. Start getting regular sleep and have regular downtime. I’m wondering about maybe offering some of my senior elves a job share just to take some of the pressures off me. I’m going to try to have a more regular routine in future and I’m always going to carry some medication on me and I’ll be careful to avoid co codamol, which you have explained is so problematic for me. So with a quick ring of the bells then I’m going to be on my way.


Dr Jessica Briscoe [00:29:57] Lovely to meet you.


Dr Nazeli Manukyan [00:29:57] Great understanding. We’ll see you next year.


Dr Jessica Briscoe [00:30:00] Well hopefully not!


Nick Claus [00:30:05] Well I know where to find you now.


Dr Katy Munro [00:30:06] We wish you a pain free year. Thank you so much for joining us on the podcast today. And hopefully all of our listeners will listen in and apply all those tips for themselves to have a pain free holiday season.


Nick Claus [00:30:18] And I just hope you’ll respect my confidentiality.


Dr Jessica Briscoe [00:30:22] Of course.


Dr Katy Munro [00:30:23] Definitely.


Dr Jessica Briscoe [00:30:26] All unidentifiable information there.


Nick Claus [00:30:28] Non attributable.


Dr Jessica Briscoe [00:30:32] Absolutely. So we promised at the beginning that we’d talk a little bit about our plans for the future and in particular our Christmas appeal, which is called #. I don’t know if you say the hashtag, but #Bring Back The Sparkle. And so I think, first of all, we’ll talk a little bit about our plans for the year. So we’ve talked about the fact that we really want to expand. We’ve got lots of lovely new doctors, but we want to be able to reach more people. So one of our plans is to try and recruit the doctors and get more clinics out there for you all to be able to- so that we can help more people. We also, we’re planning to find premises, so Naz doesn’t just have to do injection clinics at her GP surgery. We’d really like to be able to give injections to more people. I think the rest of us want to get back to injecting too, don’t we?


Dr Katy Munro [00:31:23] Yeah.


Dr Jessica Briscoe [00:31:24] Also, the thing that we’ve not been able to do so much this year is education, because we’ve done lots of education for patients like with the podcast. But we’re really keen to do some more education for other doctors like we did a couple of years ago when we held GP masterclasses, that’s something we’re quite keen to be doing in the future.


Dr Katy Munro [00:31:47]  We have done a bit of educational things for GPs with a special interest in headache. And if there are any doctors listening who would like to become more involved or more interested in learning about headache, I would urge them to join the British Association for the Study of Headache because there’s a very active GP with a special interest in headache group, which at the moment is running monthly Zoom webinars and holds conferences and it’s really important. The more GPs out there who understand a bit more about migraine, the better for patients I think. We know that quite a lot of GPs listen to this podcast so do come join us either just on the education or, you know, approach us about coming and maybe seeing how we work and what we do.


Dr Jessica Briscoe [00:32:32] Absolutely. I’ll let Katy talk a little bit more about our Bring Back the Sparkle campaign. Off you go.


Dr Katy Munro [00:32:41] OK, so we would really love it if you would give as generously as you can to our Bring Back the Sparkle for Children campaign. So this is a campaign which is basically because we see a lot of children who are really seriously impacted by migraine. And one of the things that we know is that migraine in children is very often underdiagnosed and underreported and missed completely. And sometimes it’s only in retrospect that people look back and say oh, I’m getting migraine headaches now, but I realise now that when I was a child, I used to get migraine as well, I used to get tummy aches regularly, I used to be feeling very sick and have to go lie down and sleep for half a day, I missed quite a lot of school. So raising awareness in the general population about looking at children and thinking about migraine when they present with any kind of symptoms like that is what we’re really passionate about. So there are three things that we’re trying to raise money for. We have a paediatric neurologist who would very much like to come and join our team and so we need to raise some funds for that. We are wanting to expand the website so that there’s an area for children on there with more helpful information and possibly do another episode of the podcast. Althought, there is one that we have done already on migraine and children and adolescents so feel free to wind back and listen to that one. And then the third thing is to try and have a campaign of raising awareness in schools. So already on our website we have some factsheets which you can print off and send in to schools to help them understand how to support children with migraine. Particularly children with chronic or high frequency migraine can be considered to have a disabling condition and they need to have a health care plan in place. And that is particularly important if children are coming up to changing from primary to secondary school, any of the transition times, but also exams. Exams are a big time. And a peak time for kids to get migraines is puberty so when their growth spurts or hormonal changes. So please help us. If you go on our Virgin Giving, the link will be in the blurb for this podcast and fingers crossed we will hit our target and be able to do even more next year.


Dr Jessica Briscoe [00:35:04] Thank you.


Prof. Paul Booton [00:35:09] I’d just like to say a big thank you to everybody who listens to our podcasts, and we hope you find them very useful. We’ve had good feedback from a lot of people about them. And if you are listening to them and if you’re enjoying them, we’d be very, very grateful if you would leave a review. Now, that’s not just because we’re vain narcissists, although, of course we are. But every time somebody leaves a review, then the social media companies promote the material so we get the message to more people. And that’s really what we’re doing this for, is to try to help more people take control of their migraine. So you can help us by leading a review if you found this podcast helpful. And, you know, if you don’t, do tell us or if you want other things covered get in touch with us. We’re always glad to hear from you. But please leave a review and help spread the word. Thank you very much.


Dr Katy Munro [00:36:03] So to finish off this festive edition of our podcast, we’d like to leave you with a rendition of our song, which was written specially for us by the Mealtime Musicals team of Aaron Dart and Miss Allie Munro. You can find all of their Mealtime Musical videos on YouTube but this one was just for us so have a Happy Christmas, everybody, and thanks for listening.


Prof. Paul Booton [00:36:28] Happy Christmas.


Dr Nazeli Manukyan [00:36:28] Happy Christmas.


Dr Jessica Briscoe [00:36:29] Happy Christmas.


Dorothy [00:36:32] Where can I go about my migraine?


Scarecrow [00:36:35] Haven’t you heard?


Dorothy [00:36:37] Run, Toto!


Scarecrow [00:36:37] The NMC are still open and working remotely. Oh, what I’d do if I didn’t have migraine. I could stand under the spotlight, drinking wine into the late night, not worrying ’bout pain. And my Doctor I’d be praising, saying my head feels amazing, if I didn’t have migraine! I would sail across the ocean, not minding the sea’s motion, on my way to Spain.


Dorothy [00:37:07] With the thoughts that you’d be thinkin’, it’d be champagne we were clinkin’, if you didn’t have migraine.


Both! [00:37:15] Oh, you can get advice from the Head’s Up podcast found on Spotify, and all the other podcast platforms. They’re here through rain, or thunderstorms!


Scarecrow [00:37:31] I’d keep scrolling through my phone screen.


Dorothy [00:37:32] With your friends all turning bright green.


Scarecrow [00:37:34] Coz I’ve got a crystal clear brain.


Both! [00:37:37] And we thank the inventor of the National Migraine Centre, now we haven’t got migraine!


[00:37:48] You’ve been listening to the heads up podcast, if you want more information or have any comments. E-mail 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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