S4 E4: Migraine and Acupuncture, part one

A National Migraine Centre Heads Up Podcast transcript

Migraine and Acupuncture, part one

Series 4, episode 4

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[00:00:00] Did you know that acupuncture has been found to help some people with migraine? It’s not just about taking tablets. Our host, Dr. Katy Munro, has written a book called Managing Your Migraine, packed with suggestions to help. It’s out on August 26th, or you can pre-order it on Amazon now.


[00:00:24] Welcome to the Heads Up podcast brought to you by the National Migraine Centre, the only UK charity treating migraine and headache.


Dr. Jessica Briscoe [00:00:33] Hello and welcome to this episode of our Heads Up podcast. I’m Dr. Jessica Briscoe and I’m joined by Dr. Katy Munro.


Dr. Katy Munro [00:00:42] Hello. It’s good to be back chatting again.


Dr. Jessica Briscoe [00:00:44] Always good to be back chatting. So this week we thought we’d have a chat about acupuncture. Well, not just acupuncture, acupuncture and migraine particularly. Because actually it’s something that we’ve both found- we get asked about a little bit and people talk about it in various meetings that we go to, and we thought it would be a really nice thing to talk about some sort of non-traditional therapies that actually have good evidence and also to help us and other health care professionals get their head around exactly why acupuncture is helpful and when you might choose to incorporate it into your treatment. That’s a good summary of why, isn’t it, Katy?


Dr. Katy Munro [00:01:27] Yes, I think because we’re all about the evidence. We do like to talk about things which have evidence, and there’s been quite a number of studies. And what partly prompted it was there was a recent summary paper published of all the different studies of acupuncture and migraine. And it’s something that people have been increasingly interested in. And yeah, we do get asked about it quite a lot, don’t we? I think people with migraine are often very keen to look at things which don’t involve swallowing yet another tablet.


Dr. Jessica Briscoe [00:01:56] Or have horrible side effects. I mean, I think we’ve talked about it a lot, about how some of the medications may be helpful, but actually sometimes the side effects are really unacceptable, I think the best way to put it. So I think patients are keen to find something that won’t give horrible side effects. And we’re also quite keen to be able to give the best sort of evidence for that type of treatment because we don’t want to be suggesting something that people may have to pay- you know, fork out money for out of their own pocket for, which actually has no evidence of being helpful. So for us, it’s really important to be able to provide good quality information on that.


Dr. Katy Munro [00:02:32] Yes. So acupuncture has been around for centuries, part of traditional Chinese medicine originally. And as we were finding out in our research for this episode, from at least about 100BCE, I think we have to say, Before the Common Era.


Dr. Jessica Briscoe [00:02:50] BCE, yeah. Come on, Katy.


Dr. Katy Munro [00:02:53] But of course, we know now that it’s widely used around the world and it’s been increasing in popularity since back in the sort of 1940s, which was news to me actually. I never really thought about it, I guess. But it started to be kind of a compilation of different acupuncture techniques of traditional Chinese medicine from around the late 1940s. And then in 1998, the National Institute for Health in America published a consensus about acupuncture, which also helped to kind of establish it as a recognised therapy that can be now researched and used in various different areas really.


Dr. Jessica Briscoe [00:03:39] What I found interesting, when I was reading this paper, was I remember it being talked about as a good treatment for post-operative pain and nausea so often as a medical student right back in the day, I remember going on my oncology placements or actually sometimes post-operative, you know, placements and seeing that they’d offer acupuncture and they said, yeah, it’s quite good for nausea and also for pain as well. But that seems to be where it came from. And also a study on dental- on use of acupuncture for post-operative dental pain as well around that time. And you can see why that would extrapolate to migraines because that- especially with dental pain, if anyone’s ever had it, that can feel quite similar to a migraine. So I could see why that kind of nerve pain would then be used for other types of sort of nerve related pains as well.


Dr. Katy Munro [00:04:28] It’s been looked at for various different things, hasn’t it? And there’s been some studies on urinary tract infections, on depression, on that kind of plasticity of the muscles that can sometimes happen after people have had a stroke. Pain, generally, chronic pain and nerve damage and nerve sensations like neuropathy, but also anxiety and depression. So that’s very interesting when we talk about migraine because obviously a lot of people with migraine also have co-morbidities like anxiety and depression, other conditions in association with it.


Dr. Jessica Briscoe [00:05:08] Yeah, we talked about that quite a lot in one of our fairly early podcasts. I can’t remember which series it was now, we’ve done so many. But we did a really nice one on anxiety and depression, particularly on mental health and migraine. So I think that sort of resonated particularly with us, that sort of idea that possibly- and we’ll talk a little bit more about the evidence in a bit, but the possibility that there is some evidence for co-treating other co-morbidities like anxiety and depression, too. But I think what I found really interesting is, because I’ve always found it fascinating, which acupressure points- so where you put the needles, which points you’re stimulating. How they choose it? Because you’ve had acupuncture, haven’t you, Katy. Because I had it many years ago.


Dr. Katy Munro [00:05:48] Yes, I’ve had it a number of times, actually. I’ve had it not just for migraine, but I also had it for neck and shoulder pain. I had a very bad shoulder and the osteopath who I was seeing at the time was also using acupuncture. It’s quite a strange sensation, I have to say.


Dr. Jessica Briscoe [00:06:04] Really, really strange. Because I had it for migraine when I was about 17, actually. Very traditional Chinese acupuncture. I think we were a little bit at the end of our tether. So probably I’m not going to, you know, say how old I am, but it was probably before that evidence had come out. But yeah, I remember going along and it felt really- it was a very strange tingling. It wasn’t unpleasant, but this weird tingling sensation. And I remember the practitioner saying, ‘Well, that’s how you know, it’s working’. So I’d go, ‘Oh, okay’. Well, I think I saw the same osteopath as you not that long ago for what I thought was shoulder pain. Typical headache doctor not being able to diagnose themselves properly. It was actually migraine, but they used acupuncture with electro stimulation as well. And I remember that strange tingling sensation coming back again.


Dr. Katy Munro [00:06:54] It can feel a bit like a little mini explosion, especially when they move the needles a little bit. So I know some people are very concerned about needles and a bit needle phobic. I don’t have that problem. And the needles they use are very, very fine, but they use quite a lot. You feel a little bit like a hedgehog at the end of it, don’t you? But once they’ve gone in and settled, you don’t really feel them unless the acupuncturist twists them or moves them slightly and then you get this little tiny explosion, which is very short lived. But it’s not like anything I’ve ever felt. One of the things I found with having acupuncture was that sometimes it can make you feel quite tearful or quite sleepy afterwards.


Dr. Jessica Briscoe [00:07:39] Yeah, I’d be exhausted. Yeah.


Dr. Katy Munro [00:07:40] Yes, it’s quite- it’s a strange whole body sensation sometimes afterwards, I think. But I did find it particularly helpful.


Dr. Jessica Briscoe [00:07:48] It certainly didn’t make things worse as well. I think that’s the other most important thing. And there weren’t any sort of longstanding side effects, but things did improve afterwards so that’s why I’ve never been against it even before I knew about the evidence as a, sort of, modality.


Dr. Katy Munro [00:08:02] We do always say, of course, nothing works for everybody. And I know there will be people listening who will say, ‘Well, I’ve tried it and it hasn’t worked’. And I think one of the things we know about acupuncture is it is quite practitioner dependent, isn’t it?


Dr. Jessica Briscoe [00:08:17] Absolutely.


Dr. Katy Munro [00:08:18] As I understand it, there’s a map of about 365 points on the body, and the individual practitioner has to decide which ones to use and so that will make a difference.


Dr. Jessica Briscoe [00:08:31] And also there was that evidence about how often- how many sessions you have to have. So when they looked through all the studies, and there are loads of studies on this, they found that you had to have at least 6 to 8 sessions before deciding on efficacy. They didn’t actually remark on the frequency because I think I’d always read that as being 6 sessions per week, which always seemed a bit impossible. But actually there is no- they’ve not been able to identify how frequently you need to have it, but they do say that that minimum number of sessions is needed and that it’s actually quite an investment, isn’t it? If you’re doing 6 to 8 sessions, there will be a certain amount of time that you have to do that in. But it does seem to correlate with the amount of time that we say for preventative medication. If we’re saying 6 to 8 weeks, you may have a session a week. You wonder if it does correlate slightly? I don’t know. But actually that’s an important point, that you have to give enough time. You can’t just say after 2 sessions, ‘well, nothing’s happened, that’s not worked’.


Dr. Katy Munro [00:09:28] Interestingly, I had a patient who had hemiplegic migraine quite badly, and when she was at work, one of her colleagues was a physiotherapist who knew acupuncture and if she was getting her sort of premonitory hemiplegic symptoms in the hour before her migraine headache would kick in, if her colleague was there and could stick an acupuncture needle into a certain point on her hand. It relieved the symptoms immediately and it was quite extraordinary.


Dr. Jessica Briscoe [00:09:58] It’s so interesting because that’s not a point- this is what always I find fascinating. As someone who’s never studied acupuncture and there are doctors who have but I’ve never studied it. I find it fascinating that a point in your hand essentially can prevent your migraines, can stop it from occurring or can be the point which you press. I find it completely fascinating.


Dr. Katy Munro [00:10:19] Well, we’re going to be talking later on in the episode to a couple of people who are acupuncturists, and one of them is a doctor and is part of the British Medical Acupuncture Society. And I think, as it’s become westernised, there’s the people who follow the traditional Chinese acupuncture, but then there are people who are working in our NHS hospitals like some physios and there are some GPs who do acupuncture. I know a couple of people who try and incorporate it into their general NHS work. My husband as an anaesthetist years ago did an acupuncture training course and briefly used it as part of his skills in helping people relax and contributing to that. So they’ve done some studies using scanning of the brain to try and identify what’s going on, haven’t they?


Dr. Jessica Briscoe [00:11:11] I found that really interesting. So it’s functional magnetic resonance imaging, fMRI, which is a really high tech form of MRI, where you can actually see which pathways in the brain are being lit up essentially when certain modalities are stimulated. And they had a look at the activation of an acupoint, which is traditionally associated with the visual cortex, so activation in the same region- so they were looking at what would happen if they activated this acupoint. And when they looked at the functional MRI, they saw that the part of the brain which is traditionally associated with vision in the occipital node lit up, essentially. And that’s the same thing that happens when you shine a torch into the eye. So obviously, you know, using that pressure point, that acupressure point actually was the same as shining a torch in the eye so it obviously somehow stimulating that part of the brain. So I thought that was really interesting.


Dr. Katy Munro [00:12:05] I think there’s a lot more to learn about it, but there’s a couple of theories. One is that the acupuncture targets muscles, which then target high threshold and small diameter nerves, and that those then link in to key brain structures. And as a result of those key brain structures being stimulated, then there’s some endogenous opioid release, which basically, loosely translated, means those neurochemicals which we produce ourselves in response to pain, to try and deal with pain, get released somehow. So that was one of the theories, as I understand it. And the other is that by triggering sort of micro injuries, by the needles going in, that that triggers the body’s healing processes and blood flow responses. Now, I don’t think we really know which of those is the case, but it obviously has some- it’s not all smoke and mirrors. There is something physiological that’s going on with acupressure- acupuncture, I should say.


Dr. Jessica Briscoe [00:13:12] I know because they are slightly different, aren’t they?


Dr. Katy Munro [00:13:14] They are different.


Dr. Jessica Briscoe [00:13:15] Different ways of stimulating the acupressure points. I think that’s something important to highlight. Acupuncture is where you’re actually using needle stimulation of acupressure points.


Dr. Katy Munro [00:13:23] The other thing is there is a thing called sham acupuncture, isn’t there? So when we’re doing studies on anything, what researchers like to do is to have one set of people who are having the active treatment and another control set of people who are having something that isn’t active. And hopefully neither group knows which they’re having, because it seems to be that your expectations can sometimes affect the benefit of things. And this is a thing we know about placebo effect as well, that if you think that something’s going to help you sometimes it does, even if it hasn’t got active ingredients. So sham acupuncture is done using pressure or using fake acupuncture needles. I don’t quite know how it works, do you, Jess?


Dr. Jessica Briscoe [00:14:12] No. I think probably because we haven’t been trained in it, we don’t understand it.


Dr. Katy Munro [00:14:16] Yes.


Dr. Jessica Briscoe [00:14:16] But I know that it is basically non-stimulating use of the needles. I don’t know whether they use different points or whether it’s just the technique isn’t right. I have no idea. So maybe it’s a closely guarded secret, I’m not sure.


Dr. Katy Munro [00:14:28] I will ask acupuncturists about this. Hopefully we’ll have the answer later on in this episode for you.


Dr. Jessica Briscoe [00:14:33] Wonderful.


Dr. Katy Munro [00:14:35] I think the other area where acupuncture is possibly involved is- and we get asked about this a lot, don’t we, is daith piercings.


Dr. Jessica Briscoe [00:14:44] Yes. I wasn’t sure if you’re going to mention daith piercings.


Dr. Katy Munro [00:14:46] Yeah, well, I think I’m going to mention it because it’s something people do often ask us. Sometimes they’ve tried. So a daith piercing is a little piercing that’s put into a certain area of the ear, usually just above the auditory canal. So there’s a little kind of ridge and it can be either side or it can be both sides. I know people who’ve had either one or both areas pierced. Some people are saying that that is because that’s an acupuncture point. But I’ve also heard that that may be something to do with the vagus nerve and the vagus nerve is stimulated.


Dr. Jessica Briscoe [00:15:23] I’ve heard both as well.


Dr. Katy Munro [00:15:24] So although we are very interested in daith piercings, I’m not aware of any studies that prove that daith piercings work.


Dr. Jessica Briscoe [00:15:31] No, not at the time of recording, anyway.


Dr. Katy Munro [00:15:33] At the time of recording, we can always…


Dr. Jessica Briscoe [00:15:37] Caveat…


Dr. Katy Munro [00:15:39] There may be somebody doing a study at the moment. We’ve also had a number of people who’ve come in, who’ve tried it and who’ve said it made no difference to them. But I know if you search on social media, you will find a lot of people who go, ‘Oh, I had that and it’s amazing’.


Dr. Jessica Briscoe [00:15:51] Yeah, I’ve seen a lot of articles about how it’s cured people’s migraines and you know how I feel about that anyway, because sadly there’s not really a cure.


Dr. Katy Munro [00:15:59] You can’t get rid of your genetic tendencies. So be careful with daith piercings I would say. It can cost you a lot of money to have a daith piercing depending on where you’re going. And also the cartilage can get infected.


Dr. Jessica Briscoe [00:16:12] Yeah, I mean, that’s the problem with cartilage piercings. You can get some pretty horrible side effects. And it’s really painful, as well, having a cartilage piercing. So all of these things should not be discounted. And also, I always think if you’re someone who- I always say to people, if you’re someone who wouldn’t mind having a piercing anyway, you’ve got to think about the effects of it sort of aesthetically. If you’re someone who really wouldn’t want to have a piercing, wouldn’t want that, you know, you can get issues if the cartilage gets infected, it can disfigure that area, sort of, persistently.


Dr. Katy Munro [00:16:44] It can scar, can’t it?


Dr. Jessica Briscoe [00:16:45] These things, although they sound trivial, are really important to remember, actually. So, you know, I certainly wouldn’t undertake it lightly. And it’s important to know that at the moment  there’s no evidence base for this management. So I think one thing that’s been highlighted is when would people think about using acupuncture? Because I know we’ve talked a lot, particularly when we did that topic about electrical stimulation- sorry, if you were in the same room as me, Katy, we’d be all over this…


Dr. Katy Munro [00:17:15] Do you mean neuromodulation devices?


Dr. Jessica Briscoe [00:17:17] Thank you. Neuromodulation devices. Honestly, my words aren’t working very well today. Neuromodulation devices, and actually there’s probably some evidence that people don’t use it early enough, which is possibly why it doesn’t always work. And I did read something about that possibly being the case in acupuncture. But there’s also- because like with neuromodulation devices, acupuncture is often quite a lately adopted thing. So often when people have got to the point where they’ve got chronic migraine and they’re really searching for something to use. So people do sometimes use it when they’ve not tolerated medications, when they’re sort of sick of trying different medications, when they’ve sort of reached the end of the line. But actually there is some evidence it could be used a bit earlier and it can be used for people who- so one time that people sometimes suggest using it is when certain medications aren’t safe to use or injections and I’m thinking particularly in pregnancy. And if people take other medications that would interact with a lot of the medications that they use. And then I think, as you just mentioned earlier on, if people have coexisting co-morbidities such as anxiety and depression, I think that’s a really key time to be thinking about it, don’t you think, Katy?


Dr. Katy Munro [00:18:26] Yes, anything that helps anxiety and depression tends to help migraine and vice versa because of the bidirectional relationship that they have. So we know that a huge number of patients with migraine also have depression and this sort of anticipatory anxiety. So yes, if acupuncture can help with that, certainly. We’re hoping to do a few more of these episodes looking at more complementary or, maybe thought of as, alternative therapies, maybe hypnotherapy, osteopathy, talking about other interventions that people have explored, I think, later in the series.


Dr. Jessica Briscoe [00:19:04] And now Katy is going to speak to some experts in the field of acupuncture to explore this more.


Dr. Katy Munro [00:19:12] We hope you’re enjoying this episode on migraine and acupuncture. We’ve decided to split this episode into two parts, so I’m now going to be talking to Nicola Court, who is an acupuncturist and we will be hearing from one of her patients later. In part two, which is coming out in a week’s time, I speak to Dr. Mike Cummings, who is the medical director of the British Medical Acupuncture Society, and he’s spent a lot of his career treating patients with acupuncture and in particular, people with headaches and migraine. So tune in in a week’s time for part two of this episode.


Dr. Katy Munro [00:19:56] Now, I’m going to be talking to Nicola Court, who works as an acupuncturist and has done for many years. So welcome to the podcast, Nicola. Thank you so much for agreeing to come and do this. Can you introduce yourself and tell us how you got into working as an acupuncturist and what it means to you?


Nicola Court [00:20:15] Thank you, Katy. I really appreciate you asking me on to be a guest and it’s quite thrilling to be able to share some of my experiences and knowledge with your listeners. So I started my career as a massage therapist back in 1999 and very quickly realised that there was limitations with the patients that I was treating. And so I, after a lot of searching, ended up starting my degree in acupuncture and I graduated in 2007 and I am a registered member of the British Acupuncture Council, which is our main governing body, and I’m also a member of the British Acupuncture Federation and we’re really pushing traditional acupuncture and acupuncturists with degrees forward in the UK specifically as well as- we have a lot of members in other countries as well, but we’re trying to really push the specialism and the qualifications and us and our experience as being the pinnacle of what you would want to have if you’re looking for an acupuncturist.


Dr. Katy Munro [00:21:22] So there’s a great consistency of people who registered with the British Acupuncture Council that you can kind of know that they’ve done a certain level of training. Is that right?


Nicola Court [00:21:31] Yes, absolutely. The minimum requirement is a three year degree and you get Bachelor of Science with that. There are other courses out there, but we tend to feel that our course is the most thorough. And you get a guarantee from us that we have got a very specific level of training compared to many other courses that are out there.


Dr. Katy Munro [00:21:55] That’s really interesting. So I think one of the questions that patients ask me is, is it worth trying acupuncture? And if so, who do I go to? And I’ve always sort of thought, well, I don’t really know where to direct people other than going to governing bodies or, you know, personal recommendation from other friends or people that they know. Would you say that’s right?


Nicola Court [00:22:16] Yeah, absolutely. There is a big discrepancy with training in the UK and you have to be very careful. You can as, for example, a massage therapist or a GP have minimal training to be able to stick needles in people. But you then have to remember that you have a limitation with what your what your knowledge is and what you’re able to treat. And so the, the higher level acupuncturists, we have a much better understanding of the body, we have a much better understanding of anatomy and physiology. We look at- we basically have an undergraduate level biology and physiology qualification within our training, so it’s pretty high.


Dr. Katy Munro [00:23:00] So just to kind of outline for anybody who hasn’t experienced acupuncture, if a patient came in to see you, what kind of things would they expect to experience from a consultation with you?


Nicola Court [00:23:11] Okay, So everybody is different that you go to. I trained with 20 other people and we all practice very differently and it’s all down to personality. So I don’t wear white coat. I hate them. I have a lot of patients that have white coat syndrome and come to me for anxiety and the last thing they want to see is a white coat. So at the moment I have embraced the scrubs and basically it’s like wearing pyjamas for work, but it’s really comfortable and our patients really like it. But that’s how I work, I want my patients to be really comfortable. Because I’m also a massage therapist I need to physically be able to move comfortably in my work clothes so I would never be wearing what I would consider smart clothes because the chances are I’m going to get oil all down myself at some point during the day. So I do like the comfort. So when they come in, we do a consultation which takes about 45 minutes to an hour, and then we do a treatment if it’s appropriate. At the moment with COVID, we’re having to do everything via video in the consultation stage and then invite people in after that to reduce face to face contact. But you’ll tend to find that most acupuncturists are working that way now.


Dr. Katy Munro [00:24:31] It’s a very different world at the moment, isn’t it? So when you’re taking the history, for example, of a patient who’s getting migraine or headaches, would you be asking specifically about that or you’re asking just a general overview of their health and lifestyle and things like that? You go into some depth with the history, I’m guessing.


Nicola Court [00:24:50] Absolutely. We do both. So it’s a really comprehensive consultation and, you know, mine is up to an hour, but I know colleagues that will do longer and we want to know everything. We’re very, very nosy. Acupuncturists like to know everything about you. So you might come to me for a migraine, but we want to know what your diet’s like. We want to know what your work schedules like. We want to know if you have any emotional stressors at the moment. We want to know what your poo is like. We want to know how often you pee a day. And that’s before we even ask you about your migraines. You know, we want to know absolutely everything. We look at your tongue. You know, my phone on a daily basis has so many photos of people’s tongues, because at the moment we can’t have people sticking them out in clinic because everyone is masked up, so as part of our diagnosis, you know, my phone’s got tongue photos on it, which is lovely. And, you know, we feel your pulse and we just literally want to know everything because that will then give us an understanding of you and your constitution and why maybe you have developed this if it’s not linked to a trauma, for example. Sometimes you know, somebody has been in an accident, we can say, yes, there was clearly an external influence and we can address it almost like a whiplash. So, you know, it’s very easy to do. But for something that’s you know, personally, I’ve had headaches since I was nine years of age with no trauma. So where does that come from? Why is that come in? So we will ask you about your childhood. You know, if there’s been any accidents, for some people, it could even be a birth trauma. So when they were born, they might have had ventouse or forcep delivery, which could have aggravated the skull and it could have had an impact on the neck. These things, we don’t dismiss in your history.


Dr. Katy Munro [00:26:50] It’s just exploring around everything and I’m presuming you also ask about family history, if it’s relevant?


Nicola Court [00:26:55] Yeah, absolutely. For many conditions we want to know if there’s a link with any family. And quite often, if we manage to successfully treat one person in the family, they send the rest of them. There’s always a test, you know, ‘I’ve been sent by my wife and if you’re any good, they are all going to come as well’, which is quite nice.


Dr. Katy Munro [00:27:23] Well, especially with migraine being a genetic condition, there is often other family members who suffer from it. So when you’ve made your assessment and you are deciding then what kind of acupuncture treatments to use, I’m guessing from what I know of acupuncture, that that can really vary from individual to individual.


Nicola Court [00:27:44] So once we’ve done the consultation and we found out everything we can about you, we then make our diagnosis based on usually Chinese medicine. And then we formulate a treatment strategy based on you as an individual. So for five people that potentially come in with migraine or headache, each one of those could have a different treatment. Just because you’ve been diagnosed with the same condition, it doesn’t mean that you’re going to get the same treatment from us. And that’s what I love about what we do, is that every single person that walks through the door is treated individually because the underlying cause of why you’ve got it is different for us. So we would ask about where the pain is. We ask about which area of the head is. We ask about the type of pain, and that all helps us with the diagnosis. So somebody with a stabbing screwdriver pain in their eye would have a different treatment to somebody who feels like their head is in a vise or wrapped in cotton wool eben though you know your diagnosis is migraine. So it’s very different to that.


Dr. Katy Munro [00:28:51] I think that’s our experience in the National Migraine Centre as well. In when we’re assessing people and again, like you, we ask a lot of questions, so we’re very nosy and but we come up with an individual plan because although there are some things that link patients who suffer from migraine and some symptom patterns and some, sort of, broad overview of treatments that work, nothing works for everybody. And we do find you have to really drill down into that individual person and find out what’s the recipe for them that will help them in the widest possible sense.


Nicola Court [00:29:25] Absolutely.


Dr. Katy Munro [00:29:27] So tell me a bit more about the actual process of acupuncture. So I know it involves needles and we have a number of patients who go, ‘ooh, well, I’m needle phobic, I wouldn’t want to do it’. So tell us about the needles a little bit. What are they like?


Nicola Court [00:29:41] They’re tiny. Now people usually are more scared- the thought of it is more scary than than the actual doing of it. In all the years that I’ve been practising, I have had two genuine needle phobics that I’ve treated. And if you have a big phobia, it’s still possible to do a treatment but actually what we might do is say, well, we prefer to give you herbal medicine and then we’ll do acupressure which doesn’t have needles. I also use a laser machine which will also treat, but for me, I don’t personally find it as effective. But I have it because I also treat children. I treat children from three months of age and with some parents they don’t want you to stick needles in their kids. So I have different techniques I can use to get round it. And, you know, I have a very reactive nervous system and I break out in a sweat when I have needling. Yeah, I do this for a living. So there’s certain points on me that I’m a little bit sweary when I have them done and I break out in a sweat and I get quite anxious with very specific points. But for me, that shows that actually I need that point doing. And I talk about this with my patients and usually find that if sometimes I’m not keen on certain ones, they’re happier because they know I understand how it can feel. Now the needles themselves, depending on what area you’re putting them into, are tiny and in comparison to a hypodermic where you’re doing an injection, you could fit up to ten acupuncture needles within a hypodermic. That’s how tiny they they can be. And the way that they’re inserted in the body is we usually use, what we call, a guide tube. So there’s a little circular plastic tube and you press on the skin and people often jump with that because they can fill that but not the needle. So it desensitises the skin just lateral to where the needle is going to go in. So you tap it quite firmly and it goes in. Now, with children, I mean, I often when I have children that are nervous, I will let them needle me because they can see it’s not a problem and they get to feel it and I usually do a really nice safe one on the elbow, and usually once they’ve done it to me, they’re quite happy for me to do it to them. It is a good way to build confidence and trust, especially with youngsters. But yes, every needle that we use is individually wrapped. It’s sterile. We do not reuse needles anymore, which I know is a concern for many people. So everything is brand new. There’s expiry dates on them. It couldn’t be more hygienic.


Dr. Katy Munro [00:32:50] I think you’re right. That is sometimes what people ask about as well is the hygiene, isn’t it? Especially these days of infections being high in the news. And I’m interested in- you were saying I was going to ask you, actually, is there any sort of age range but really anybody could have acupuncture of any age?


Nicola Court [00:33:09] Yeah, absolutely. So the youngest I’ve treated is a month old.


Dr. Katy Munro [00:33:15] Wow.


Nicola Court [00:33:15] For colicky symptoms and the eldest, I’ve had somebody in their late nineties who’s wandered in and wanted treatments to help with insomnia. So any age it doesn’t matter what you come with, we’ll take you. A lot of us love seeing a variety of patients.


Dr. Katy Munro [00:33:39] So going back to the needling now. Is it- I know sometimes people expect that if they’ve got a headache, they’ll have needling in their heads, but it doesn’t necessarily work like that, does it? So I know some people have needling in their hands. I have a patient who had needling in her hand for her hemiplegic migraines that used to really help, immediately help, with the attacks. And so is that right? It depends on your assessment of the patient rather than the location of the symptom that they’re pointing to at the time.


Nicola Court [00:34:11] Yeah, absolutely. So there are points specifically in the head that we do use for headache, but sometimes people, if they’re so tender, they don’t want you anywhere near their head. And there are points we often treat the furthest away from the head. So if there’s a lot of, what we call, heat in the head and a lot of congestion, we want to drain that and we want to sedate the body and we want to clear the body so we’ll use points in the feet and we’ll use points in the hands. And there’s some really fascinating research about acupuncture points and what they do. And we very often do not needle the head. Now for something that’s maybe a musculoskeletal issue. So say somebody has neck pain that’s causing tension headache, then yes, I will probably needle the top of the shoulder into the trapezius into just the base of the skull. And I will do a very different type of treatment where I’m not using energetics. I will be doing very functional work on those people. So I work in two very different ways, but both very effective ways. But then that comes from how I’ve diagnosed you and what the problem is. So, yes, people often do not want needling in their head, which is fine. And actually sometimes if you needle head, it can aggravate a migraine.


Dr. Katy Munro [00:35:39] Yes, I could imagine that. And people with migraine tend to have hypersensitivity to any sort of sensory inputs and stimuli, that’s one of the things that we know about the migraine brain is it’s kind of tuned in a bit too much to sensations.


Nicola Court [00:35:57] So sometimes we may only use three or four needles in a treatment. My average is 12 to 15, but for some people they can tolerate one or two needles and then you have to really think about your treatment strategy and say which points are the ones that are really, really important, that are going to do the best job for this patient right now. And you reduce the treatment down to absolute basics until they’re feeling better and you can start to increase what you’re doing.


Dr. Katy Munro [00:36:27] How quickly- if somebody is going to respond, how quickly would you expect to notice a difference? Or is that just one of those crystal ball questions that you just have to try and wait and see.


Nicola Court [00:36:40] Yeah, it’s the how long is a piece of string question. You would hope for somebody who has a chronic problem, who’s had pain for years- I mean, bearing in mind we are seeing patients who have been suffering for a long time, patients that have been suffering for decades sometimes. To get an improvement within one or two sessions is unusual. You can’t fix something in one or two sessions. It’s the same as if somebody came and said, ‘I’ve got a really bad infection’ and you say, ‘here’s 14 days of antibiotics’. They take two tablets and then complain that it doesn’t work. You have to do the course. Now for us a standard course of treatment is 12 sessions. So you’re looking at, you know, you could be looking at three months. That’s once a week. Now, I’ve had patients who are so severe, I would see them three times a week, because what we’re trying to do is keep knocking the pain down. So, you know, if somebody is off work and struggling to function on a day to day basis, having six days between each session it just doesn’t work for them. So to do that is unusual, but we do do it if it’s needed and to get that patient’s quality of life back.


Dr. Katy Munro [00:38:03]  It’s quite a time commitment for the patient if they’re having to come- because roughly an hour I’m guessing for a treatment?


Nicola Court [00:38:12] Yeah it can be. I mean, I will see patients for half an hour. So, if I know I’ve got to see somebody three times a week, for example, I might just see them for half an hour per session because they might find that actually laying for an hour or 45 minutes is too long for them and they can’t be still for that long, or they find that lying on their back or whichever position they’re in, it’s just too much. So we reduce the treatment time, if that’s appropriate. For other people that are very deficient and very tired and exhausted they’ll get on the bed, we’ll put needles in and almost by the time I’ve finished doing the needling, they’re asleep. And I will wake them- I will physically wake them up at the end of the session because they are so drained they need- part of that hour session is the rest. And that’s where a lot of the healing takes place.


Dr. Katy Munro [00:39:06] Does acupuncture make people often feel sleepy and emotional, or is it that they’ve come to you and put their trust in you and it’s that?


Nicola Court [00:39:16] Both. Absolutely. Both. So if you have chronic pain. It’s boring. It bores people. If you have chronic pain, all you can think about is your pain. And it gets to the point where they stop talking about it because they think people don’t want to hear it any more or people don’t understand. They’re not being listened to. So when they come in and you sit there and you listen to them and you hear them and you make space for them to let out their emotions, yeah, people cry. We go through a lot of tissues in our clinic for people who are just trying to get their frustration and their often their anger out and their fear that they’re never going to be better. So that can happen. But actually also when we’re treating people, there are points that will release emotions, even if they don’t feel emotion when they come in. We talk a lot about stagnation, about emotional stagnation. And when you needle, the stagnation is released. And often people have an emotional release and, you know, crying can be very therapeutic and it’s a very healthy thing. So if people cry on the table, I’m more than happy with that and they’ll usually feel great afterwards. So cry away, it’s fine, and not a problem.


Dr. Katy Munro [00:40:38] I agree with you. I think crying is underestimated and people often apologise for crying, don’t they? And I always say ‘it’s absolutely fine to cry in here, if you want to cry, you cry’. So yeah, we have big boxes of tissues delivered when we’re doing face to face consultations.


Nicola Court [00:40:55]  I try and make my clinic room a really safe space. For some people it’s the only place they can come and be honest and just come in without fear of being judged or dismissed. And it’s quite overwhelming for them often because maybe they’ve gone a long time without- you know, haven’t felt like that for a long time. The connection is very important.


Dr. Katy Munro [00:41:20] Feeling listened to is often so hugely valuable to people, isn’t it? I really know that that’s the case. So are there any dangers? So is there anything that can go wrong or you would sort of urge caution if somebody had a particular condition, anything that we need to know about that?


Nicola Court [00:41:40] Absolutely. With any therapy, there’s always side effects. I mean, we like to say the major side effects of coming to us is feeling better. Acupuncture is one of the most safe therapies that you can have, if practised by somebody who has thorough training. Unfortunately, the majority of negative occurrences or injuries happen through therapists that have minimal training or have done weekend courses. Who we do not class as acupuncturists, but unfortunately acupuncturists are then- the press do like to attack this kind of work and you know, ‘acupuncture caused this’. Well actually, if you look into it, you’ll find that the acupuncture was provided by somebody that had done an eight hour course and caused an injury. Now, the majority of things for me, there could be bruising. You might put the needle in and you’ll just catch a small capillary and you’ll get a bruise or a small haematoma under the skin. And, you know, I think though for most people a bruise is a small price to pay for feeling better.


Dr. Katy Munro [00:42:55] And so the fact that there was a bruise wouldn’t stop the treatment working if it was going to work?


Nicola Court [00:43:00] No, absolutely not. Absolutely not. Some people are very vascular and there are points that I’ve used that are classically known to help migraine or headache. And they’ll come and they will bruise on every session. So it’ll come and I’ll go, ‘well clearly there is something’, maybe, you know, there’s a point between the eyebrows that we use for treating and for some people it bruises. So I don’t use it anymore because the last thing people want is a bruise between the eyebrows. Girls can put make up on, mostly men don’t want to use cover up. So there are some times if an area does repeatedly bruise, then we generally stop using that point and use something else. So we will monitor things case by case. And for me in my clinic, if anyone has a concern after they’ve had a treatment or they don’t feel right, they can contact me and email me and I will phone them back and talk them through what they’re feeling. So we always say, ‘yes, you might feel tired’. It’s almost like, when you have acupuncture, you’re resetting your system, you’re resetting your body. And when people are very adrenalized and in their fight and flight mode all the time, by having acupuncture, it calms down. So often they feel absolutely shattered. So if that keeps happening we use less needles. We find if we use a lot of needles, people can feel more tired, so we use less needles. Occasionally, we’ll do a treatment and maybe for that person it’s, what we call, a little bit strong and it could trigger a headache, which obviously is not ideal. But what we would want to do is for the patient to talk to us about it. And we work out, we go back and say, ‘Well, I used these points, I’m going to remove certain points’. So we’re not going to keep- so we’d make the treatment a quieter, calmer, softer treatment for them. Until we start treating we don’t know how you’re going to react. I haven’t got a clue how you’re going to react. So we constantly are monitoring patients and adjusting accordingly. A patient should never, ever be worried about contacting their practitioner if they’re concerned about a treatment.


Dr. Katy Munro [00:45:23] It should be a very good, strong, communicative relationship with the person that you’re having acupuncture with.


Nicola Court [00:45:30] Yeah, absolutely.


Dr. Katy Munro [00:45:31] So if patients are hoping to try acupuncture and they come, what sort of success rate would be realistic for them? Can you put any figures into how many people would actually not find any benefit from acupuncture? I know it’s hard with figures and certainly many of the medications that we prescribe for migraine prevention we think we’ve achieved something good if we’ve reduced the headaches by 50%, we’re not aiming to get rid of them. It’s unrealistic to think that we’re going to get rid of them completely. What is the goal for most people? What would you say is realistic?


Nicola Court [00:46:11] Yeah, I think, you’re right. I mean, to completely cure- we’re not allowed to say the word cure, by the way-.


Dr. Katy Munro [00:46:18] We wouldn’t either.


Nicola Court [00:46:18] But to have somebody be completely free of their pain would be the goal but actually, in real life, it doesn’t happen so much because we don’t have perfect lives. We don’t have perfect diets. We watch too much TV, we spend too long on a computer. And as we know, these are all triggers for developing a migraine, especially now, you know, in the current climate, we are all under an awful lot of pressure. And I’ve certainly noticed an increase in people’s headaches and migraine. So we do give more life advice. We talk about diet, we talk about doing some exercise, gentle exercise, not necessarily vigorous, because that doesn’t always work either. We talk about meditation, so it’s not just about needling. We talk to people about everything that’s going on. And so, you know, I have patients who the stress levels have been so severe with them so if I can make them just even be more accepting of their situation, I think that that’s success. And if they are able to manage their pain better, that is a success. Now I have patients that will come once a month because it’s linked to their menstrual cycle, for example. So we treat around the part of the menstrual cycle that, for them, they have a migraine, for example. And that for some women might be ovulation, for some of them it’s the week before their period or it could be day one. So we tailor their treatment for that. So for other people, it could be that that, you know, it’s specifically related to having to do Zoom calls, you know, and they know they’ve got a Zoom call and it builds up and builds up and builds up. So, you know, we think, ‘right, well, okay, in a week’s time you’ve got this big presentation you have to do, come for treatment few days before and we can get you into a better state’. So they manage it. So it’s about reducing the pain and I always use a MYMOP form usually to monitor pain so the Map Your own Medical Outcome Profile and a lot of patients improve, but they don’t realise they’re improving because they’ve had it so long they don’t recognise when they’re feeling a bit better. So we choose a couple of symptoms that affect them the most and we can numerically score that over the session so that they can see the reduction. So if a patient comes in and they’re five out of five in terms of pain and in six sessions they’ve gone down to a three, that’s a big improvement as far as I’m concerned. And you know, for a lot of patients they’ll go down to a one or two and for them that’s a big improvement in their life. And that for me is a win and for them as well. Reduction of medication, I think for a lot of people, is a good way to see how they’re improving. So not relying on medication, not having to take medication every day is great. So I’ve had patients that are, you know, having to take five or six days a month off work due to severe migraine attacks. And if you get them down to only having one or two days off a month, which I’ve done with patients, that’s a huge improvement. So, yes, we’ve not fixed their migraine, they’re still getting migraine, but they’ve gone down to one or two a month as opposed to five or six a week. That’s huge. That’s huge for people.


Dr. Katy Munro [00:49:49] Makes people much better able to engage in life doesn’t it, despite their condition. That’s really a positive thing for mental health as well.


Nicola Court [00:49:59] Yeah. I think for a lot of women especially who have children, I think there is a huge issue with them feeling like they’re not being the best parent that they can be because they’re suffering so much. They feel like that their issues are affecting their children.


Dr. Katy Munro [00:50:19] Yeah.


Nicola Court [00:50:19] And so by them feeling better, they are then able to look after their children better and I think that’s really, really important. I know men have this as well, but I see much more of that with my female patients.


Dr. Katy Munro [00:50:31] There’s a certain amount of sort of guilt and shame sometimes because the general sort of society’s stigma about migraine is ‘oh, it’s just a headache. Everybody gets those. Why don’t you pull yourself together?’ And that kind of unhelpful pressure to try and pretend you haven’t got it and function through it and all of that. So yeah, just addressing that with people and saying ‘it’s not your fault. It’s not your fault and we’re going to help’.


Nicola Court [00:50:55] And clearly those comments have been made by people who’ve never had a migraine. Because if they ever had one, they wouldn’t be saying it.


Dr. Katy Munro [00:51:04] It’s hard to describe the impact to people and get that across if they haven’t ever experienced something like that, I think.


Nicola Court [00:51:12] Yeah. They really don’t understand how debilitating it can be. And you know, I suffer myself. I’m lucky I don’t get them that often, but I totally understand. And it’s one of the few things I will cancel my clinic for.


Dr. Katy Munro [00:51:34] Yeah.


Nicola Court [00:51:34] So my patients know if I say ‘I’ve got a migraine’, they know I’m really not very well. And you know, the understanding is great, but luckily I can stick needles myself and go home. A bit of  self-treatment.


Dr. Katy Munro [00:51:55] So most of the patients who are coming to you, I’m guessing, have migraine of which a big feature is headache but of course, some people with migraine are more bothered by their brain fog or dizziness or other kind of symptoms like nausea and vomiting. And I’m guessing acupuncture could be helpful for those kind of symptoms as well?


Nicola Court [00:52:15] Yeah, absolutely. It doesn’t really matter what your symptoms are. We can start to improve that. Yeah okay, pain is one of the ones that people associate with more. But actually that constant feeling like your brain is wrapped in cotton wool and you can’t think straight is a problem, especially if you have a job that you have to think a lot. So people make mistakes in work and then they’re worried about losing their jobs because they’re not functioning properly. So it’s a worrying time for them. So, we can treat all of that. There’s some really interesting research into acupuncture about how it can treat and what it does in the body and in the brain and how it affects the nervous system. So all of this is proven in the research, which is lovely to finally start getting some really decent research out there to back up what we do.


Dr. Katy Munro [00:53:13] Yeah, there’s really a lot more science- kind of, a scientific understanding of what’s happening in acupuncture, isn’t it? I think that’s really, really helpful. And of course it has been approved- you know, it’s on the sort of guidelines from NICE as to being suggested as one of the treatments for migraine. One of the things that puts my patients off is often, you know, jobs have been impacted, the finances may be an issue and it isn’t terribly easily available on the NHS. So are many people getting it sponsored by their employers or are they paying privately themselves or are their health insurance companies prepared to cover acupuncture as an intervention?


Nicola Court [00:54:00] Yeah, absolutely. I mean, I can’t speak for the insurance companies. I think that’s a case by case for them and whether they cover it, there’s a lot of insurance companies out there. The majority of my patients in my clinics are self referred and pay. I do have referrals from a neurologist who refers me migraine patients. And it is often word of mouth that people hear about personally what I do but there’s, you know, so many of us out there that are treating. There are many low cost acupuncture clinics available, more so in the cities, in London, where you, and hopefully at some point, the multi-beds will reopen again. The multi-bed clinics, the low cost clinics where you have more than one person in the room is a really great financial way of of having more treatment and those are out there but at the moment they’re not because we just can’t do that.


Dr. Katy Munro [00:55:06] Because of restrictions.


Nicola Court [00:55:06] Yeah. But hopefully you know in 2021, things will start to be more available for people again.


Dr. Katy Munro [00:55:18] So to find one of those multi-bed clinics, would it be through the British Acupuncture Council? Would there be information on their website?


Nicola Court [00:55:26] They’re not advertised as multi-beds in that way. I think you would have to look at your local area where you live and Google ‘Multi-Bed clinic’. I know in the area that I’m in, I don’t think there are any multi-beds. I’ve done the odd multi-bed for anxiety and you know, my clinic room is quite small so I could have four patients in here sitting up so you wouldn’t be lying down, you’d be sat up. And it can be quite nice actually, because people have a chat to the person next to them or they sit reading a book and it’s a nice way- there’s a lovely vibe when you have more than one person in the room having the treatment. It’s really quite interesting. The energy in the room is very different to others. But other people just like being by themselves. They like having that 1 to 1, that’s really important to them. And, you know, they can go to sleep without worrying people are looking at them.


Dr. Katy Munro [00:56:26] Yes. So obviously, you wouldn’t spring that multi-bed clinic on somebody without them knowing.


Nicola Court [00:56:33] Absolutely not.


Dr. Katy Munro [00:56:34] ‘By the way, there’s all these other people here.’


Nicola Court [00:56:37] Yeah, exactly. But no, you know, there’s some really interesting stuff about research in multi-beds as well. And you know, acupuncture has been researched for the last 60 years really thoroughly, almost more thoroughly than any other therapy. So there’s so much research out there and you can look and find an amazing amount of research on specifically migraine as well.  and the way that acupuncture- we call it modulation. So it modulates the nervous system and the parasympathetic system as well, because it has an effect on the adrenal system and the hypothalamus and the pituitary and all these other systems that are involved. And you can monitor that, you can test that. And the clinical research is fascinating when you read it.


Dr. Katy Munro [00:57:35] Yeah, it’s certainly something that we’ve been increasingly aware of, that there’s more and more interest and scientific back up for using this and offering it. So just to sort of summarise, are there any sort of key points that we’ve missed that you’d like to share or any key messages you want to say to somebody who’s wondering, should I have acupuncture for my migraine?


Nicola Court [00:57:58] Yeah, give it a chance. Honestly, give it a chance, but give it a good chance to work, you know, one or two sessions, and I know it’s frustrating, you know, you might have four or five sessions with no change. That’s normal. If you’ve got such an entrenched issue, you could come for a number of weeks without there being any change at all. But that’s not to say that it’s not working. Acupuncture is a little bit like peeling an onion. You have to take the layers off. We take a layer off and uncover the next layer and then we go, okay, now we’re going to treat that and then we take the next layer off. So it’s a wonderful modality. And I think it’s also very important to find a therapist, a practitioner who you get on with. If you don’t have a therapeutic connection, go to see somebody else. Just because you didn’t get on well with one practitioner doesn’t mean that that means that acupuncture is not going to work for you. It just might be the energetic between you and the practitioner. You know, try somebody else. It’s really important and you know, it’s a wonderful thing. And most of my patients, we like to, even when they’re feeling better, to have them continue to come as a prevention. It’s like a body MoT. You have an MoT for your car, even if it’s working okay to make sure and you service your car regularly, even if it’s working okay to make sure that it continues to work okay. And we use that with the body as well. We like to make sure that you’re working properly and we will pick up sometimes really subtle things that you maybe are not aware of. And you know, with doing the tongue diagnosis and the pulse and talking to you, we can see things that maybe you’re not aware of and we can correct that before it develops into a problem. And that’s really beautiful about what we do. And also if you are really not interested in acupuncture, contact your practitioner and ask if they would be prepared to do acupressure for you.


Dr. Katy Munro [01:00:08] Yes. So acupressure with no needling involved, maybe an introduction or even a complete therapy in itself if you get the right person.


Nicola Court [01:00:18] And again, right now with acupressure, you know, I’m doing mine on Zoom so I can treat anyone.


Dr. Katy Munro [01:00:24] Oh.


Nicola Court [01:00:25] Irrelevant of where they are. Most of us are doing that and the appointment is for an hour and we stay with you online for an hour. And once we’ve done the consult and, you know, we treat with you, you know, we show you where to press and we talk you through it. It’s lovely. And people then get a treatment. They then have that and they can continue to do that on a daily basis after we’ve gone.


Dr. Katy Munro [01:00:49] That’s very interesting.


Nicola Court [01:00:50] So it’s a really good way of managing in between sessions.


Dr. Katy Munro [01:00:55] Are there studies on acupressure as well as on needling?


Nicola Court [01:01:00] Yeah, yeah. There’s the studies for all of it. I’d say, acupuncture there’s a lot more. There’s a lot more research for acupuncture. But there’s much more interest coming through now about acupressure.


Dr. Katy Munro [01:01:19] Fascinating.


Nicola Court [01:01:20] So yeah, it’s definitely something to look at. But you know, in terms of safety, you really have nothing to be concerned about. You have practitioners that have very, very high skill levels and acupuncture is one of the safest things you can have.


Dr. Katy Munro [01:01:40] Well, I think on that note, I’m going to say thank you again so much for doing this. It’s really fascinating to hear all about it.


Nicola Court [01:01:45] You’re very welcome.


Dr. Katy Munro [01:01:47] And I’m sure everybody will be fascinated by this whole episode. So thank you. Thanks, Nicola.


Nicola Court [01:01:53] Thank you so much for having me. Take care.


Dr. Katy Munro [01:01:59] We’re now going to hear from one of Nicola’s patients. She didn’t want to speak on the podcast and so her account of her story of experience of acupuncture is read by an actor.


Actor [01:02:14] This May, I will be 70 years old, but 50 years ago, more or less, migraine came into my life. It found the doorway into my head and brain and, unable to find the door back out again, decided to stay with me from then on. I didn’t invite it in and it has most definitely overstayed its welcome, but I assume it arrived as an inheritance from my mother, who I believe suffered from it and passed it on to my older sister and me. I can’t remember when the first attack happened. Well, maybe I don’t want to remember, but I must have been around the age of 20 years or so. I left school to start work at 17 years old, but I certainly never had time off school because of headaches and migraine. So it waited for me to come out of my teens and into my twenties before finding me. Those early years of migraine attacks can only be described as horrendous. Mostly it would happen on a Saturday when I began to relax after a busy week at work, and it would paid to any social life arranged for that day. The only painkillers around in the seventies were mainly paracetamol based or much stronger prescribed medication, but nothing really helped. The sickness, vomiting and then retching when there was nothing left to bring up were awful and the head pain was sometimes off the scale. I would lie in a dark room with a cold flannel on my head, trying to keep my head perfectly still. The slightest sound, such as a doorbell or phone ringing would make my head feel as if someone was pounding a huge drum in my brain. The pain would reduce me to tears. It was the only real outlet I had at the time. I once remember saying to my husband that if there had been a loaded gun by the side of the bed, I would have used it to blow my brains out. Anything to get out of the pain. Living with migraine is living with the underlying fear of when the next attack will come. But hoping and praying that it won’t be for a while. And if you make plans for a special occasion, will that be achieved? Or will those plans be spoilt once again by the onset of a migraine? I knew that my menstrual cycle would bring on a migraine or headache, and I always hoped that after the menopause it would bring some relief. But sadly that wasn’t to be the case. The most noticeable thing, however, was that the sickness accompanying my migraines has now completely disappeared. I have read, and still read, many articles on migraine, have tried various remedies and prevention medication, but at the end of the day, all to no avail. I attended the City of London Migraine Clinic for help and advice, but I had long ago accepted that there was no miracle cure. However, the introduction of the triptan drugs has certainly revolutionised the treatment of migraine. As soon as imigran became available, I went to my GP and was prescribed the drug. Apart from the very strange tingling sensation in my left arm and chest, it worked. Usually, within a couple of hours the symptoms had disappeared and I could get on with my life. I may have felt a little hung over, but anything was better than spending a day in bed and in pain. From imigran, I moved to Naramig and continued with this treatment until in March 2017, I went to see a consultant neurologist. I’d known for quite a long time prior to the appointment that I had been seriously overmedicating and probably suffering rebound headaches from overuse of medication. I was at that time suffering up to 15 days a month with migraines, headaches and sinus pain problems and knew I couldn’t carry on any longer like this. That appointment proved a turning point in my life. The consultant arranged for me to have a greater occipital nerve block and I was to go cold turkey and take no medication at all for quite some while to treat any migraines or headaches. He recommended taking coenzyme Q10 and riboflavin, reducing the amitriptyline from 75 milligrams to 10 milligrams (I no longer take this), buying a Cefaly scalp stimulator and finally, acupuncture. On my follow up appointment he prescribed nasal zolmitriptan and I have found this to be much more effective in the treatment of migraine. I made contact with Nicola Court almost immediately after seeing him and have been having acupuncture treatment since April 2017. To start with, my treatments were fairly frequent, but now usually between 4 to 6 weeks apart and I will continue to see Nicola for the foreseeable future. I accept that acupuncture will not cure my migraines completely, as amazing as that would be, but the frequency and severity of them has diminished in a way I never would have thought possible. Acupuncture helps me to maintain this balance in my life, and I am extremely grateful to have been recommended to such a fine practitioner. The sense of calm and relaxation felt whilst the needles are in place allows me to dismiss the negativity within my brain and body and to absorb the positivity that the treatment gives. Occasionally, after treatment I will get a headache, but I regard this as a clearing and cleaning out process from the effects of the acupuncture. I still have to resort to taking medication when really needed, and I always write this in a diary so that I have an up to date record. Looking back over the past 50 years, migraine has without a doubt impacted on my life, and it’s impossible to count the numbers of hours, days and months of my life lost to this awful condition. However, I have an empathy with people who suffer pain in their lives too, that unless you walk in those shoes, it’s often difficult to understand and comprehend.


Dr. Jessica Briscoe [01:07:22] Hello. I hope you’ve enjoyed listening to this episode of the Heads Up podcast. I’m not sure if you’re aware that we’re a charity, but we do rely on donations in order to keep going with both our podcasts and with our clinics that we run through the National Migraine Centre. If you have enjoyed the podcast, we’d be really grateful if you could visit the link, which is in the blurb in the podcast information, which will take you to our donation page. It would be great if you could donate whatever you feel was necessary for us, however big or small, in order to help us keep going as a charity. The other thing that we really rely on in order for our podcast to reach as many people as possible is your ratings and reviews on whichever podcast platform you listen to us on. So if you could leave us a rating and a review, we’d be really grateful. Thank you.


[01:08:10] 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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