20 years of migraines cured by a pacemaker in my tummy



Six million people in the UK suffer from migraines, but painkillers are not always effective.

Debbie Hounslow, 44, a customer services adviser from Buckinghamshire, underwent a new procedure.

THE PATIENT



'It was an excruciating pain, like my skull was being crushed,' said Debbie Hounslow of her migraines

My migraines started when I was 18. My left eye developed blind spots, then I saw flickering lights and a really bad headache came on.



It was scary, but my Nan and Mum had migraines so I knew what it was.



My GP advised me to take over-the-counter painkillers if another came on.



I would have a couple a year, but in my early 30s they started coming every few months. They were much more intense and lasted from one to three days.



It was an excruciating pain, like my skull was being crushed; an agonising throbbing throughout my whole head. I also felt nauseous and sometimes was physically sick.



I started taking beta-blockers as well as painkillers, which helped a little to begin with, but the migraines carried on.



By 2005, I was having one a week. Even when I wasn’t having an attack, they made my life miserable because the medication I was on had side-effects — I felt ‘foggy’ and found it hard to watch TV, read or look at a computer.



Even simple things like cooking, driving and walking were impossible.



My partner Bob and my family and friends were really supportive, but it must have been difficult as I couldn’t make any firm plans.



At first my work was understanding about all the time off I took, then it started to be at least two weeks every month. In the end I took redundancy in February 2009, aged 42.

I felt desperate. I was offered Botox, which is supposed to work because it paralyses the muscles in the neck and forehead that can set off the condition. But I didn’t like the thought of it as it’s a poison in your system.



Then, in January 2010, I was referred to Alexander Green at John Radcliffe Hospital in Oxford.

He told me about Peripheral Nerve Stimulation, a new procedure where they implant electrodes in the back of the neck, close to the nerves they think send signals to the brain that cause migraines.



'I've only had three migraines in the 18 months since the procedure,' said Debbie

The electrodes would be connected by wires running under my skin to a tiny battery implanted under the skin in my stomach. The battery would send off little electrical pulses to jam the signals.



He said some people had seen their migraines virtually disappear after this operation. I thought I had nothing to lose.



My operation was in July last year under local anaesthetic.



After the hour-long procedure, it was sore where they’d inserted the electrodes and the battery on the left side of my stomach. I was allowed home after a few hours.



I took painkillers for a week, though the soreness in my stomach took six weeks to go away. You can’t see the wires, but the battery (which is about the size of a stopwatch) is visible as I’m quite slim.



When everything had settled, I went back to hospital for Mr Green to set the electrical pulses. It felt like pins and needles, and was strange at first, but now I’ve got used to it.



The pacemaker can either work constantly or it can be switched on when I feel a migraine coming. I have mine on all the time, but I do turn the stimulation up when I sense an attack approaching.



I’ve only had three migraines in the 18 months since the procedure, and even those were much shorter and far less intense than before — I only had to take painkillers for one of them.



Compared with how it was, this is a miracle.



I’m back working, can cook and go on walks again. This Christmas was the first in more than 20 years that I felt confident enough to arrange to meet people for social events. I’m in control of my migraines, rather than my migraines controlling me.



THE SPECIALIST



Alexander Green is a neurosurgeon at the Oxford University Hospitals NHS Trust.



Migraine is a complicated, life-long condition. Symptoms range from intensely painful headache to disturbed vision, nausea, vomiting and a dislike of light and sound at normal levels. Attacks can last anything between four hours and several days.



More than half of sufferers have one or more attacks every month. It can have a debilitating effect on work, family and social life.



No one really knows the cause, but a genetic link was identified for the first time in 2010. We also know migraines are more common in young pre-menopausal women.



More than half of migraine sufferers have one or more attacks every month

Some people have triggers, others don’t. These can include red wine, cheese, chocolate, citrus fruits, stress, alcohol, tea and coffee.



Drugs called triptans can help — migraines are thought to be caused by the widening of blood vessels in the brain, and triptans reverse this. But they need to be taken at each attack, and at £8 per tablet, they are expensive.



There are other options, including anti-epileptic medications and painkillers, such as gabapentin.



There is also the option of Botox injections to the scalp, or rhizolysis — deliberately damaging the occipital nerves at the back of the neck, which have been associated with chronic migraine.



However, these do not work in all patients and the effects are temporary. Many of the drugs can have severe side-effects, such as drowsiness, rashes and nausea.



Peripheral Nerve Stimulation (PNS) was developed in Seattle, in the U.S., in the 1990s to treat occipital neuralgia, a chronic pain in the back of the head, upper neck and behind the eyes. It was first developed as a treatment for migraine in 2003.



It involves implanting two electrodes and a pulse generator, much like a cardiac pacemaker. But instead of sending mild electrical pulses to the heart, the pulses are carried to the occipital nerves.



The pulses influence the way the nerves communicate with the brain. The exact mechanism is not understood, but somehow it jams the transmissions that cause migraine.



It’s been used on only about 200 patients in the UK — so far restricted to those whose drugs do not work or whose drug prescription is at a toxic level.



Just under half of patients who have PNS will experience more than a 50 per cent reduction in attacks, although the results are much more dramatic in some.



The operation can be performed under local or general anaesthetic and takes an hour.



Two incisions are made at the top of the neck, pockets are made under the skin and fat layer, and the electrodes are inserted, tested and anchored with a stitch.



The two thin wires from the electrodes are tunnelled just below the skin to the pulse generator or battery, which is placed in a pocket also under the skin.



The pulses can be switched on as a migraine starts using a remote device, or constantly generated, which is what most patients have.



Patients can go home the next day. Six weeks later the device is ‘fine-tuned’. We wait a few days to see if the voltage, frequency and length of pulse is working.



Patients can have a battery which is recharged once a week from a charger placed on the skin for an hour or so, or a non-rechargeable unit, which is replaced in a minor operation every three to five years.



The procedure is available on the NHS.



Privately it costs £15,000. Further information from migraine.org.uk, 0116 275 8317.mshire, underwent a new procedure.

