1. The Genesis of Pain in Migraine
Anna Andreou
The Headache Centre
Wolfson Centre, King’s College London &
Guy’s & St Thomas's NHS Foundation Trust
Headache Centre

2. Migraine – More Than a Pain Disorder
A clinical syndrome characterised by headache with specific features and associated symptoms
Structural
Functional
Behavioural
Environmental
Nausea/Vomiting
Sensory disturbances
Poor Concertation
Limited Activities
Disability
Craving
Yawning
Fluid retention
Heighten Perception
Hangover
Anorexia
Tired
Diurisis
Visual changes
Speech difficulties
Confusion
Numbness
Multifactorial predisposition
Multifactorial predisposition
Interictal Phase Premonitory Aura Headache Postdrome Interictal phase
Adapted from Blau JN. Lancet 1992; 339: 1202–7

3. How is Migraine Headache Generated Following Hypothalamic Activation?
Other brain areas
Hypothalamus
Migraine pain pathways
Premonitory phase Attack progression Migraine Headache

4. The Hypothalamus- A Brain in the Brain

5. Our Results:
Migraine-Triggering Substances Change the Activity of the A11 Hypothalamic Nucleus
Migraine-Triggering Substances in the A11 Hypothalamic Nucleus Facilitate the Migraine Pain Pathway
Many hypothalamic chemicals change their activity during experimental induction of a migraine

6. …But We Remain Committed and
WE WILL SUCCEED
Thank you for all your support!

7. Guy’s and St Thomas’ NHS Trust & King’s College London
How does Single Pulse Transcranial Magnetic Stimulation (sTMS) Prevent Migraine?
Joseph Lloyd
Headache Research Lab
The Headache Centre
Guy’s and St Thomas’ NHS Trust & King’s College London

8. sTMS in the Acute and Preventive Treatment of Migraine
? Underlying Mechanism of Action in the Treatment of Acute Migraine ?
Acute Treatment
Lipton et al. Lancet Neurol,2010; 9(4):
Preventive Treatment
Bhola et al., JHP 2015;16:535
Starling et al., Cephalalgia 2018, Vol. 38(6) 1038–1048

9. GSTT data
Demographic and clinical characteristics at baseline of 42 migraine patients treated with sTMS
Sex, M/F
5/37
Age (y), mean ± SD
43 ± 19
Aura, N (%)
11 (26.2%)
Chronic migraine/High frequency episodic migraine
37/5
Failed Botox, N (%)
20 (47.6)
Headache days
14.7
Migraine days
11.1
HIT-6
63.3
MTIS

10. ? Underlying Mechanism of Action in the Treatment of Acute Migraine ?
Non –Invasive Single Pulse Transcranial Magnetic Stimulation – A Cortical Treatment for Migraine
? Underlying Mechanism of Action in the Treatment of Acute Migraine ?
The long history of developing a portable sTMS device
Future

11. sTMS Mechanism of Action in Migraine
? Underlying Mechanism of Action in the Treatment of Acute Migraine ?
11 mm rodent sTMS coil
Andreou et al, Brain, 2016; 139(7): 2002–2014

12. sTMS can influence hypothalamic activity in A11 dopaminergic nucleus
Our Results:
sTMS can influence hypothalamic activity in A11 dopaminergic nucleus
sTMS effect on hypothalamic activity is consistent and cumulative

13. London Marathon 2018
Total of £17,450 raised
Massive thank you!