53: Headaches, Chilli Pepper Patches and the Placebo Effect

This edition has been supported by a grant from the Scottish Government. Paul Evans meets Dr Paul Davies, a Consultant Neurologist from Northampton General Hospital, who explains that whilst most headaches are benign and can be self-medicated, some headaches – those that are frequent and very painful – require medical attention. He outlines the different types of headaches, including migraines, tension headaches and cluster headaches, and says that each kind requires a specific treatment. Dr Davies admits that GPs have a long way to go in diagnosing and treating chronic headaches effectively. Dr Mick Serpell, a Consultant in Anaesthesia and Pain Medicine in Glasgow, gives us an introduction to topical medicine – medication applied to the surface of the body rather than introduced into it. The medication is applied to the painful area and the drug has a painkilling effect at a local level. Topical medicines can take the form of a cream, a gel or a plaster impregnated with a drug. We hear about two types which are usually used to treat neuropathic conditions – lidocaine and a chilli pepper plaster. One benefit of topical treatments is that they have very few side-effects and can usually be used alongside other analgesics. Finally, Paul meets Michael Lee, a Research Associate at Oxford Centre for the Functional Magnetic Resonance Imaging of the Brain, who carries out extensive research into placebos ¬– treatments given purely for psychological effect. In defiance of those sceptical of the placebo effect, Lee’s brain imaging research shows that placebo medications can have a visible effect on the way that pain is transmitted to the brain. Lee also highlights the importance of psychological context in treatment, saying that what a patient believes about their doctor, their medication and the therapeutic process as a whole affects their response to medication.Contributors: Dr Paul Davies – Consultant Neurologist at Northampton General Hospital and runs headache clinic at John Radcliffe Hospital in Oxford Dr Mick Serpell – Consultant in Anaesthesia and Pain Medicine in Glasgow  Michael Lee – Research Associate at Oxford Centre for the Functional Magnetic Resonance Imaging of the Brain. #Clusterheadaches #Headache #Migraine #Neuropathicpain #Brainimaging #Medication #Painkillersandsideeffects #Psychologicalapproachestopainmanagement