1) What are your qualifications and experience in treating headaches and migraines?

I am an experienced osteopath, qualifying in 1991 following an early career as an orchestral violinist, followed by a five-year extended pathway Diploma in Osteopathy (DO) at the London School of Osteopathy. I developed a special interest in headaches owing to suffering from frequent migraines myself during my 20s and 30s. Fortunately, I was helped by osteopathic treatment. This inspired me to keep searching for answers for people whose lives were likewise blighted by persistent headaches. In 2014 I began an online clinically integrated Master’s degree at the University of Edinburgh, graduating with Merit in 2020.
Over my last 31 years in osteopathic practice, I have undertaken many further courses, and attended lectures on both osteopathic technique and the use of drugs, medical procedures and adjunctive therapies for headaches & migraine. I continue to try to expand my skill set in order to help my patients, attending world expert clinicians’ practical workshops on all aspects of manual therapy treatment, and have recently been undertaking a 4-day short course at the University College of Osteopathy on psychologically-informed osteopathic practice.
Membership of Professional Groups:
Although headaches used to be seen as rather unglamorous in the field of neurology, headache science has become more exciting recently. This is due to enormous advances in the understanding of headaches and migraines. In order to stay up-to-date with new developments, I am a member of the International Headache Association, and also of BASH (British Association for the Study of Headaches). I have recently become a member of the prestigious American Headache Association, and am honoured to be accepted as an associate member of the Royal Society of Medicine. I regularly attend the Oxford Headache Symposia (specialised case-sharing seminars run principally for headache specialist neurological consultants) where I have also presented cases.
In addition, I have trained in teaching adults, gaining a PGCE in academic and clinical education. I have lectured GPs, osteopaths, physiotherapists, chiropractors and soft tissue therapists on safety, diagnosis and management of headaches & migraines. In 2016, half-way through my Headache master’s degree, I founded and led the ESO Headache Clinic (to hear me talk, CLICK HERE). I have attended the Migraine Trust International Symposium (a premier international event showcasing the latest research for headache specialist neurologists, physicians, scientists, patient advocacy groups and international experts). Also, my master’s research project poster presentation on UK osteopaths’ undergraduate headache education was accepted at the international CONy (Controversies in Neurology) 2021 online conference.
Course creation/Research:
I am of the opinion that the lack of undergraduate headache education in all clinical schools is indeed a controversy in neurology and have dedicated myself to addressing this education gap by helping to found OPHM (Osteopaths for Progress in Headaches & Migraines). I have created an undergraduate osteopaths’ headache safety and diagnosis course, addressing clinical confidence in graduating osteopaths. I have also been on the OPHM team delivering the EdACHe Project, acting as course lead on Phase 2, creating a headache e-learning course for osteopaths and other allied health professionals. This is part of a recently-concluded 3-year Osteopathic Foundation-funded research project. (For more on EdACHe CLICK HERE).
Lastly, I am proud to have been named as co-author of two academic papers on headache education:
To read about the nationwide survey of osteopaths done to inform the EdACHe e-learning course CLICK HERE
To see a poster on the effect of my master’s research on osteopaths’ clinical behaviours CLICK HERE

2) How long is the consultation?

An extensive, detailed case history needs to be taken and a thorough examination carried out. In addition it may be necessary to fill in further questionnaires or supply other information at a later date.

Other clinical tests may also sometimes have to be organised.

All of this takes time and here at Putney Osteopaths your initial consultation may take well over an hour, but this is time well spent.

All the information is then collated before discussing treatment/management. I will almost always perform a clinical and physical examination which may include blood pressure measurement and a neurological screening (for example if the headache is new or changing significantly). You may be referred immediately for an urgent GP appointment or exceptionally on grounds of safety, but this is rare.

Please note: You may only have a short treatment on the first occasion. Subsequent appointments last up to 45 minutes – 3-4 sessions are normally recommended before any re-assessment of progress. This is to allow for all aspects to emerge and begin to be addressed. Of course, it is entirely up to you whether you decide to stop treatment at any time and for any reason.

3) What information do I need to bring to the consultation?

Please bring anything you feel may be relevant such as;

4 ) Do I need to be referred by my doctor/general practitioner?

Although many patients are referred by their doctors it is not essential. However, if you are intending to claim from medical insurance a GP referral may be required.

5 ) Can I claim my fees back from my medical insurance?

I am registered with most medical insurance companies however you may need a GP referral. There may also be a limit on the amount you can claim. Please check your policy.

Unless your company is on our list (please call 0208 788 7895 to check), all fees are payable at time of consultation and receipts will be provided.

6 ) Will I need to have any tests/x-rays/scans?

This depends on many factors such as your symptoms, how long you have had the pain and which tests you have had before. It is worth noting that on many occasions following the consultation and examination the diagnosis is relatively straightforward and further tests are not required.

If deemed necessary, MRI scans, x-rays, blood tests etc can all be arranged privately at very competitive rates. Alternatively, some tests can be arranged through the NHS although these often take much longer to organize and requires the co-operation of your general practitioner.

7 ) How many sessions will I need?

Obviously this depends on a number of factors such as the cause of headaches/migraines, how long you have had them and what changes need to be made to achieve long-term relief.

Occasionally only one consultation is needed, for example if the diagnosis is straightforward and specific advice can be given for effective self-help strategies or if further referral is required to a different specialist.

If the problem is more complicated and long-standing a number of treatments may be required to ensure maintained improvement.

8 ) What will treatment consists of?

This depends on the cause/causes of your headaches/migraines and which therapy or combination of therapies is most likely to achieve the best results.

On-site therapies include; osteopathy (cranial and structural) & massage therapy, but others e.g. nutritional therapy (including herbal advice), acupuncture, psychological support, exercise rehabilitation and homoeopathy are available by referral.

Alternatively it may be that you are advised to seek further medical opinion and tests via your GP or an appropriate medical consultant.

9 ) I have already seen other doctors/therapists without success. How do I know you can help?

Firstly it is important to consider why previous treatment approaches have failed. Usually treatment failure in headache/migraine is multifactorial. A common pitfall is that the headache diagnosis is simply wrong. For example, population studies have shown that around 50% of migraine sufferers are self-diagnosed, and a possible 50% of the rest are misdiagnosed, and by extension mis-managed. For an overview CLICK HERE

In other instances the diagnosis is incomplete. Often patients suffer from more than one headache type, treating one headache type, while ignoring the other will lead to an incomplete treatment response.

It is also very common for coexistent precipitating or exacerbating factors to have been overlooked, resulting in poor success rates.

At Putney Osteopaths the initial consultation is 1 hr 15 mins. By taking the time to obtain a detailed description and history of your headaches/migraines plus carrying out a thorough examination, many of these pitfalls can be avoided.

Also it is important to stress that we are not tied to any one type of treatment( unlike many other clinics) and more than one approach may be required to ensure long term relief from your headaches/migraines .

10 ) Could I have a brain tumour?

Most head pain sufferers have heard or read about someone they knew with headaches who had a brain tumour! In reality it is estimated that in the general population for every 10,000 people with headache (and no other symptoms) only 5 to 10 of them will turn out to have a brain tumour.  Even in those headache patients serious enough to be referred to  specialist Neurologists , less than one per cent have a cerebral tumour and in the majority of those patients there were other more significant symptoms in addition to the headache.

Headache in isolation is very rarely due to serious illness.

11 ) Is treatment suitable/ available for all age groups?

Yes, children (and probably infants, in whom a link between colic and maternal migraine has been established by Amy Gelfand MD CLICK HERE) commonly suffer from headaches and various types of migraine. These may include atypical forms such as abdominal migraine or vestibular migraine. They also require accurate diagnosis and can benefit from advice and/or treatment (or referral if required).

12 ) Do I need to have head pain at the time of the consultation for accurate diagnosis?

No, this is not necessary. A full assessment, examination and likely diagnosis can be carried out whether or not you have symptoms at the time of consultation.