We have all had a co-worker who has had migraine headaches. Maybe you are that co-worker and that is why you are reading this article. Often it can take you out in the middle of your shift and you have to go home, or you can’t make it into work. You feel like you have tried everything with only minimal results. This article will help guide you on what to do. That is because migraine headaches are a complex, chronic neurologic disorder. There are two primary types of migraine that have been identified they are “migraine without aura” (formerly common migraine), and “migraine with aura” (formerly classic migraine). (1)
The aura shows up before the actual headache and can be visual disturbances, altered sensation in the arms or face, nausea, vomiting, and hypersensitivity to light or sound. These are all symptoms of dysregulation of the autonomic nervous system. (2) There is still no comprehensive understanding and explanation of the cause of migraines, but you will learn what to do based on what is currently known about these headaches.
Originally migraines were thought to be caused by a change in circulation in the brain characterized by constriction and dilation. (3) Now migraines can include dilation of the blood vessels in the brain in addition to a more complex series of neurologic and vascular events. (4-8) The brain has become hyper-excitable in certain ways and that is what creates the migraine headache. It has been proposed that this predisposition to migraine headaches is like how an epileptic is susceptible to seizures. (8,9) Like the co-worker you have who has Migraine’s there is a significant change in performance of simple motor tasks. (87)
Anatomy of migraine headaches
A lot of people get migraine headaches. One in six women suffer from migraine headaches and the prevalence of migraines among woman is 3 times more likely than with men. (12,13) Over 30 million Americans suffer at least one migraine headache each year. (12) It has an impact on your work lives and your family lives causing absences from work and family. (14) Even though 13 billion dollars is spent per year in the United States to treat migraines you won’t find permanent relief with medication.
Boys and girls may have migraine headaches before puberty and once puberty hits then migraines in females become more prevalent. (13) The migraines usually get more intense or frequent once an individual turns thirty and then improve when you turn 40. (15,81) The onset of a new migraine headache after age 50 is rare and is a cause for concern. (15)
Causes of migraine headaches
At the time of writing this article there are multiple causes and risk factors associated with migraine headaches. Let’s look at the risk factors first. The primary risk factor is genetic. Children of parents with migraines have a 50% risk of developing the disorder. If both parents are affected, the risk climbs to 75%. (17) Additional risk factors include being overweight, high blood pressure, high cholesterol, insulin sensitivity, and a history of stroke. (18) Another common risk factor is the overuse of certain medications. (19) Migraines can become “chronic” following overuse of acetaminophen, naproxen, aspirin, opiates, barbiturates, and triptans. (19) Do not take any of these NSAID’s more than 10 days a month because that will make your migraines become chronic. (19) As was mentioned earlier many people start having migraines in their 30’s and they go away in their forties, this will not be the case if you overuse medication. Medications can also trigger migraines. These are estrogen, oral contraceptives, vasodilators nitroglycerine, histamines, reserpine, hydralazine, and ranitidine. (21)
It is important to know what your “triggers” are and to do your best to avoid those triggers. Common triggers are: stress, smoking, strong odors (i.e. perfumes), flickering lights, fluorescent lighting, excessive or insufficient sleep, head trauma, weather changes, motion sickness, cold stimulus (i.e. ice cream headaches), lack of activity/exercise, dehydration, hunger or fasting, and hormonal changes (menstruation/ovulation). (20) Another common trigger is neck tension, especially of the upper cervical region. (59,65)
There is no one size fits all for food triggers, but the following foods are regularly implicated: alcohol (especially beer or red wine with tannins), excessive caffeine, artificial sweeteners, MSG, soy sauce, citrus foods, papayas, avocados, red plums, overripe bananas, dried fruits with sulfites (figs, raisins, etc), sour cream, buttermilk, nuts, peanut butter, sourdough bread, aged meats and cheeses, processed meats, chocolate, and anything fermented, pickled or marinated. (22,23)
Common symptoms of migraine headaches
The symptoms of migraines go through four stages, these are: prodrome, aura, attack, and postdrome. The features of each of these stages can vary, but you will go through all four stages during a migraine attack. (8)
The prodrome stage affects 60% of migraine sufferers in the hours to days before headache onset. (8) Common prodrome symptoms include lethargy, yawning, food cravings, mood changes, excessive thirst, fluid retention, constipation, diarrhea, hypersensitivity to light, hypersensitivity to sound, or hypersensitivity to odors. (8)
The aura stage affects 20-33% of migraine sufferers during or before the headache attack. (17,26) The aura develops slowly, over 5-20 minutes and can last up to an hour. The most common visual symptom is a band of absent vision with an irregular shimmering border (scintillating scotoma). (8) Sometimes you will get tunnel vision. Another possible aura is altered sensation usually in the upper body. This can happen in 40% of cases. (28) Usually, the altered sensation is pins and needles (paresthesia) followed by numbness in the hand that progresses up the arm to the face, lips, and tongue. Less people will experience a sense of heaviness in their limbs or difficulty speaking or a change in speech. (28) The slow development of auras (5-20 minutes) is what differentiates migraines from strokes. (28)
The attack phase affects all migraine sufferers, and the symptoms are a one sided, throbbing, or pulsating headache. Where the pain is felt can vary. The most common region is the front of the head, the temples, or the eyes. The pain will develop over a period of one to two hours and can last between 4 and 72 hours. While in the attack phase it is good to retreat to a silent, dark place. Up to 80% of migraine sufferers experience nausea and many of them will vomit. (30-32) Over 70% of migraine sufferers report associated neck discomfort. (32)
The postdromal phase includes fatigue, irritability, euphoria, muscle pain, food insensitivity, or cravings for hours after the attack. (22)
The diagnosis of migraine is based on you having at least five episodic headaches, each lasting 4 to 72 hours. These headaches are associated with nausea/vomiting or photophobia/phonophobia and at least of two of the following characteristics: moderate to severe intensity, on one side of the head, pulsating quality, and aggravated by physical activity. (34) Usually, a migraine is diagnosed if there is nausea, disability, and light sensitivity. Many migraine patients do not meet this criterion. Forty-one percent of migraine patients report bilateral pain and 50% report “non-pulsating” pain. (30-32)
If you are not sure if you have a migraine ask yourself the following questions:
1. Are you nauseated or sick to your stomach when you have a headache?
2. Has the headache limited your activities for a day or more in the last three months?
3. Does light bother you a lot more when you have a headache?
If you answer yes to 2 of 3 questions, then you have a migraine headaches. (36)
How to evaluate migraine headaches
Migraine is primarily a diagnosis of exclusion, so an evaluation would be to ensure that something else besides a migraine is not going on. Symptoms that would indicate a more serious problem then a migraine is headaches that are becoming progressively worse over time, severe headaches, new or unfamiliar headache, headache following a recent head injury, unexplained weight loss, impaired consciousness, presence of fever, significant neck stiffness, rash, vertigo, double vision, passing out, difficulty speaking, difficulty swallowing, difficulty walking, and rapid eye movements.
The evaluation is primarily made through your history. (39) Measurement of vital signs may demonstrate irregularities during a migraine attack, including tachycardia, bradycardia, hypertension, or hypotension. This is because the presence of migraine increases one’s risk of cardiovascular disease (stroke and heart attack) by approximately 25%. (41,42) That is why it is important to get proper treatment.
MRI is the preferred neuroimaging choice. (43) Suspicion of cerebral vascular pathology (aneurysm, vasculitis, arterial dissection) is better screened through magnetic resonance angiography (MRA). (44) The use of EEG lacks sensitivity and specificity for the diagnosis of migraine. (45)
Sometimes migraine headaches are misdiagnosed as tension-type headaches. Tension-type headaches are typically bilateral, non-throbbing, and not aggravated by physical activity. Patients report that their symptoms are less intense and are generally not associated with nausea or vomiting.
Upper cervical chiropractic for migraine headaches
There at two treatment types. One is used to stop a current headache and the other is to prevent future headaches. Upper cervical chiropractic can help with both.
In order to stop a current headache, you must act fast. The best results are found within the first minutes of an attack. (47) When you feel a migraine coming on you can take medications like NSAIDs, selective serotonin receptor agonists, and ergot alkaloids. (48) This is also a good time to use soft tissue manipulation and massage therapy. (66,67) The tight muscles surrounding the upper cervical joint dysfunction is a trigger for headaches, including migraine. By treating the tight muscles and restoring joint function your headache can be alleviated, or the intensity can be reduced. (65) You usually have trigger points in the SCM, upper trapezius, and splenius capitis that, when pressed, can reproduce a migraine headache. (86) Treating the trigger point in these areas can reduce the headache. Other muscles that are commonly involved are the suboccipital muscles since the rectus capitus posterior minor shares a dense connective tissue bridge with the pain sensitive spinal dura at the level of the atlantooccipital junction. Soft tissue manipulation and myofascial release techniques of this and other areas in the shoulders and upper back are needed to treat the migraine.
The main strategy in preventing future headaches is to control the migraine triggers. One of the best ways to do this is through an upper cervical chiropractic adjustment. (49,52-62) One study showed a “significant reduction” in migraine intensity after an adjustment and a reduction in attacks up to 90% of the previous numbers. (55) Upper cervical adjustments have a longer lasting benefit with fewer side effects when compared to the well-known medical treatment (amitriptyline). (55,57,58,61) The upper cervical adjustment is thought to inhibit pain through various mechanisms, including central nervous system activation, elevation of endorphin levels, disruption of pain-spasm-pain cycles, and reduction of mechanical triggers. (63-65)
In order to prevent headaches a self-management strategy for trigger avoidance and stress management must be developed. (72) A headache diary is a powerful way to identify and eliminate triggers. (73) This allows you to identify and eliminate your unique food triggers. (22) Patients with medication triggers, including oral contraceptives and hormones should consult with their medical provider about changing or discontinuing those drugs. (47) Exercising for 40 minutes, three times per week can be used to reduce migraine frequency. (84) Home remedies like Feverfew (125mg/ day), riboflavin (400mg/ day), and Magnesium (400-600mg/ day) may provide some benefit for the prevention of migraine in non-pregnant patients. (50,75-78,85)
Botox injections have been used with varying levels of success to prevent migraine headaches. Surgical deactivation of migraine trigger points is discouraged by the American Headache Society. (43)
In order to prevent migraines it is important to assess for and treat posture abnormalities, including weakness of the deep neck flexors. Acupuncture and biofeedback may be useful in the treatment of migraine. (51,68,69,79,83) The FDA recently approved a transcranial magnetic stimulator (TMS) for the treatment of migraine headaches. Early studies have demonstrated improved outcomes from TMS over no treatment. (70,71)
Exercises to help heal migraine headaches
To see more videos visit the Dr. Noah Volz YouTube channel.
Migraines can be healed and this article gives you some suggestions on what to look for to determine you have a migraine and what to do about it. I hope that this information helps you. If you have any additional questions please leave a comment. In addition to this article you can also read the Guide to Chronic Neck Pain eBook.
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