Migraine is the most common type of headache that propels patients to seek care from their doctors.
Migraine headaches can vary from person to person, but they typically last from four hours up to 72 hours. Some people get them several times per month, while others experience them much less frequently. Many migraine sufferers report throbbing or pulsating pain on one side of the head, blurred vision, sensitivity to light and sound, nausea, and vomiting. Roughly one in five migraine sufferers experience an aura, or visual or sensory disturbance, before the onset of the headache. Examples of an aura include: flashes of light, loss of vision, zig-zag lines, pins and needles in an arm or leg, and speech and language problems.
Several risk factors have been identified that increase a person’s chance of having migraines:
• Family history: A significant majority of migraine sufferers have a family history of migraine attacks. For a person who has one or more first-degree relatives with migraine headaches, the likelihood rises substantially.
• Age: Migraines typically affect people between the ages of 15-55. Most people have had their first attack by 40 years old.
• Gender: Women are more likely to suffer from migraines than men.
• Certain medical conditions: depression, anxiety, stroke, epilepsy, and high blood pressure are all associated with migraine headaches.
• Hormonal changes: Women who suffer from migraines often find that the headaches have a pattern of recurrence just before or shortly after the onset of menstruation. The headaches may also change during pregnancy and/or menopause.
Migraines are vascular headaches but the exact cause is not fully understood. Some researchers believe that migraines occur when there are abnormal changes in the brain. When these changes occur, inflammation causes blood vessels to swell and press on nerves, which can result in pain.
Researchers have learned that certain triggers can set off migraine attacks. These triggers vary from person to person and can include: sleep disturbances, stress, weather changes, low blood sugar, dehydration, bright lights and loud noises, hormonal changes, foods that contain aspartame, foods that contain tyramine (fava beans, aged cheeses, soy products, etc.), caffeine, and alcohol.
Unfortunately, migraines have no known cure, but they can be managed effectively with the help of a health care provider and chiropractic care has been found to be helpful in some cases.
A new study shows cellular-level changes in nerve structure and function that may contribute to the development of migraine headaches, reports the November 2014 issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).
Nerve specimens from patients with migraine show abnormalities of the myelin sheath that serves as “insulation” around the nerve fibers,” according to the study by Surgeon Bahman Guyuron, MD, of Case Western Reserve University, Cleveland. The findings help to explain why a plastic surgery procedure provides effective pain relief for migraine patients — and may provide useful clues for developing new approaches to migraine treatment.
Nerve Fiber Abnormalities in Patients with Migraine
The researchers performed in-depth studies on tiny specimens of the trigeminal nerve (one of the cranial nerves), from 15 patients who underwent surgical treatment for migraine. Samples from 15 patients undergoing a cosmetic forehead lift procedure were studied for comparison. The study — conducted through collaboration by three independent departments at Case Western Reserve School of Medicine — included electron microscopy to assess nerve cell structure and proteomic analysis to assess the presence and function of proteins.
The results showed important differences in nerve structure between the migraine and cosmetic surgery patients. “Essentially, the protective layer surrounding and insulating the normal nerves, called myelin, is missing or is defective on the nerves of the patients with migraine headaches,” said Dr. Guyuron.
He likens the myelin sheath to the plastic coating used as insulation material around electrical wires and cables. “If the insulation becomes cracked or damaged by conditions in the environment, that’s going to affect the cable’s ability to perform its normal function,” said Dr. Guyuron. “In a similar way, damage to the myelin sheath may make the nerves more prone to irritation by the dynamic structure surrounding them, such as muscle and blood vessels, potentially triggering migraine attacks.”
Organization of the cellular elements in nerve fibers also differed between groups. Healthy nerves were tightly organized with elements uniformly distributed through the nerve, while nerves from migraine patients showed discontinuous, “patchy” distribution.
Reasons Why Migraine Surgery May Be Effective
Dr. Guyuron developed migraine surgery techniques after noticing that some migraine patients had reduced headache activity after cosmetic forehead-lifting, which involved removal of some muscle and vessel tissue surrounding the cranial nerves. The new study lends some important new clues for understanding the mechanisms by which migraine headaches occur. It also adds new evidence that the peripheral nerves play an important role in triggering the complex cascade of migraine attacks that ultimately involve the central nervous system.
Meditation might be a path to migraine relief, according to a new study by researchers at Wake Forest Baptist Medical Center in USA. “Stress is a well-known trigger for headaches and research supports the general benefits of mind/body interventions for migraines, but there hasn’t been much research to evaluate specific standardized meditation interventions,” said Rebecca Erwin Wells, M.D., assistant professor of neurology at Wake Forest Baptist and lead author of the study published in July 2014 in the online edition of the journal Headache.
The study was designed to assess the safety, feasibility and effects of a standardized meditation and yoga intervention called mindfulness-based stress reduction (MBSR) in adults with migraines.
Nineteen adults were randomly assigned to two groups with 10 receiving the MBSR intervention and nine receiving standard medical care. The participants attended eight weekly classes to learn MBSR techniques and were instructed to practice 45 minutes on their own at least five additional days per week.
Study participants were evaluated before and after the trial period using objective measures of disability, self-efficacy and mindfulness. They also maintained headache logs throughout the trial to capture the frequency, severity and duration of their migraines. “We found that the MBSR participants had trends of fewer migraines that were less severe,” Wells said. “Secondary effects included headaches that were shorter in duration and less disabling, and participants had increases in mindfulness and self-efficacy — a sense of personal control over their migraines. In addition, there were no adverse events and excellent adherence.”
Specifically, the MBSR participants had 1.4 fewer migraines per month that were less severe, effects that did not reach statistical significance. The participants’ headaches were significantly shorter as compared to the control group.
Based on these findings, the research team concluded that MBSR is a safe and feasible therapy for adults with migraines. Although the sample size of this pilot study was too small to detect statistically significant changes in migraine frequency or severity, secondary outcomes demonstrated this intervention had a beneficial effect on headache duration, disability, self-efficacy and mindfulness.
Future studies with larger sample sizes are planned to further evaluate the impact and mechanisms of this intervention in adults with migraines, Wells said.
“For the approximate 36 million Americans who suffer from migraines, there is big need for non-pharmaceutical treatment strategies, and doctors and patients should know that MBSR is a safe intervention that could potentially decrease the impact of migraines,” Wells said.
WHAT IS AVAILABLE AT THE AVENUE CLINIC TO HELP YOU WITH YOUR MIGRAINES?
Chiropractic, Acupuncture and Yoga
There aren’t many large studies on the value of chiropractic treatment in managing migraines. One study examined chiropractic treatment for different types of headaches including migraines. The study combined the results of 22 studies, which had more than 2,600 patients total. The studies show that chiropractic treatment may serve as a good preventive treatment for migraines.
Another trial found that 22 percent of people who had chiropractic treatment saw the number of attacks drop 90 percent. In that same study, 49 percent said they had a significant reduction in pain intensity.
One study of 127 migraine sufferers in Australia found that those that received chiropractic treatment had fewer attacks and needed to take less medication. The 1999 study found that more than 80 percent of the patients blame stress for leading to their migraine. Re researchers believe chiropractic care might physically help reduce the body’s reaction to stress.
Current evidence from randomized trials suggests that massage therapy, physiotherapy, relaxation therapy and chiropractic spinal manipulative therapy are all likely as efficient as propranolol and topiramate in the prophylactic management of migraine.
An Australian study included patients with frequent migraine diagnosed by a neurologist. Participants were divided into three groups: cervical manipulation administered by a chiropractor, neck manipulation administered by a physiotherapist or physician, or cervical mobilization administered by a physiotherapist or physician (designated as the control group).
It is supported at least by the existing evidence that assessing and treating cervical spine/shoulder musculature as well as cervical joint mechanics/motion is a reasonable clinical approach for migraine patients.
At the Avenue Clinic, the Chiropractors can help with the muscle and joint problems that you have and which may be contributing to your migraines. Heather Langley is at the clinic using yoga to help with relaxation and Cristina is our acupuncturist. Do give us a call if you would like to discuss how we can help you.