MIGRAINE AWARENESS WEEK 2021
What IS a Migraine? How is it different to ‘just a headache’?
10 million people suffer from migraine in the UK alone – that is one in seven people.
Migraine is actually a neurological disease. It is not something that you ‘get’ but something that you ‘have’. It affects how the neurological system functions.
It is NOT just a headache – it can involve a lot of symptoms and can last for a few hours up to a few days and they can have a huge impact on people’s lives.
So what IS a migraine?
Recent studies have shown that there are several areas of the brain and pathways involved in the symptoms of all of the ‘phases’ of development of a migraine.
The hypothalamus is activated in the ‘prodrome’ or the stage prior to the onset of migraine development. The hypothalamus acts to process nociception (irritant effects on the brain), control of the sleep-wake cycle, feeding, thirst, arousal and autonomic and endocrine regulation.
Therefore, the hypothalamus neurons can contribute to the non-pain symptoms during the pre-pain stage of a migraine for example, nausea and vomiting, changes in appetite and fatigue.
The next stage or ‘aura’ is thought to be caused by cortical spreading depression and involves inhibition of cortical activity and blood flow throughout the cortex of the brain.
The headache is thought to be caused by neuropeptides that create a state of hypersensitivity in the blood supply to the trigeminal nerve area, which relays head pain signals to the brain. This contributes to pain and other aspects of migraine. CGRP (calcitonin gene-related peptide) is a neuropeptide that is involved in neurogenic inflammation and hypersensitivity in other systems of the nervous system. It is this sensitisation that may contribute to the pain of the headache in migraine. The sensitisation may also contribute to light sensitivity, skin hypersensitivity, joint pain, neck stiffness.
MRI scans of the brain have also shown that patients with migraine have structural abnormalities within the brainstem that may contribute to the severity of the headache.
There is a ‘postdrome’ in migraine too which means that the feelings of fatigue, food cravings and cognitive symptoms may continue throughout the attack but these feelings are overshadowed by the pain, nausea and aura. The area of smell detection and the hypothalamus are seen to remain abnormally activated after the migraine attack.
Migraine can include the following
Throbbing intense severe debilitating head pain
Nausea, vomiting, sensitivity to light, sound or smell
Visual or auditory disturbances such as flashing lights or sound sensitivity
Gastro intestinal issues
Stiff neck or back muscles – see the neck and how close it is to the spinal cord and brain stem
Fatigue and aching body
Suicidal feelings or depression
Memory issues or lack of ability to concentrate
Migraine is the 3rd most prevalent and the 6th most disabling illness in the world.
More than 90% of sufferers are unable to work or function normally during their migraine attack.
Each person suffering may experience some or all of the above during an attack and it is impossible to imagine how that feels unless we have experienced a migraine episode.
When a migraine occurs, cranial blood vessels expand. In an ordinary headache, cranial blood vessels contract. Many drugs that are prescribed for migraine are based on reducing this expansion of blood vessels. A new spray called Trudhesa which tightens blood vessels in the brain has been produced recently. It contains dihydroergotamine which forms the basis of drugs commonly prescribed for migraine and cluster headaches.
CGRP is Calcitonin Gene-related Peptide and is antibody migraine medication which is the first ever medication developed to prevent migraine as opposed to dealing with the pain. However, it is difficult to obtain on the NHS.
Nasal sprays – Trudhesa is a recently produced nasal spray and in a late-stage trial two thirds of 360 patients with migraine reported pain relief two hours after being treated with the spray.
Sumatriptan can help but they can also cause a stroke so you can only take maybe 6 per month maximum.
Betablockers help some people.
Aspirin has been shown in research to be effective in some cases of migraine without aura. It functions to inhibit some enzymes and prostaglandin synthesis and may help to reduce pain and inflammation.
Food diaries can help as by keeping a record of what you eat and when a migraine occurs afterwards can help you to see if there are food triggers particular to you that you might be better off avoiding.
Magnesium and B vitamins.
Learning to breathe correctly.
Can Chiropractic Treatment Help?
Chiropractic treatment can relieve irritation on nerves that control blood flow to the head and cause the migraine. Because neck and back pain can be triggers for migraine, treatment to these areas has proven to be very helpful for some people at reducing the severity or frequency of migraine headaches.
Chiropractic treatment is not likely to cure your migraine headaches because they are so multifactorial, however, it has been proven in research that participants who received chiropractic treatment in a trial to examine the efficacy of chiropractic treatment in this area, had significant improvements in their migraine frequency, duration, disability and their use of medication.
Another study showed that the participants reduced the number of migraines by more than half.
Chiropractic treatment is unique because it incorporates multiple methods to treat the source of migraine headaches rather than just trying to dull the effects once a migraine has already started.
It works by restoring better nervous system communication.
Treatment of migraines should involve a combination of treatments including advice for good self care, manual therapy and medication in conjunction with each other.
The most important thing is to find a form of treatment that works for you. What one person swears by may well not help you at all. It is a question of trial and error based on what you tell us as practitioners are the symptoms that most bother you and the triggers that you have discovered over time.
Holistic therapies can be incredibly helpful as they integrate many forms of treatment.
Chiropractors use gentle, non invasive therapy. This treatment helps to reduce inflammation and improve function of the joints in the spine and other joints in the body. By increasing joint mobility and improving your nervous system function and spinal health, your body has the ability to better manage the pain caused by migraines and tension headaches.
How does Chiropractic Treatment Work?
Decreases irritation in the nerves that send pain signals to the brain
Reduces muscle tension which is a common trigger for migraine
Helps to restore normal blood flow
Unlocks the body’s healing potential
Strengthens the muscles that support the spine
Identifies the migraine triggers so helps you to avoid them
How do I know what to choose to try to help?
The trouble with migraine it that there is rarely just one cause and trying to pin down which of the potential various causes triggers the migraine in you, is tricky and time consuming particularly when some causes are stress related; some are food related; some are musculoskeletal or hormonal or genetically linked or linked to how hydrated you are – but how many of any of these potential causes are leading to migraine in your particular case is very difficult to assess because every day is different.
For example, you don’t sleep well as you are stressed by work and worried then you sit all day at your computer at work. Later you go out and drink alcohol and become dehydrated and don’t get enough sleep again and when you do sleep, you do so awkwardly. Also you didn’t eat enough before you went out then you had a burger before you went to bed – how many potential triggers are there in that situation alone? How can you unravel which of those potential irritants actually triggered the resultant migraine? It is likely too that the combination of one or two or three in the space of a few hours was the trigger – but what and when?
People with migraine do need to be assessed and an individualised plan should be developed with them, because as you can see in the list above, there are many different symptoms that people with migraine can exhibit and everyone is different.
Chiropractic treatment has been found to be helpful in a lot of cases either to reduce the severity of migraines or the frequency or both but there are no studies that show that chiropractic treatment alone is effective for preventing migraines or helping reduce the pain or the duration. You need to be assessed to understand all the potential triggers and then you need to trial reducing those triggers and the impact if any on your migraine pattern.
If neck pain is the most disabling migraine component for you then chiropractic may be more relevant. Chiropractors will look for the presence of trigger points in your jaw, under your skull, in the muscles around your shoulders. They will look at and try to and correct your postural faults. Examining your spine for movement problems and muscular imbalances and treating those will be an important part of your treatment with a chiropractor. We all sit too long and most of us do not take enough exercise or we do too much of the same kind of exercise, which can all overload tissues in the musculoskeletal system and contribute to migraine development.
Soft tissue work and manipulation can be very effective but again, you will know quite quickly if the treatment is going to be beneficial to you.
For more information see European Journal of Neurology, 2017;24(1):143-153
Headache. 2019 Apr;59(4):532-542
BMC Complementary and Alternative Medicine 17, Article number:519 (2017)
Verywellhealth Chiropractic Therapy for Headaches and Migraines – Coleen Doherty MD 2021
The overall consensus is that integrating chiropractic care into your treatments for migraine is definitely worth considering.
The important thing to remember is that not any one treatment will help everyone – all you can do is try a few treatments and see how you feel.
At the Avenue Clinic we will never treat you for a long period of time if you are not showing improvement. We will always work with you and discuss how you are feeling after treatment and after a short while, if you are showing no signs of improvement, we will not continue to treat you.
Chiropractic treatment has been found to be effective in reducing the impact or the frequency of migraines in many different studies. Therefore, for those people who do not want to experiment with medication, a trial of chiropractic treatment is definitely worth it as it is a safe treatment and if used in conjunction with other tactics including exercise and diet and lifestyle changes it can be very effective.
How to Avoid Migraines
Avoid loud noises and bright lights
Limit the time you spend looking at blue screens
Eat and sleep regularly
Get enough sleep
Be aware of hormonal changes
Watch the weather changes and how you react
Exercise or yoga and relaxation techniques