Migraine
Migraines affect around one in 10 people. They are three times more common in females and peak between 30 - 39 years of age.
What is migraine
A migraine is a recurrent headache that strikes after, or along with sensory disturbances known as aura. These disturbances can include flashes of light, blind spots and other vision changes, or tingling in your hand or face. A migraine comes on gradually (over 15-30 minutes), last between 2 to 48 hours (sometimes longer), and usually affects one side of the head. Migraine is often aggravated by routine physical activity.
Nausea, vomiting, pulsating or throbbing pain, along with a hypersensitivity to light and noise are also common symptoms. Most people who get migraines will have a family member with the same problem.
What causes migraine
Migraine was thought to be a neurovascular pain syndrome ie. involving nerves and blood vessels where electrical activity in the nerves in the brain stimulate the surrounding blood vessels to release painful inflammatory chemicals, but more recently research has shown that migraine is caused by a sensitised brainstem.
Nerve centres in the brain stem are more easily activated and more sensitive to what we would consider to be normal feedback coming from joints, discs, muscles and ligaments in the upper neck. This ongoing activation or sensitisation results in information being relayed to higher centres in the brain. Higher centres in the brain perceive this information as a threat and generate pain as a warning sign that something is wrong in the neck or face or both.
The team at Auckland's new Headache & Migraine Clinic have specific training in migraine headaches, and are here to help you.
Migraine with aura typically consists of a combination of disturbances:
Visual - including seeing spots, zig zags and lights or loss of vision
Sensory - include tingling and pins and needles or numbness in the arms or legs
Movement problems - include reduced coordination, dizziness, vertigo and problems getting words out.
These symptoms will be completely reversible and tend to happen up to 60 minutes before the onset of a migraine, almost like a warning sign.
What are triggers for migraines
There are many ‘triggers’ for migraines and some common triggers include:
History of head trauma, underlying neck problem
Vasodilators (some heart medication like calcium channel blockers, aspirin and nitroglycerine)
Skipping meals
Weather changes
Dehydration or insufficient clear fluid (water) intake
Sleep deprivation
Stress
Excessive afferent stimuli (eg. flashing lights, strong odours)
Hormonal changes, monthly cycle, contraception
menopause
Certain foods – chocolate, caffeine, aspartame (artificial sweetener), sugar, processed meats, foods containing lots of colorants and preservatives like MSG
Genetics – there is a family history of migraines in about 60% of cases, suggesting a hereditary factor exists.
How are migraines diagnosed
Everyone presents differently and may have features of other headache types which can make diagnosis difficult. Most headaches can be diagnosed and classified according to your history and an examination by a healthcare practitioner. There is no one specific test, scan or examination that can confirm or differentiate migraine from another headache type. In some cases you may be referred to a neurologist who specialises in migraines.
Medication for migraine
Due to the severity of the pain from the very beginning of the attack, patients are usually treated with fast acting, abortive medications like inhaled oxygen, sumatriptan injections or nasal spray. Sumatriptan medication by way of a tablet, nasal spray or injection is commonly prescribed to patients with migraines. Triptans are more effective if taken very early in the attack, typically within 20 minutes and work by releasing a chemical in your brain called seratonin which has a calming/desensitising effect on the brainstem.
Preventative medication may be prescribed to reduce the frequency, severity and length of the attacks. These medications must be taken everyday and are either beta-blockers, anti-seizure or antidepressant type medication. Many patients do not tolerate these medications long term due to many common side effects such as weight gain, tiredness and depression.
Some patients may experience medication-overuse headaches or ‘rebound’ headaches from taking too much medicine for headache. It is not recommended to take sumatriptan for more than 10 days per month or to take paracetamol and NSAID’s for more than 15 days per month.
Case study - Migraine with Aura
Miss B, a 32-year-old marketing executive began suffering from migraines 17 years ago, after an accident where she fainted and fell onto the left side of her head. Soon after she began to experience visual auras, numbness in her right fingers and arm, face, tongue and lips. She also experienced an intense pressure pain behind her right eye which would spread to involve the left eye and then her forehead. During a migraine she found it difficult to organise her words and get her words out, she was very worried that she was having a stroke. Each migraine would begin with neck tension and eye pain, intense visual aura and numbness of her right side . Her GP had prescribed her rizomelt, ibuprofen and Panadol, however these were not helping.
She had recently returned to NZ after a 12-month OE, having had 2 migraines during this time. Back working in a stressful role, she began noticing more frequent and intense migraines. At the time she called us she was having 2 migraines per week, each lasting 1-2 days.
Miss B had a very head forward posture and had developed a small hump like area at the base of her neck (upper thoracic kyphosis). Her right eye pain, neck and forehead pain were reproduced during an assessment of her upper neck. After 5 treatments using The Watson Approach, Miss B was feeling so much better. She worked on our postural correction exercises to improve her head forward posture and kyphosis, learning how to apply this to her workstation and sleeping positions. Miss B has returned for maintenance treatment following the initial treatments, to check on her posture and keep her muscles and joints in the upper neck symptom free. Initially maintenance sessions were monthly, and as Miss B gained confidence in her migraine free life, these have become 6 monthly. Miss B remains migraine free 3 years after beginning her treatment.
Our approach
It makes sense that if neck pain or stiffness is a symptom you experience in association with migraine headaches, have your upper cervical spine assessed by a skilled practitioner to ‘rule in’ or ‘rule out’ your neck as a cause of your migraines. Our approach involves finding the neck segments responsible for this sensitisation, treating them, and desensitising the brain stem for long term relief.