I know we’ve all heard of a friend, family member, or co-worker complaining of their horrible migraines. Picture them going on about being laid up in bed all weekend with the lights off and a cold washcloth on their forehead… How dramatic, right?
I hate to admit that I had the same thought prior to working with my first patient suffering from chronic, debilitating migraines after a whiplash injury from a bad car accident.
You can read more here about how that case really sparked my interest in pursuing a focused practice treating headache, migraine, and neck pain.
What is a migraine?
Migraine, a neurologic condition and a type of primary headache, is one of the most common reasons for a visit to the doctor with a prevalence of about 10% of the population!
A migraine often causes moderate to severe headache on one side of the head with or without a slew of additional symptoms.
To make it clear, these are not your typical headaches. The throbbing pain is merely the visible tip of the iceberg. The effect of migraines on emotional well-being, mental health, and overall function should not be underestimated.
They have the power to disrupt your daily routine, strain your relationships, and dampen your overall quality of life. The duration of a single episode can range anywhere from four to 72 hours. Females are 3 times more likely to be affected and it is most common between the ages of 25-55.
But what actually causes these awful episodes? Keep reading as this article will discuss the potential causes, common symptoms, and treatment options for migraine headaches.
What causes a migraine?
It is thought that a cumulative change in the body’s homeostasis (both internal or external causes) results in hypersensitivity of the trigeminovascular system.
This in turn leads to the release of various chemicals responsible for local inflammation along the nerves that innervate our head and face, causing the severe headaches as well as central sensitization to various parts of the brainstem, trigeminal nucleus, and cortex.
What this essentially means is that the symptoms can become persistent and worsen over time without intervention. It’s no wonder that migraines are the seventh highest cause of disability in the world!
What are the most common migraine triggers?
Triggers are factors that are thought to contribute to the overall cause of migraines by affecting the body’s homeostasis. While the precise triggers can vary from person to person, they often act as the catalysts that awaken a dormant storm. There are three main categories of triggers that include:
Physiologic - Hormones (linked to menstruation, pregnancy, menopause), dehydration, hunger, sleep deprivation, exercise, stress.
Environmental - Excessive sensory stimulation (visual, olfactory, auditory, touch), motion, weather changes, pain.
Foods - Products of aging and fermentation containing tyramine (wines, cheeses), caffeine, chocolate, certain beans, bananas, peanuts.
Recognizing these triggers can empower individuals to adopt preventative strategies, mitigating the onset of migraines and allowing for better control over their lives.
Keeping a migraine journal is a great way to help track your symptoms and give you more control over your condition. By taking note of the interconnected web of triggers, individuals can navigate toward a path of proactive management and enhanced well-being.
What are the four phases of migraine?
There are four phases of a typical migraine and each has a unique set of symptoms associated with them. These include:
Prodrome Phase
Aura Phase
Headache Phase
Postdrome Phase
The prodrome phase often precedes the onset of pain by hours or even days, and can act as a prelude for a flare up. During this phase, subtle changes in mood, energy levels, or even food cravings might serve as early indicators.
The aura phase is next. Aura is a cascade of reversible neurologic symptoms that typically occur 5-60 minutes before the actual headache. The two main categories of migraine are those with or without aura. These auras are thought to be the result of a “spreading cortical depression” or a change in the charge of the brain’s tissues that most commonly begin in the occipital cortex at the back of the head and spreads around to the front. Many migraine sufferers don’t actually experience any form of aura at all. For other individuals, this phase can create many different symptoms that we'll discuss below!
The headache phase consists of the typical symptoms we think of when talking about migraine. Intense throbbing pain, usually affecting one side of the head, that can be horribly debilitating. Other common symptoms with the pain include bouts of nausea and vomiting, photophobia (heightened sensitivity to light), and phonophobia (an aversion to sound).
The postdrome phase, sometimes referred to as the "migraine hangover," follows the storm. While the pain has subsided, a state of mental and physical fatigue lingers, leaving individuals feeling drained and sometimes irritable. Understanding the intricate symptoms across these phases helps paint a comprehensive picture of the multifaceted migraine experience.
What are common symptoms of migraine?
Moderate to severe headache on one side of the head is usually present with migraine, though some people don't experience any headache at all.
Depending where in the brain this cortical depression affects it can produce very different symptoms!
Visual cortex (most common) - visual disturbances/blindness
Sensory strip - numbness/tingling
Motor strip - weakness/paralysis
Vestibular pathway - dizziness/vertigo
Auditory pathway - hyperacusis/phonophobia
What are your treatment options for migraine?
The primary goal for treatment of migraine is to decrease the overall frequency and duration of attacks, giving clients more time between each episode.
The most common treatments for this condition include both preventive and abortive medications. Due to being outside of the scope of physical therapy practice, I won’t dive much deeper into the different medications used in this article.
Physical therapy (SHOCKER!) is also a major component in the treatment of migraine headaches. This can include gentle soft tissue mobilization, spinal manipulation, therapeutic exercise, dry needling with or without electrical stimulation, and guided relaxation techniques.
A 2016 Cochrane analysis for migraine prevention found acupuncture to be effective in reducing the frequency of attacks. Similar to acupuncture, dry needling can achieve similar effects.
Fortunately, this is all included in a typical treatment session here at Carroll Physiotherapy! Check out this page for a full list of interventions that we utilize!
Along with the typical pharmacological and physical therapy treatment of migraine management lies a realm of proactive lifestyle modifications that lend to a holistic approach to navigating this condition.
Recognizing individual triggers is an essential step toward proactive management, many migraineurs keep a headache journal to track their symptoms.
Managing stress, often a key trigger, involves adopting relaxation techniques such as deep breathing, mindfulness, or even regular physical activity and exercise.
Establishing a consistent sleep schedule not only aids in prevention but also enhances overall well-being.
Staying well-hydrated and maintaining regular meal patterns provide the body with a foundation for resilience.
Risks and side effects of treatment
As with any medical intervention, it's essential to address potential risks and side effects transparently. While physical therapy can yield remarkable results, temporary soreness, discomfort, and, in rare cases, adverse reactions and exacerbation of symptoms are possible outcomes.
It's crucial to emphasize that these potential downsides are significantly minimized when a skilled and qualified physical therapist conducts a thorough assessment, tailoring the treatment to the patient's specific needs.
Ensuring open communication and informed consent can further mitigate these risks, making physical therapy a safe and effective option for managing migraine headaches.
For a more in depth discussion about the risks and side effects of different manual therapy interventions, check out this article.
Conclusion
Migraines are one of the most debilitating conditions and are the third most prevalent disorder in the world.
With the help of Carroll Physiotherapy, you can start taking the first steps in the right direction toward recovery from your condition. If you experience migraine or have any specific questions about how your condition can benefit from physical therapy, schedule a free phone consultation with me by clicking here and filling out the form with your information!
**Disclaimer: The information provided in this article is intended for educational and entertainment purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult with a qualified healthcare provider for personalized guidance and recommendations regarding your specific health concerns. The content presented here is based on general knowledge and research available up to the date of this article's publication. Any reliance on the information provided is at your own discretion and risk. The author and publisher do not assume any liability for any actions taken based on the information presented in this article.
References:
Migraine Disorders. (2018, January 25). Spotlight on Migraine - Episode 6 - The Sensitive Brain and Migraine Triggers [Video]. YouTube. Retrieved September 29, 2022, from https://www.youtube.com/watch?v=8iKsXZMEqCU
Migraine Disorders. (2019, April 1). The Manifestation of Different Migraine Disorders with Dr. Michael Teixido - Episode 20 [Video]. YouTube. Retrieved September 29, 2022, from https://www.youtube.com/watch?v=5N6uTngJL0c
Mullally, W. J. (2018, January). Headache. The American Journal of Medicine, 131(1), 17–24. https://doi.org/10.1016/j.amjmed.2017.09.005
Stanford Health Care. (2015, November 12). Stanford Hospital’s Meredith Barad on Migraine Headaches [Video]. YouTube. Retrieved September 29, 2022, from https://www.youtube.com/watch?v=bhB-Poczp2Q&t=4125s
TED-Ed. (2021, May 17). What happens to your brain during a migraine - Marianne Schwarz [Video]. YouTube. Retrieved September 29, 2022, from https://www.youtube.com/watch?v=qwZypa0iKq8&t=1s
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