Migraine headaches tend to be more severe than the common tension type of headache, and are even disabling for some people. There are signs that the brain itself is involved; often there is an “aura” that precedes the actual headache, where the person may see flashing lights or have tunnel vision. During the headache, there is often light sensitivity and nausea, even vomiting for some patients. Once a migraine has “run its course,” many patients feel “washed out” and tired.
While the brain may be affected by migraine, it is a peculiar fact that the brain itself cannot feel pain. The blood vessels and connective tissue that line the brain are sensitive to pain, however, and they are the likely source of migraine pain. One theory is that swelling of the blood vessels causes the headache, because patients who have taken nitroglycerin (used to open up the vessels of the heart for relief of angina) report it can also trigger a migraine. The changes in blood flow to the brain affect its function and produce the secondary effects such as visual changes and nausea.
Migraines have a fairly strong genetic tendency, and are more common in women. But having the genetic tendency is not enough by itself, as migraines also usually require some sort of trigger. For some women, it is their menstrual cycle; for others, it can be a certain food or that common culprit in so many health problems, stress. Some of these triggers are obvious and some are not, and some patients have multiple triggers.
In my experience, many patients get relief with treatment of the neck and shoulders; a few get complete relief, which means their only trigger was the neck. Neck problems are a common “silent” trigger, because there is not always a clear connection between the neck and the headache.
There are two theories about how the neck can trigger migraines: First, the joints and muscles, when inflamed, strongly refer pain to the head, especially the forehead and base of the skull. (Referred pain is caused in one location but felt in another, like a heart attack causing pain in the arm and jaw.) This is a common trigger for both tension headaches and migraine, and in fact the distinctions between the two types are not perfectly clear. Many patients have both, and tension headaches have been known to be a trigger for migraine.
Secondly, the blood vessels of the brain are involved in migraine, as mentioned before. Blood vessels have muscles that contract or relax to cause the vessel to constrict or open up. The nerves that control these muscles do not come from the brain directly, but travel through the neck first, before they loop back inside the head. Problems with the muscles and joints of the neck can cause a reaction in those nerves. This may set off a migraine in those people who have the right genetic makeup.
Chiropractors, osteopaths, physical therapists and massage therapists all treat these types of mechanical neck problems. To the degree that the neck is a trigger, to that same degree these treatments will be helpful. The best way to know if a particular person’s headache is stemming from the neck is to try a course of treatment.
It is less clear how acupuncture helps migraine, although there is evidence that it does. My experience with acupuncture is the same as with any migraine treatment — some patients respond very well, some improve partially, and some not at all. It just depends on whether acupuncture helps their particular trigger, and the only way to really know is, again, to try the treatment.
For some patients, foods are a migraine trigger. While some foods (especially alcohol, caffeine, some cheeses, processed meats and food additives such as MSG) are common triggers, every patient is different. I had one patient whose trigger was citrus fruits. These triggers can be difficult to pick up as the headache may not start until a day or two after eating the trigger food. The best way to determine if a food is a trigger is to try an elimination diet, where the patient eats only foods that are not common triggers for a few weeks. Like with any chronic health condition, highly processed foods and foods that have a lot of additives are more of a problem than whole, simple, intact foods.
Migraine can be a difficult condition to treat because there are so many potential triggers that need to be addressed. My recommendations are the same for migraines as for any chronic condition — exhaust your wellness care options before you start to use medications to control your pain. There is no drug that will cure migraines, only ease the symptoms, but they can be very helpful if they are your only option.
Dr. Michael Noonan practices chiropractic, acupuncture and other wellness therapies in Old Town.