Migraines: Cause, Treatment and Prevention (part 2)

For part 1 click here...

Drug Free Treatment:

Chiropractic:

Two recent systematic literature reviews (from the Cochrane Database of Systematic Reviews) have provided evidence in favour of the treatment of migraine headaches by means of cervical spine (neck) manipulation/adjustment.  One such study reported that "spinal manipulation may be an effective treatment option with a short term effect similar to that of a commonly used, effective drug (amitriptyline)".  The second review provided evidence that spinal manipulative therapy patients reported improvement in pain intensity, duration and disability associated with migraines.  One study in the review found a non-significant trend of improvements on a headache index to remain at 4 weeks in the manipulation group.  This trend was not evident in the amitriptyline and combined amitriptyline and manipulation experimental groups.

Acupuncture:

According to Traditional Chinese Medicine, migraines are caused by a blockage in the energetic pathway related to the eyes and the temples.  For the most part, the blockage is due to a relatively excessive amount of energy.  Normally, this energy should be appropriately radiated out, but for certain reasons, it is not and becomes blocked.  We see that there are often triggers such as light (a form of energy) or other types of "heating" stimulation that bring on a migraine.  This is due to the further addition of energy to an already blocked pathway.  Often, the sufferer will have a still neck and shoulders, or tension in the hips and sides of the legs (blockage along the same pathway).  Because each individual is different, advice on prevention and recovery may slightly vary.  In general, it is good to radiate out the blocked energy by appropriate exercise, stretching, occasional baths, spicy food and dealing with irritability and/or anger.  However, please consult a TCM trained acupuncturist first.  Research has shown acupuncture to be effective in the treatment of migraines (Vickers AJ, et al 1999).  

Thank you to Dr. John Blazevic.  A former TCM and acupuncturist colleague of mine from Vancouver BC, Canada for providing me with this information.  www.johnsacupuncture.com

Massage Therapy:

Massage therapy may be useful in reducing the occurrence of migraine headaches.  A study done by the Touch Research Institute showed that those receiving massage therapy experienced less sleep disturbing headaches.  60% of these participants also went the entire month without any headaches compared to 40% of participants who received no massage therapy.

Prevention:

Prevention of migraines revolves around the identification and subsequent avoidance of triggers.  Often the trigger is a food substance.  Keeping a food and headache journal on a daily basis will help identify what, if any, food triggers the headache.  Once this is determines, try cutting that food out of your diet and see if this helps to alleviate the onset of migraines.  There may be more than one food that triggers the migraine, so do not be alarmed if it does not help instantly.

There are a number of nutritional supplements that have been shown to be helpful.  These include:

• Feverfew
• 5-HTP
• Omega 3 fats
• Calcium with Vitamin D
• Riboflavin and multivitamins containing B vitamins and magnesium

Please seek the advice of your health care practitioner prior to using any of the supplements listed.

References:

Efficacy of Spinal Manipulation for Chronic Headache: A systematic review.  JMPT 2001 24(7): 457-466

Non-invasive physical treatments for chronic/recurrent headache.  The Cochrane Database of Systematic Reviews 2004, Issue 3.

The effectiveness of spinal manipulation for the treatment of headache disorders: a systematic review of randomized control trials.  The Cochrane Database of Systematic Reviews 2005, Issue 4.

http://www.healthscout.com/ency/416/96/main.html

www.simplymassagetherapy.com/migraine.htm

Souza TA. Differential Diagnosis and Management for the Chiropractor: Protocols and Algorithms 2nd Ed. Aspen Publishers Inc 2001.

Vickers AJ, et al.  BMJ 2004 Mar. 27; 328.  Cephalgia, Nov. 1999

Migraines: Cause, Treatment and Prevention (part 1)

Other than colds, headaches are probably the most common human ailment.  They are usually a passing annoyance, but as many as 45 million people suffer from chronic and/or severe headaches that interfere with their lives.  There are various types of headaches with much overlap.  This overlap is due to the fact that headaches are still not completely understood by scientists.  The following information will present information on one type of headache...migraines.  I will educate you on what they are, how to treat them and most importantly how to prevent them!

Symptoms:

Migraine sufferers are often female and present with a complaint of one sided throbbing headache that is occasionally (10-15% of the time) preceded by aura.  An aura consists of visual disturbances including blind spots and flashing lights or neurological change including numbness and/or tingling in an area of the body.  This aura can last for about 30 minutes followed by an incapacitating headache that lasts from several hours to days.

The other 85-90% of migraine sufferers do not experience the aura.  They still have a debilitating headache, but the person is usually able to continue their daily lives.  Migraine sufferers will seek dark, quiet environments.  There can be associated nausea and vomiting and often there is a fa

mily history of migraines.  The headaches are commonly triggered by foods (chocolate, caffeine, wine, additives etc.), lack of sleep, environmental pollutants and medications.

Causes:

There is still a lot of uncertainty as to the exact cause of migraine headaches.  The following represent some of the theories.  One theory centres on a disorder of the central nervous system (CNS)(CNS = Brain and spinal cord).  A trigger (as stated above) overly excites a nerve called the trigeminal nerve.

This nerve is responsible for the sensation of the face and head.  This over excitation causes a release of proteins that cause a dilation of the blood vessels in the head and result in an inflammatory response.  This inflammation spreads to the meninges (the membranes that cover the brain and spinal cord).  Unlike the brain itself, the meninges are sensitive to pain.  This reaction then reaches the cortex (outer layer) of the brain and reduces blood flow (known as "spreading depression").  Some regions of the decreased blood flow results in the aforementioned auras.

Another theory is that there are abnormalities with the flow of calcium ions between cells.  The calcium ion is responsible for the release of a substance called serotonin.  Serotonin is involed in pain perception and mood.  Interestingly, the receptors for serotonin particles are on the trigeminal nerve.  The serotonin normally acts to block the proteins that overstimulate and produce inflammation.  If there is not enough calcium and therefore not enough serotonin, the nerve becomes over stimulated.

In Summary:

An abnormality in the calcium channel results in decreased calcium flow which further results in a decreased release of serotonin.  Without serotonin the trigeminal nerve is not blocked from releasing the proteins responsible for inflammation and blood vessel dilation.  The reaction spreads to the brain meninges resulting in aura and pain.

Part 2: Drug Free Treatment and Prevention (click link)