Jenny is worried. She knows what is coming. In front of her eyes she can see little sparkly things, floating around, and her tongue has started going numb. Has Jenny been poisoned? Is she having a stroke? No, Jenny has the beginning stages of a type of migraine, and she knows it won’t be long before an angry Hobbit will being wielding a large sledgehammer inside her right temple, and she will be forced to hide in the dark– away from anything that makes noise– probably vomiting into a bucket.
Almost 90% of the Australian population will suffer from headache, over the duration of a year. These headaches can be the result of a range of different conditions, broadly classified as “primary” or “secondary” headaches.
The most common primary headaches are migraines and tensions headaches. A secondary headache is a headache due to a secondary cause. These secondary causes may be a neck disorder, vascular disorder, an infection, the side effects or a drug, or a host of other causes. The “bible” of headches, The International Classification of Headache Disorders (3rd edition), devotes 86 pages of different secondary headaches, 15 pages to migraine alone, and has 144 pages of headaches, in total!
This article will focus on migraines, of which there are many subtypes. The most common subtypes are migraine with aura (sometimes called “classic migraine”) and migraine without aura (sometimes called “common migraine”). In the Global Burden of Disease Survey 2010, migraine was ranked as the third most prevalent disorder and seventh-highest specific cause of disability, worldwide!
Patients often tell me they have a “migraine”, but actually have another type of headache, such as a tension headache.
How do I know if I have a migraine?
Migraines have a quite distinct pattern of pain and duration. If you have a migraine, you are likely to have some or all of these symptoms. Usually the headaches recur episodically (it could be weekly, monthly, a few times a year, or even a few times in a lifetime). The migraine attacks may last 4-72 hours, and results in a moderate to severe headache on one side of the head, are pulsating in quality, are aggravated by routine physical activity and are usually associated with nausea and/or sensitivity to light or sound. If the type of migraine is “migraine with aura”, the headache is usually preceded by a “prodrome”. The prodrome is a reversible group of symptoms which may include the sufferer seeing flashing lights or sparkles, temporarily losing vision in some part of their visual field. The prodrome may also include a huge variety of other potential symptoms such as dizziness, confusion, hypersensitivity to touch, or affect the use or understanding of language. The prodome is usually followed by the full-blown headache.
Your headache is probably not a migraine, if it does not include at least two of the following: one-sided head pain, pulsating in nature, moderate to severe intensity, aggravated by or causing avoidance of routine physical activity. In addition those symptoms, to be a migraine the headache must be 4-72 hrs in duration, and include nausea/vomiting or light or sound sensitivity.
What causes a migraine?
Because there are a number of different types of migraines, there are likely to be a number of underlying causes for migraines. The causes of migraine are not fully understood, but we know genetics and environmental factors play a role. It appears that changes in the brainstem and its interactions with the trigeminal nerve may play a role. Imbalances in brain chemicals including serotonin have been studied as a factor in migraines.
What triggers a migraine?
Migraine sufferers typically have a number of “triggers” that work together to set the migraine off. In some people, a single trigger, on its own, can be enough to set the migraine off. In others, a number of triggers combine to initiate the attack. In the latter case, it can be tricky to work out what the trigger is, as the final factor can be different, every time.
Typical triggers for migraine may include:
- Hormonal changes in women
- Dietary (skipping meals, specific foods such as dried fruit, yeasty breads, chocolate or cheese)
- Food additives (for instance Nutrasweet or MSG)
- Drinks (especially wine and caffeinated drinks)
- Stress (periods of high stress, or stress “letdown”)
- Sensory stimuli like bright lights and strong smells
- Change in sleep wake pattern
- Physical exertion
- Weather changes (change in barometric pressure)
- Spinal issues that lead to irritation of the nerves connecting to the trigeminocervical nucleus
How can chiropractors help with the migraine?
The first job of your chiropractor is to correctly diagnose and classify the headache. We will identify if you have migraine, or if there is another cause of the headache using clinical history and examination to look for any worrying signs that your headache may be due to more sinister causes.
Secondly, your chiropractor will help identify possible triggers of the migraine. As mentioned, above, there are many potential triggers. We will discuss these with you, to try to work out which ones are relevant to your case.
Lastly, your spinal health is assessed. There appears to be an intricate relationship between the spine (especially the upper neck) to the brainstem and the trigeminal nerve. It is believed that spinal irritation, if present, it may further aggravate a compromised trigeminal nerve, adding another trigger to the already existing mix. Even if the neck isn’t painful, there may still be undetected spinal issues that, if corrected, may relieve the migraine frequency, duration and/or intensity. If appropriate, we will perform a trial of care, and look for changes in the frequency or duration of your headaches.
We will also assess your full spine, as there may be problems remote from the neck itself. For instance, poor posture (hunching forward, slumping over iPhones, slothing on the lounge) can negatively impact the muscles and joints of the neck, placing them under excessive stress. In addition, poor foot posture/footwear can negatively impact posture and neck position.
Several studies have been conducted on chiropractic adjustments and their effect on migraine. Many quality studies shows adjustments to be as effective as prophylactic drugs and better than placebo. It is interesting to note that the potential benefits of treatment probably extend beyond just the adjustment and correction of the spinal joints, as these studies have not looked at the efficacy of activity modification and advice that is given by the practitioner.
What can I do to help my chiropractor identify my headache?
If you are unsure what sort of headache you have, keep a headache diary for a week or so, and then report in to your chiropractor. The headache diary should include when the headache started, how long it lasted, what symptoms you had before or during the headache, its intensity (out of 10) and whether anything triggered it. He or she will be able to use the information you have collected, along with questions you will be asked during your consultation, to form a diagnosis. Then you can begin planning, with your chiropractor, how to tackle the headaches. This may include co-management with other health professionals, such as a dietitian, neurologist or general practitioner.
The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia 33(9) 629–808
Chaibi et al, Manual therapies for migraine: a systematic review (2011)
A controlled trial of cervical manipulation for migraine. G. B. Parker, H. Tupling and D. S. Pryor, Aust. N.Z. J. Med., 1978, 8, pp. 589–593
Tuchin PJ, Pollard H, Bonello R. A randomized controlled trial of chiropractic spinal manipulative therapy for migraine. J Manipulative Physiol Ther 2000;23:91–5
Vernon HT. The effectiveness of chiropractic manipulation in the treatment of headache: an exploration in the literature. J Manipulative Physiol Ther 1995;18:611–17.
Chaibi A, Russell MB. Manual therapies for primary chronic headaches: a systematic review of randomized controlled trials. J Headache Pain 2014;15:67