Migraine Headache Treatment
What is a migraine headache?
Migraine is one of the most prevalent health conditions in the world, it accounts for the 6th highest amount of days lost to disability, globally [1, 2].
People who experience migraine describe pain on one side of the head primarily. This pain may switch sides either during an attack or between separate attacks. The sensation is often a moderate to severe, pulsating or throbbing pain [2]. Migraine sufferers also experience a range of other symptoms, including; nausea and vomiting, as well as sensitivity to light, sounds and smell. Lasting between a few hours and up to 3 days, migraines can cause significant disability and have a big impact on people’s quality of life.
Types of migraines
Migraines can differ in terms of the types of symptoms that are experienced, therefore it is important to be accurately assessed, in order to be given the correct diagnosis and then successful treatment. These are a few of the most common types of migraines.
1. Migraine with Aura
An aura is the build-up of neurological symptoms that is commonly experienced as part of a migraine. Aura will often precede a full attack and lasts for between 20-30 minutes.
Symptoms may include:
- Visual disturbances such as; dark/white spots, lines, waves or even a temporary loss of vision
- Temporary sensory changes such as; numbness, burning or a prickling sensation
- Changes to your speech
- Nausea and or vomiting
- Becoming sensitive to light, sound and smell
- Changes to sensation down one side of the body or face
- Confusion
2. Migraine without Aura
Migraine without aura is when a pulsating or throbbing headache is experienced, without the build-up of neurological symptoms prior to it. This is reported to occur in 70-90% of migraine cases. As described earlier, pain is pulsating, or throbbing in nature and will affect one side of the head or face.
These can include;
- Vomiting and nausea
- Mood changes and confusion
- Sensitivity to light, sound and smell
- Fatigue
- Diarrhoea
3. Migraine without Headache (Silent Migraine)
It is possible for people to just experience the associated symptoms of a migraine, without the head or face pain. These can still be quite disabling to a sufferer, due to the nature of the associated symptoms.
Symptoms of a Silent Migraine can include:
- Altered vision or visual disturbances
- Speech disturbances
- Nausea and/or vomiting
- Sensitivity to light, smell and sound
- Altered or absent sensation down one side of the body or face
- Fatigue, confusion or mood changes
- Diarrhoea
4. Chronic Migraine
People who suffer from headaches or migraine on 15 or more days in a month, over a three-month period are considered to suffer from Chronic Migraine. Of these attacks each month, at least 8 would have to be considered migraines, and the rest can be other types of headache. These types of headaches can be debilitating for sufferers, due to the frequency at which attacks occur [3].
5. Episodic Migraine
Episodic Migraine is when a sufferer will experience headache or migraine on less than 15 days in a month. These types of headaches can include migraine, both with or without aura. Episodic and chronic migraines together have been reported to affect 14% of the world’s population, and 18% of women [3].
6. Migraine with Brainstem Aura (Basilar-Type Migraine)
This type of migraine is most common in children and adolescents. It specifically is most common in teenage girls and can be associated with the start of menstruation. Symptoms include everything that a Migraine with Aura would have, without the muscle weakness. Due to where this type of headache originates from, these migraines can cause vestibular or balance symptoms [4].
Symptoms include:
- Vertigo or dizziness
- Loss of co-ordination
- Ringing in the ears
- Fainting
- Loss of vision, or double vision
- Throbbing, pulsating pain on one side of the head
7. Hemiplegic Migraine
Sometimes a migraine sufferer may experience a temporary paralysis to one side of the body, during a migraine attack. These migraines are called a Hemiplegic Migraine. This weakness or paralysis can be accompanied by pins and needles or numbness. Given the closeness in symptoms to that of a stroke, these migraines can be quite alarming and cause considerable distress. Head pain may be similar to typical migraine with aura, or be absent.
Symptoms may include:
- Vertigo
- Difficulties with swallowing or speaking
- Weakness on one side of the body
- Temporary visual loss
- Confusion
What is the cause of migraines?
Modern research suggests that the idea of Migraines being caused by an increase in blood flow to the vessel in the head, is incorrect [1, 5]. It was originally thought that this abnormal or excess blood flow was causing damage and therefore migraine pain was experienced. It has been shown that any changes to blood vessel flow in migraineurs is minimal and insignificant, and is very unlikely to cause the symptoms of migraine [5].
Central sensitisation of the brainstem, arising from dysfunction in the upper cervical spine has been shown to be a contributing factor to migraines, in more recent research [1]. Nerves travelling to a sensitised Trigeminal Cervical Nucleus in the brainstem, can be used to reproduce migraine headache and symptoms in sufferers. This indicates that migraine is more a neurological condition arising from the cervical spine, rather than a vascular one, and therapy to the neck can be successful in its treatment.
I’ve done it all, is there anything else that can help me?
Many Migraine sufferers have experienced their symptoms for decades, and have had many different therapies and medications, with varying success. Often medications can be only masking the symptoms, and not treating the cause. It isn’t uncommon for sufferers to have tried; physiotherapy, chiropractic-care, osteopathy and acupuncture, as well as advanced treatments like; Hormone Replacement Therapy, Botox injections or radiofrequency and cauterisation of nerves in the head or neck.
Despite the level of previous treatment, most sufferers continue to live with Migraines. A big reason why this is the case, is because most practitioners don’t attempt to identify the root cause of your headaches. At ‘The Headache & Migraine Clinic’, we use the experience that we have gathered from seeing countless similar patients with migraine, as well as utilizing the most current and up-to-date research to assess, treat and correctly diagnose your headaches. By assessing the joints in your upper cervical spine and then using techniques to determine the level of sensitivity in your brainstem, we can determine if this is the cause of your migraine. If we can determine that this is indeed the cause of your migraines, then treatment can start immediately. When appropriate, out technique is effective in 85-90% of sufferers, and is safe, medication-free and non -invasive. If it looks like we are unable to help with your migraines, then we will refer you to the appropriate heath provider.
Watch the video to understand more about Migraines.
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What are Cluster Headaches?
Cluster Headaches are a rare type of headaches that affect around 0.1% of the population, according to the International Headache Society. While they are rare, it does affect males 3-4 times more frequently than females [1].
Despite being uncommon, Cluster Headaches are regarded as being the most severe and debilitating type of headache. Research has shown Cluster Headaches frequently described as having the highest pain levels [2], out of all 300 different types of headache and migraine. Cluster Headache attacks occur in cycles, and will often wake sufferers during the night, or at regular times during the day. Attacks generally last between 15-180 minutes, and can happen multiple times per day, or once every couple of days [1, 2]. People who suffer from Cluster Headaches generally experience periods of attacks, or “cluster periods” that can last weeks or months. These periods are then followed by periods of remission lasting weeks, months or even years. The pain is often severe, on one-side of the head, and generally around the eye and/or temple region. Cluster Headaches have adopted the nickname, ‘suicide headaches’ due to their severe and debilitating nature [2].
What are the signs and symptoms?
Cluster Headaches are often severe enough that a sufferer cannot keep still during an attack. They may pace back and forth, have to take a shower, or even resort to banging their head in an attempt to reduce the pan.
Symptoms commonly associated with Cluster Headaches include [2]:
- Severe pain around one eye, that can radiate further around the face or neck
- Restlessness, shortness of breath and/or a sweaty face
- Watery/teary eyes or eye redness
- Swollen or droopy eyelids
- Runny or congested nose
- Pale or flushed skin
- Pain is unilateral, or affects only one side
What are the different types of Cluster Headache?
There are 2 types of cluster headache.
Episodic Cluster Headache
Cluster Headaches most commonly occur episodically. This is when sufferers experience bouts of “cluster periods” that can last for weeks or months, followed by an extended period in remission that can last up to years. They can occur seasonally or at set times each year. Episodic Cluster Headaches account for up to 80% of all Cluster Headaches [1, 2].
Chronic Cluster Headache
When Cluster Headaches occur without a prolonged period of remission, they are termed a Chronic Cluster headache. Sufferers often have “cluster periods” that will last over a year. While they may have days without attacks, the remissions will not last longer than a month.
What are the risk factors?
- Men are 5-6 times more likely to experience cluster headaches
- Sufferers are generally heavy smokers
- Higher alcohol consumption may be a factor
- Cluster Headaches most commonly affect people aged 20-50, but can occur at any age
- People with family members who are sufferers may be at a higher risk
What causes Cluster Headaches?
Historically, it was believed that cluster headaches, as well as migraines, were caused by the dilation of blood vessels in the head, causing pain. This was thought because medications, like triptans, are effective at relieving the pain if taking early enough in an attack. It was believed that triptans prevent this vessel dilation. However, recent research has shown that Cluster Headache and migraine sufferers do not experience blood vessel dilation at any different levels to people who do not suffer. So, how do these medications work?
Modern research has shown that Cluster Headaches and migraines arise from increased sensitivity in the central nervous system [2], more specifically, a sensitised brainstem which is located in the upper cervical spine (the upper neck). Faults in the upper neck can lead to this sensitised brainstem, which then can refer severe pain and associated symptoms into the head and face [3]. Triptan medication has also more recently been shown to de-sensitise the brainstem [4], as well as its original purpose of constricting blood vessels in the head. This would explain why they work, as well as identifying a sensitised brainstem and the cervical spine as a cause of cluster headaches.
I've tried it all, is there anything that can help me?
While Cluster Headaches are very uncommon, they are still experienced in the Gold Coast region. The severity of symptoms causes sufferers to try a range of therapies in an attempt to resolve them, with mixed results. Often, they have tried; medications, injection therapy, or even surgical interventions such as, nerve blocks or blood vessel cauterisation.
At The Headache and Migraine Clinic, we aim to use the most modern research to find the root cause of your cluster headaches. If we can determine that a sensitised brainstem is the cause of your headaches, then we can use world-leading treatment techniques to address the faults in your neck and de-sensitise the brainstem. We have seen plenty of Cluster Headache sufferers at our clinics, and have an 85-90% success rate with our treatment technique. The best part is that it is safe, non-invasive and medication-free.
