Migraine

Migraines are a severe type of headache. What is a headache and what causes them?

Headaches are a very common complaint. It is a problem that most people have at sometime during their life. A headache that comes on when you have spent too much time in the sun, missed a meal or two, or following a time when more than a little alcohol was consumed is not a reason to panic, but rather to make some lifestyle changes.

The pain that we call a headache doesn’t originate from the brain itself because the brain has no nerves that give rise to the sensation that eventually is interpreted as pain. There are several types of tissues/structures that overlay the skull (skin, muscles, tendons, and even the membrane that adheres to the bones of the skull) that can have their “nociceptors” activated to turn into a pain signal. Very often the structures in the neck are responsible through a variety of mechanism for producing the pain that we call “headache”. Similarly, the jaw joint, commonly referred to as the TMJ (for temperomandibular joint) can frequently be the hidden source of headache or even a migraine.  The structures inside the skull, that may send “warning signals” to the brain, include, but are not limited to the meninges, arteries, veins, mucous membranes of the sinuses, multiple structures of the eye, and the ears. The pain may vary in character and timing.

Feeling sick and tired. Frustrated young man massaging his nose and keeping eyes closed while sitting at his working place in office

In 2013, the International Headache Society published its newest headache classification system (1). These categories are based upon the tissue source of the pain creating the headache.

  1. Primary headaches (tension, migraine, cluster)

  2. Secondary headaches (sinusitis, hang-over or toxic headache, post-concussion or other brain injury headache  

  3. Cranial neuralgias, facial pain, and other headaches

Combinations of the various types of headaches may occur simultaneously.

Of all the headache types, migraine is most common debilitating headache.

What is a migraine?

Migraine is typically a disabling brain disorder that affects approximately 20% of women and 7% of men during their lifetimes. Its hallmark is severe, recurrent headache. Some people that have migraines have a signal or symptoms that precede the migraine from as long as a day before to only a few minutes prior. These symptoms are called auras and may be in the form of a visual disturbance or other neurological issue. Migraines may also produce nausea, vomiting, and light sensitivity. Most people who suffer from migraines (which means “half a head”) associate some causal factor as a trigger for their migraine. Triggers can be singular or multiple in nature. Foods and other environmental factors may be triggers. Hormonal fluctuation associated with menstrual cycles or birth control pills as well as other medications can be triggers. Some types of migraine show familial connections so there is a genetic or epigenetic factor in these cases (2).

The precise causes of migraine is still being researched. Theories regarding diffuse, intracranial vascular dynamics have been replaced by evidence pointing to problems with the large sensory nerve of the face and the vasculature associated with it. The newer understanding of migraine focuses on cortical and brain stem hyper-excitability followed by spreading cortical depression. Additionally, studies have shown that migraneurs have visual motion processing abnormalities related to the cerebral cortex not associated with a failure of attention (3) (4).  Long term studies of people that suffer from migraine have shown that they are at greater risk of stroke than those who do not have migraines. What is clear is that people with migraine have an issue with how their brains handle stimuli for possibly a variety of reasons.

How are migraines typically diagnosed?

Migraines are typically diagnosed by the history of severe, unilateral (one sided) headaches or through a complex of visual and or other vascular generated symptoms.

How are migraines typically treated?

Migraines are typically treated acutely by the general classes of medicines including analgesics, ergotamines, and triptans. Analgesics are general pain blocking medications. Ergotamines and triptans are migraine specific medications that are restricted to how often you can take them because of potential side effects and adverse reactions. There are also treatments that are classified as migraine preventatives such as nerve blocks, trigger point injections, and radiofrequency nerve ablations (5).

Migraine Smaller 2

The Innova approach to migraines

The doctors at Innova understand that the cause of you migraine are going to be unique to you. Most often we find that it is rarely caused by a singular issue, but rather by a collection of neurological issues that taken together result in an overly sensitized brain that is not capable of processing routine stimuli in a typical fashion. By looking at specific functional aspects of your brain through careful neurological, physical and special diagnostic testing that scrutinizes balance and eye movement functions, we are able to determine what areas of your nervous system are failing to operate properly. Once the diagnosis is determined, a customized, targeted approach is developed to reduce the excitatory influences. Often with our migraine patients, we work to build up the parts of the brain that dampen or silence the pain generation in the central nervous system. Our “pain” nerves have to send “pain” messages constantly to our brain or they would wither away from inactivity. Our brain, when working correctly is able to cover up these signals so that we never know that a pain message was sent. Migraine sufferers get better and better at feeling the pain. This is an example of neuroplasticity, but on the negative side. We consider all aspects of the migraine syndrome and address it from a multi-modal approach. Brain based therapies are selected that will change how your brain functions. When we rehabilitate the areas of your brain that were dysfunctional, your nervous system is now able to respond appropriately to the various triggers you were struggling with. Think about it. Not everyone gets a migraine when subjected to the things that may make you suffer greatly.

References

1. Headache Classification Committee of the International Headache Society (IHS), The International Classification of Headache Disorders, 3rd edition (beta version) Cephalalgia, Volume: 33 issue: 9, page(s): 629-808, June 14, 2013

2. Migraine, Mayo Clinic

3. McKendrick AM, Badcock DR, Motion Processing Deficits in Migraine,  Cephalalgia, Volume: 24 issue: 5, page(s): 363-372: May 1, 2004

4. McKendrick AM, Badcock DR, Badcock, JC, et al,  Motion Perception in Migraineurs: Abnormalities are Not Related to Attention, Cephalalgia, Volume: 26 issue: 9, page(s): 1131-1136: September 1, 2006

5. Natbony, LR,  Spotlight On: Interventional Headache Management, American Migraine Foundation

A new approach to migraine

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