Migraine: Not just a headache

Most of us have suffered from a headache at one time or another. For many, an aspirin is all it takes to get things back on track. For others, they can be life-altering. They can arise all of a sudden or be chronic with varying degrees of severity. Symptoms include: throbbing, squeezing pain, face or skull pain, nausea, visual disruption, sensory sensitivity, cognitive impairment, and more. According to the International Headache Society, there are three primary types of headaches based on the source of the symptoms: Primary headaches, secondary headaches, and cranial neuralgias/facial pain/other headaches. In total, there are actually 17 distinct types of headaches. The focus of this article will be on primary headaches, specifically migraines.

Primary headaches are broken up into three sub-types: tension headaches, migraine headaches and cluster headaches.

Tension headaches are the most common, affecting roughly 1 in 20. They tend to occur more in women than in men. They are represented by dull pain, tightness, or pressure around your forehead or the back of your head and neck.

Migraine headaches are the second most common but often the most devastating. Before puberty, boys and girls are affected equally, but after puberty, many more women than men are affected. They feature myriad symptoms, often including autonomic affects.

Cluster headaches are rarer, commonly affecting men in their late 20’s, but also affecting women and children. They are characterized by a series of relatively short but extremely painful headaches every day for weeks or months at a time.

Secondary headaches result from structural problems of the head and neck. The symptoms of headaches are all linked to the same basic mechanism, often referred to as the migraine mechanism. With the migraine mechanism, inflammation is present in the blood vessels of the brain causing dilation. Inflammation of other tissues of the head such as the meninges and periosteum can be present as well.

Migraine headaches are moderate to severe headaches, often on one side of the head. They can create symptoms such as: head/face pain, jaw pain, visual disturbance, sensitivity to light and sound, nausea, vomiting. Migraines occur in four phases.

Phase 1: Prodrome:

This phase can begin hours or days before the other. It’s often called the pre-headache phase. This phase is experienced by 30-40% of migraine sufferers. It can serve as a warning of what’s to come. Symptoms include:

• Difficulty speaking or finding words (aphasia)
• Sleepiness
• Neck pain
• Yawning
• Constipation or diarrhea
• Fatigue
• Food cravings
• Difficulty concentrating
• Increased frequency of urination
• Mood changes

Phase 2: Aura

This phase is experienced by about 25% of migraineurs (as sufferers are sometimes called). Symptoms include:

• Allodynia: hypersensitivity to feel and touch
• Aphasia
• Auditory hallucinations
• Dizziness
• Confusion
• One-side paralysis
• Smelling odors that aren’t present
• One sided weakness
• Parasthesia
• Vertigo
• Visual disturbances

Phase 3: Headache

The pain can range from moderate to severe and is often the most debilitation of the phases. It’s often on one side of the head, pulsing or throbbing, and worsened by activity. Other symptoms include:

• Confusion
• Dehydration
• Dizziness
• Sensitivity to light, sound and odors
• Neck pain
• Nausea/vomiting
• Hot flashes/chills
• Fluid retention
• Nasal congestion
• Vertigo

Phase 4: Postdrome

This is the post-migraine hangover. Symptoms include:

• Fatigue
• Cognitive impairment
• Lowered mood
• Poor concentration and comprehension

Migraine is most commonly initiated by one or more triggers. What constitutes a trigger (as well as their relative strength) is unique to the individual, though some are more common than others. Triggers can include:

• Flashing lights
• Anxiety and stress
• Lack of food or sleep
• Hormone changes
• Foods
• Tyramine
• Caffeine

The three most common dietary triggers are caffeine, glutamates, and sulfates. Every individual also has what’s known as a trigger threshold. This is how much trigger exposure they can endure before a migraine is initiated. The goal is to make sure that your trigger load is below your trigger threshold. If you do this, you don’t get a migraine. Some of the most common treatments for migraines include:

• Sinus relief medications
• Acetaminophen
• NSAIDS
• Sedatives for sleep
• Prescription narcotics
• OTC headache meds like Excedrin
• Ergotamine medications
• Butalbital combination pain relievers

Unfortunately, all of these are classified as rebound drugs, in that they’ll often help with headaches initially, but eventually result in worsening of symptoms and more frequent headaches.

So what to do about it?

Part of the process is identifying one’s triggers. This can be done through trial and error and elimination diets, but also through testing I do in clinic. Once necessary dietary changes have been made, from my experience, anxiety and stress is the single most pertinent trigger. I do a lot of emotional work with clients to help with these. Additionally, I have found craniosacral work to be especially useful, along with addressing upper cervical dysfunction. Improvements in frequency and severity are often seen after a single visit. I’ve had clients with years-long, several day per week migraines get total resolution after a single session. If any of this sounds familiar, I encourage you to make an appointment now. There is hope.

Additional sources:

• Benjamin Wedro, MD, FACEP, FAAEM
• Danette C. Taylor, DO, MS, FACN
• Migraine.com
• David Buchholz, MD
• Webmd.com