Migraine Brain

Migraine Brain

Introduction:

Migraines are not just headaches; they are intricate neurological events that can significantly impact one’s quality of life. In this blog, we’ll explore the complexities of migraines, from their triggers to effective management strategies, shedding light on this pulsating world of chronic headaches. We have discussed in detail cervicogenic headaches for those who do not suffer from migraines and for information on how chiropractic can be beneficial for those patients who suffer from this condition.

For ease of this blog “migraine sufferers” will be referred to as migraineurs hence forth.

Defining Migraines:

It is estimated that one billion people worldwide suffer with migraines1. Migraines are a type of headache disorder characterized by recurrent, intense throbbing headaches that often present with additional symptoms. These additional symptoms include nausea, vomiting, sensitivity to light and sound, and, in some cases, visual disturbances known as auras. Migraines can be debilitating, impacting daily activities and overall well-being2. Migraine is described as “a disorder of sensory processing”3 with its pathophysiology compared to that seen in epilepsy due to its gradual propagation of neural signals through the brain4.

Physiology of Migraine Brain:

The phrase “Migraine Brain” is often used by clinicians to help migraineurs understand their condition. For those of us who are not neuroscientists, the important term that will be helpful to learn is related to how a nerve cell or fibre works. When a nerve cell becomes excited, it reaches a threshold of voltage where the cell membrane opens channels leading to depolarisation. The reason this is important, is because during a migraine attack, there is a slow progressive wave of depolarisation that propagates throughout the cortex of the brain leading to the different symptoms and severe head pain known as a migraine. This process is know in the scientific literature as cortical spreading depression, or migraine brain4–7.

In a nutshell, the brain of migraineurs can be hypersensitive to stimuli. A hypersensitive brain is one that is on the verge of depolarisation most of the time, so any extra stimuli will push it over the edge, causing the chain reaction of cortical spreading. Like a bucket filled to the brim, it doesn’t take much for it to over-flow. These stimuli can be environmental from food, chemicals in perfumes, and stress related factors from hormonal changes and life in general. So, the migraineurs brain is on the edge of firing signals to the rest of the brain all the time. A simple example might be that the persons hypersensitive brain then experiences a stressful event at work, which causes them to drink a coffee to help work a little later than they normally would. These events cause the already hypersensitive nerve cells in the brain to depolarise, leading to a cascade of depolarisation of other local nerve cells, which eventually propagates throughout the cortex of the brain.

Types of Migraines:

  1. Migraine without Aura: The most common type, characterized by moderate to severe pulsating pain on one side of the head, along with associated symptoms listed above. This type of migraine attack can last 4-72 hours8. Approximately 40% of migraineurs will experience their pain on both sides of their head9.
  2. Migraine with Aura: Approximately 33% of migraineurs experience aura shortly before their migraine attacks. We will discuss auras in greater detail below as they are a fascinating neurological event.
  3. Chronic Migraines: Defined as experiencing migraines on 15 or more days per month, for 3 months with at least eight of those being migraines with or without aura 1,8.

Phases of Migraines:

If you take only one thing away from this blog post, I hope it is this section. The rest of this blog is interesting of course, but in my experience, the most important thing to learn about migraines is their phases. It is important to remember that the triggering event of a migraine may have occurred hours or even days before the attack is experienced.

Phase one: The Prodrome

The first phase of a migraine attack is known as the prodrome, which consists of vague symptoms such as fatigue, yawning, malaise, mood changes, craving certain foods, photophobia and phonophobia (sensitivity to light and sounds). This is considered the best time to commence any abortive treatments, so it is important migraineurs learn to recognise their prodrome symptoms. If migraineurs can recognise their individual triggers and prodrome symptoms, they may become the master of their migraines. Just remember, your prodrome may have been triggered days before the onset of symptoms.

Phase 2: The Aura

As stated earlier, not all migraineurs experience an aura but those that do typically experience an aura within an hour of the attack phase. The symptoms of an aura can vary from person to person, with some experiencing visual disturbances including small dots, zig-zag lines or “visual snow syndrome” characterised as small flickering dots across the field of vision10–12. Others may experience speech disturbances, cognitive fog/confusion, weakness, numbness, and paraesthesia’s. Auras are described as the result of a unique sequence of short nerve cell excitation followed by short-lasting depression of nerve cell activity4.

Phase 3: The Migraine Attack

This is the painful phase of the migraine resulting in either one sided (unilateral) or both sided (bilateral) severe throbbing head pain with typically photophobia and phonophobia, nausea, and vomiting. Attacks typically last between 4 and 72 hours and are often made worse with exercise or even general movement. Once this phase has started, there is often no way to stop it, it must simply run its course. Ice packs on the head, neck and face can provide some relief, however, being in a dark, quiet room is most effective due to the photo and phonophobia. The migraine attack phase has been found to be the result of unique changes in blood flow due to constriction of the small arterioles in the brain4.

Phase 4: The Postdrome

Once the migraine attack has passed comes the final phase known as the postdrome. During this phase, migraineurs tend to feel “washed out”, foggy headed and exhausted. This tends to last days also, meaning the patient can lose several days to these attacks.

Triggers and Contributing Factors:

There are many known triggers for migraines and their complex pathways of how these factors trigger an attack are too complicated for this blog. They deserve their own blog for a deep discussion, so I will briefly gloss over these triggers for the sake of this blog.

  • Hormonal Changes:
    • Many migraineurs experience migraines related to hormonal fluctuations, often occurring during menstruation, pregnancy, or menopause.
  • Environmental Factors:
    • Sensory Stimuli: Bright lights, loud noises, or strong smells can trigger migraines.
    • Weather Changes: Changes in weather patterns, such as pressure changes or high humidity, may contribute.
  • Emotional Factors:
    • Stress: High-stress levels are a common trigger for migraines.
    • Emotional Upheaval: Intense emotions, whether positive or negative, can contribute.
  • Dietary Triggers:
    • Caffeine: Withdrawal or excessive intake can both be triggers.
    • Certain Foods: Common culprits include chocolate, cheese, and processed foods containing additives like MSG.
  • Spinal dysfunction: 
    • Cervical spine syndromes: we have discussed cervicogenic headaches in a previous blog post. However, it is entirely possible that these same patterns of dysfunction and neurological overlap that can cause headaches may contribute to a migraine attack in migraineurs due to the “migraine brain” phenomenon discussed above.
  • Sleep Disturbances:
    • Irregular sleep patterns, lack of sleep, or oversleeping can trigger migraines1.

Diagnosis:

Diagnosing migraines involves a thorough medical history, discussion of symptoms, and ruling out other potential causes of headaches. Keeping a migraine diary, documenting triggers, symptoms, and the timing of each episode, can assist healthcare professionals in making an accurate diagnosis.

Treatment and Management Strategies:

  • Medications:
    • Pain Relievers: Some over-the-counter pain relievers or prescription medications can help alleviate migraine pain. For more information on these and how they might help you, I recommend you consult your GP.
    • Triptans: Prescription medications that specifically target migraines by constricting blood vessels and blocking pain pathways. Again, seek advice from your GP for more information on these medications.
  • Preventive Medications:
    • Also known as “abortives” for individuals with frequent or severe migraines, preventive medications may be prescribed by your GP or a neurologist to reduce the frequency and intensity of episodes.
  • Lifestyle Modifications:
    • Identifying Triggers: Keeping a migraine diary to identify and avoid triggers.
    • Regular Sleep: Establishing consistent sleep patterns and ensuring an adequate amount of sleep.
    • Stress Management: Incorporating stress-reducing techniques such as meditation, yoga, and a regular exercise program.
  • Cognitive Behavioural Therapy (CBT):
    • CBT can be beneficial in identifying and modifying thought patterns and behaviours that may contribute to migraines.
  • Nutritional Approaches:
    • Identifying and avoiding specific dietary triggers.
    • Ensuring a well-balanced diet with regular meals to prevent hunger-related migraines.
    • Here at Spriggs Chiropractic & Nutrition, our nutritional therapist has a keen area of interest in helping migraineurs regain control of their lives.
  • Hydration:
    • Staying well-hydrated can be important in preventing migraines triggered by dehydration.

When to Seek Medical Attention:

While many individuals can manage migraines with lifestyle modifications and over-the-counter medications, it’s crucial to seek medical attention if:

  • Frequent or Severe Episodes: Migraines that significantly impact daily life.
  • New or Worsening Symptoms: Changes in migraine patterns or the development of new symptoms.
  • Ineffective Self-Care: If over-the-counter medications or self-care measures are ineffective.

Medical doctor holding a board with migraines written on it

Chiropractic Care and Spinal Manipulation for Migraine Prevention:

When a patient presents to me in clinic with a primary complaint of migraines, I always explain the mechanisms that trigger a migraine attack are complex and we must identify the triggers and prodrome symptoms to achieve the best results. From the start of care, it must be understood that we are not shooting for a cure, because of the complexities already discussed. Therefore, a long-term management strategy must be the goal where we are looking to get your migraines under control, rather than eradicated. Managing expectations in these clinical scenarios is key for both the migraineur and the clinician. In my clinical experience, chiropractic and/or spinal manipulative therapy can be an effective treatment for migraine management due to similar mechanisms discussed in our previous blog on cervicogenic headaches.

Chiropractic has been found to be an effective therapeutic technique to reduce the frequency and intensity of migraine attacks13. A detailed assessment of the migraineurs cervical spine (neck), their head and neck posture and muscle function of their neck and shoulders is required for successful manual therapy management of migraines13,14. In their study Ferracini et al (2016) found that a loss of cervical lordosis (neck curve), a forward head posture and the presence of trigger points within the muscles of the head and neck were associated with migraines14. Therefore, a plan of management that attempts to address these changes could become part of many migraineurs long-term management strategy.

We have discussed “How Chiropractic Works” and Trigger Points in previous blog posts.

Conclusion:

Migraines are complex, and their management often requires a multifaceted approach. Chiropractic care, with its emphasis on spinal manipulation and holistic wellness, has shown promise in contributing to migraine prevention. As part of an integrated care plan, chiropractic adjustments tailored to individual needs can address underlying factors that may trigger or exacerbate migraines. If you are considering chiropractic care for migraine prevention, call us on 01635 43238 of email hello@spriggschiropractic.co.uk to book your consultation.

Migraines are more than just headaches; they are complex neurological events that require a multifaceted approach to management. Understanding triggers, adopting lifestyle modifications, and exploring various treatment options can empower individuals to navigate the challenges posed by migraines. If you or someone you know is experiencing chronic headaches consistent with migraines, seeking the guidance of a healthcare professional is essential for accurate diagnosis and the development of an effective treatment plan. With the right approach, individuals can regain control over their lives and find relief from the pulsating world of migraines.

 

By Mark Spriggs DC, MChiro, MSc, PGCE, FRCC

 

References:

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  2. Eigenbrodt AK, Ashina H, Khan S, et al. Diagnosis and management of migraine in ten steps. Nat Rev Neurol. 2021;17(8):501-514. doi:10.1038/S41582-021-00509-5
  3. Goadsby PJ, Holland PR, Martins-Oliveira M, Hoffmann J, Schankin C, Akerman S. Pathophysiology of migraine: A disorder of sensory processing. Physiol Rev. 2017;97(2):553-622. doi:10.1152/physrev.00034.2015
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  9. Rasmussen BK, Olesen J. Migraine with aura and migraine without aura: an epidemiological study. Cephalalgia. 1992;12(4):221-228. doi:10.1046/J.1468-2982.1992.1204221.X
  10. Barrachina-Esteve O, Hidalgo-Torrico I, Acero C, Aranceta S, Cánovas-Vergé D, Ribera G. Visual snow syndrome and its relationship with migraine. Neurologia. 2024;39(2):190-195. doi:10.1016/J.NRLENG.2021.05.012
  11. Liu GT, Schatz NJ, Galetta SL, Volpe NJ, Skobieranda F, Kosmorsky GS. Persistent positive visual phenomena in migraine. Neurology. 1995;45(4):664-668. doi:10.1212/WNL.45.4.664
  12. Schankin CJ, Maniyar FH, Digre KB, Goadsby PJ. “Visual snow” – a disorder distinct from persistent migraine aura. Brain. 2014;137(Pt 5):1419-1428. doi:10.1093/BRAIN/AWU050
  13. Rist PM, Hernandez A, Bernstein C, et al. The Impact of Spinal Manipulation on Migraine Pain and Disability: A Systematic Review and Meta-Analysis. 2019;59(4):532-542. doi:10.1111/head.13501.The
  14. Ferracini GN, Chaves TC, Dach F, Bevilaqua-Grossi D, Fernández-de-Las-Peñas C, Speciali JG. Relationship Between Active Trigger Points and Head/Neck Posture in Patients with Migraine. Am J Phys Med Rehabil. 2016;95(11):831-839. doi:10.1097/PHM.0000000000000510

 

 

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