by David Drysdale, Osteopath
The word migraine is French in origin: Hemi=Half and Crane=Head. This etymology came about, because the Classic Migraine affects half the head.
Classical Migraine usually takes the form of self limiting episodes of extreme pain affecting one side of the head, frequently accompanied with nausea, vomiting, photophobia and facial pallor. An attack is usually preceded by a prodromal symptom such as disturbance of vision, tingling and numbness down one side of the body and occasionally disturbance of speech.
Common migraines are experienced more frequently, and often affect both sides of the head - usually there are no prodromal symptoms.
Migraines are 3 times more common in women than men. This female preponderance would seem to be associated with the vascular changes that occur as a result of the fluctuations in oestrogen.
There is an association with certain foods, such as chocolate, citrus fruits, tyramine containing cheeses and alcohol. Alcohol is a non-specific vasodilator.
Tyramine causes the release of noradrenaline, which causes vasodilation followed by rebound vasoconstriction. Blood vessels are pain sensitive, and can cause pain when they dilate or contract. Excess carbohydrate consumption causes a surge and then fall in blood sugar levels, and reactive hypoglycaemia can cause migraines.
The mechanisms of migraine headaches are not fully understood, but there seem to be three components, Vascular, Myofascial and Emotional.
The prodromal phase is associated with cerebral vasoconstriction. This is linked to the experience of flashing lights, blind spots, slurred speech and numbness. The painful episode is linked to vasodilation of the intra and extra cranial blood vessels. Pain receptors in the blood vessel walls, meningeal membranes and venous sinuses become activated. This causes the deep seated pain typical of a migraine.
When the muscles of the head and neck of migraine sufferers are examined, both during and between attacks there is widespread tenderness of these muscles. There are also small, discrete focal points of extreme tenderness. When these points are treated (using acupuncture) between attacks, the frequency of migraines is reduced. The probable reason for this is the pain impulses sent from these points to the brain is stopped, and the summation affect is not reached, and the migraine does not materialise.
70% of migraine sufferers consider that emotional upsets play an important part in developing their headache. Reducing stress, and responses to stress plays a vital role in controlling migraines.
Where simple analgesics do not help, Beta-Blockers such as Propranolol & Atenolol are the first drugs of choice. There are few side effects. Experimental work shows that these drugs work paradoxically by dilating constricted cerebral vessels while at the same time preventing dilation of the extra-cranial vessels. Pizotifen (Sumatriptan) A Serotonin receptor agonist, alters the levels of brain serotonin. Side effects are drowsiness and increased appetite. Serotonin causes the blood vessels within the brain to contract, this medication prevents this happening, stopping the migraine progressing.
Alternative treatments can often help with migraine headaches by reducing muscle tension, treating specific trigger points, freeing spinal and cranial restrictions and advising on diet.