Migraines

First let us start by saying we are very optimistic about the treatment of migraine as well as many other headaches, we have a very high success rate in reducing the frequency, intensity and duration of migraine and many other headaches in our office.

 

There is a lot of confusing information about migraines. Websites from major hospitals talk about the “cause” of migraines and yet only list what are commonly known as “triggers” without really talking about the cause of migraines. Migraines are the body’s response to a nervous system imbalance which results in dysfunction of one or more of the body’s systems and functions. The human body is able to cope with many stressors or triggers when it is functioning optimally, but there is a limit to what any body can cope with. If the communication system of the body is not functioning optimally, then it is less capable of adapting to stressors and may not respond normally to an otherwise acceptable insult such as a trigger.  Think of it like the number of cashiers at the store. If there are only 3 shoppers with 3 items each, then one cashier can easily handle them. If however, there are 30 shoppers with 300 items each and half of them need a “price check”, a serious problem is about to occur for that one cashier. Now for the human nervous system, multiply that by a trillion!

 

Migraine headaches are usually severe headaches that are frequently described as pulsing or throbbing headaches which have frequent complaints of nausea, vomiting, extreme  light sensitivity (photophobia) and/or hearing sensitivity (phonophobia). Some migraines are preceded by sensory experiences known as auras. These may include sparkles, pixilated areas, or flashes of light in the visual field, or fading/darkening or blind spots in the visual field, lightheadedness or a feeling of distance from your surroundings, or even numbness or tingling in the arms, hands, legs or feet. The symptoms of a migraine may last for minutes or days, and may evolve or rotate through symptoms.

 

For medical science to identify and describe the malfunction which creates a malady in the human body is an exceptionally complex issue. Imagine orchestrating every human being to play an instrument in a classical concerto simultaneously in perfect tempo, intensity, pitch, etc. This is a simple task compared to the second by second function of the human body. On top of that, even though humans are made very much the same, there are minor variations in all of them, even in identical twins, let alone ones that are related as distantly as genetically possible. Bearing that in mind, I will describe the evolution of a migraine as best as I can.

 

The human body has many components that are vital to its function. Virtually everything is dependent upon the nervous system. The nervous system controls virtually every function at some level. Pressure upon the nerve affects its’ ability to perform its function. This pressure can be physical or chemical. The pressure from muscle tension or spasm, edema (swelling), subluxation (misalignment of a bone less than a dislocation), may cause these tissues to impinge or “press upon” the nerves and affect their function by causing a physical pressure on a nerve. Damage to tissues causes inflammation. This inflammation is mediated by many chemicals which resolve the issues of tissue damage and promote healing. Many of these chemicals, ie prostaglandins and leukotrienes alter the function of the nerves which they contact in the process. The “pressure” of this chemical contact as well as the resulting edema or swelling, and increased heat due to increased blood flow affect the function of the nerve. When pressure is applied to a nerve, it either increases or decreases the function of that nerve.  If that nerve is a sensory nerve, increasing the function can create pain while decreasing it can create numbness. Consider that nerves control the flow of blood vessels, the function of the kidneys, blood pressure, sense of balance etc etc etc. If you put pressure on a nerve it can alter, increase or decrease, any function in the body.

 

According to Peroutka SJ in Headache. 2004 Jan;44(1):53-64.

Migraine: a chronic sympathetic nervous system disorder.

“Migraine is an episodic syndrome consisting of a variety of clinical features that result from dysfunction of the sympathetic nervous system.” And further concludes that “It is proposed that the sympathetic dysfunction in migraine relates to an imbalance of sympathetic co-transmitters.” I propose that this imbalance of sympathetic transmitters is due to pressure on autonomic nerves thus altering their release of neurotransmitters thus resulting in dysfunction of the sympathetic and further the autonomic nervous system.

Additional studies have shown that altering the function of these nerves through electric stimulation have had a dramatic effect on not only migraines, but other primary headaches including cluster headaches. Some of these studies refer to stimulation of the occipital nerve “area” or the direct stimulation of the vagus nerve. Rev Neurol. 2013 Jul 16;57(2):57-63.

[Vagus nerve stimulation in patients with migraine].

Cephalalgia. 2011 February; 31(3): 271–285.\

These studies show that the medical model of treatment has very little effect on the duration or intensity of migraines and that alteration of the function of these nerves by artificial regulation has a significant impact on the reduction of symptoms.

If one considers the anatomical juxtaposition of cranial nerve X (vagus) which exits the cranial vault through the jugular foramen, and the occipital nerve (C1 root) to the atlanto-occipital joint, it is easy to see how direct physical pressure due to misalignment of this joint or chemical pressure due to inflammation of this joint could lead to alteration of the function of these nerves.

In addition, cranial nerve IX exits through the same foramen. CN IX and X have a significant impact on blood pressure to the cranial vault and would affect the pulsing/pounding of the headache.

The primary difference between our approach and those of these studies is that they artificially stimulate nerves in a set manner, while we strive to remove the pressure on the nerve that alters its function initially. By removing the interference and allowing the brain to effectively control the function of the nerve, the body is allowed to achieve homeostasis with the brain naturally.

Many migraneurs and other headache sufferers have tried chiropractic with varied results, so why should this help when chiropractic care has not helped in the past.

The anatomy of the upper cervical area involved in these studies and involved in our treatments is very different than any other area of the spine and for many people requires a very delicate correction with very great specificity in order to remove the pressure from the involved nerves. Only about 5% of chiropractors study and practice an upper cervical (upper neck) specific technique giving this crucial area of the spine the accurate correction it must have for most persons. Of the upper cervical specific chiropractors, many neglect the other segments of the spine including the occiput (base of the skull) and thus only correct a portion of the problem putting pressure on these nerves and affecting their function, resulting in dis-ease such as migraine.

We have treated hundreds of headache patients from multiple states and countries with great results. There are other factors that are important to consider and affect the outcome of care. There are some who have more severe issues that are the cause of their headache such as infections, aneurysm,  or tumors. Chiropractic care cannot treat these complaints, but fortunately these are not the most common causes of headaches.

As a general rule, we usually do not see persons with headaches, especially true migraines, who do not have pressure due to spinal dysfunction in the upper cervical area. Correction of the cause of this dysfunction generally significantly reduces or resolves this pressure and thus the complaint. The response to care varies in how quickly a person responds, and to what level the frequency and intensity of the complaint improves. Some people have almost immediate resolution of the complaint for a long period due to correction and stabilization of the area, others require periodic care to maintain the correction (much like some need periodic medication to mask the symptoms). There are numerous factors that influence the individual response to treatment including past injuries, lifestyle choices, physical fitness, and diet for example. By addressing factors which reintroduce the pressure to the area, one should be able to reduce the treatments necessary to undo those influences and improve outcome.

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