What is a Migraine?

Approximately 23.6 million Americans have suffered from migraine headaches. Severe headaches have a significant impact in the United States, both to the individual suffering from them and on society as a whole. Considering just the cost of lost work and productivity, migraine headache costs in the U.S. are approximately $13 billion annually. This is the equivalent of 112 million “bedridden days” per year. Migraine headaches have also been shown to negatively affect an individual’s life more than osteoarthritis, hypertension, or diabetes.

Migraines are headaches that can be either one-sided or on both sides, and are recurring. Often, the patient can “predict” the headache before it begins. Nausea, vomiting, and hypersensitivity to sensory stimuli, including light and sound, usually accompany them. Migraines are often incapacitating. Aspirin and other pain relievers rarely help.

Current theory is that migraines are caused by a disturbance in blood flow around the head, especially in the back, which then causes an inflammatory response to begin. Common migraine triggers include: stress; excessive sleep; menstruation; pregnancy; oral contraceptive, antihistamine, or diuretic use; or a variety of food triggers, including red wine, aged cheese, MSG, and chocolate.

Migraines without aura, or common migraines, account for 80% of all migraine headaches. There is no “prodrome,” or visual disturbance prior to the headache. They typically last 4 to 72 hours and are associated with nausea, vomiting, and sensitivity to light and sound. Common migraines are aggravated by physical activity, but are usually not disabling. These migraines can be either unilateral or bilateral, and are more common in women.

The Classical Migraine, or migraine with aura, is preceded by a progressively increasing blind spot surrounded by flashing lights about 30 minutes prior to the onset of the headache. These migraines last for several hours up to 1 to 3 days, and are relieved somewhat by a dark, quiet environment. They are one-sided and throbbing, and there is often associated nausea and vomiting. There is also usually a family history of these headaches.

If the prodrome is more prominent than or outlasts the headache, it is known as a complicated migraine. There are three types of complicated migraines:

opthalmoplegic, which causes double vision and eye pain; hemiplegic, where one side of the body is paralyzed, often for days; and basilar, which leads to vertigo, difficulty swallowing, double vision, difficulty hearing, and ringing in the ears. There are also subsets of classical and common migraines, including:

retinal, which produce a “jigsaw” pattern of visual disturbance that enlarges and merges; coital, which affects mostly men and is brought on by the changes in blood flow from intercourse and orgasm; and rebound, which is caused by the excessive use of medications used to treat migraines (more than two days a week). There are many conservative treatment approaches to migraine headaches. First and foremost, patients with migraines need to pay attention to what may be triggering them and avoid those triggers. Migraines often respond to chiropractic manipulation. Other conservative options are biofeedback and acupuncture. Nutritional supplementation has also been shown to decrease the incidence of migraines. Feverfew, 5-hydroxytryptophan (5-HTP), omega-3 fatty acids (fish oil), magnesium, calcium, vitamin D, and riboflavin have all been shown to help migraines. Deep tissue massage and trigger point therapy relax the muscles in the back of the head that may be involved, and ice packs applied to the back of the head will constrict the blood vessels and decrease the inflammatory response.

References: Souza, Thomas A. Differential Diagnosis and Management for the Chiropractor: 415-433. Gaithersburg, Maryland: Aspen Publishers, 2001. Huff, Lew, and David M. Brady. Instant Access to Chiropractic Guideline and Protocols: 12-15. Saint Louis, Missouri: Mosby, Inc., 1999. Flanagan, Michael, DC. “Migraines, Strokes, and Chiropractic.” Chiroweb. 26 Sept 2002. Dynamic Chiropractic. http://www.chiroweb.com/archives/20/21/06.html

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