Migraine

What is a migraine?

Migraine is a brain disorder that occurs in episodes, often accompanied by severe headaches. Physical therapy for headaches can complement migraine treatment. ¹

What are the causes of migraines?

Migraines involve changes in brain function, influenced by both genetics and the environment. The networks of nerve cells that process sensory information function differently throughout the migraine cycle. ^{2, 3} Migraines were long thought to be primarily caused by blood vessels in the head. Research now suggests instead that there is an interaction between the brain, nerves, and blood vessels. ^{1, 4} Fluctuations in estrogen, a hormone involved in the menstrual cycle, can also trigger attacks in some people. ⁵

The exact mechanisms underlying migraines remain partly unknown. The factors associated with migraine attacks vary from person to person. ^{3, 6} Research distinguishes between symptoms associated with migraine attacks, possible triggers, and factors that make a person more susceptible to migraines:

• La douleur au cou (notre guide sur la Neck pain) fait souvent partie de la crise. Les troubles douloureux de la mâchoire sont aussi plus fréquents chez les personnes migraineuses. Ces études d’association ne permettent pas de déterminer si ces douleurs déclenchent les crises^{7, 8}
• Stress and changes in sleep patterns are often reported as triggers, but this data is based primarily on the participants’ perceptions ⁶
• Certain foods or beverages may be associated with seizures, but the overall quality of the evidence regarding diet is low ⁹
• Fluctuations in estrogen levels—particularly the drop around the time of menstruation—are associated with seizures in some people ⁵
• Traits inherited from parents can increase the likelihood of experiencing migraines. This hereditary influence is not the same as a one-time trigger ¹⁰

What are the symptoms of a migraine?

A migraine usually causes a moderate to severe headache, often on one side, accompanied by nausea or sensitivity to light and noise. The pain may be throbbing, meaning it feels like a pulsing sensation in the head.

The main symptoms are:

• A headache lasting 4 to 72 hours in adults without effective treatment. In people under 18, the duration can range from 2 to 72 hours. These durations are part of the criteria for the International Classification of Headache Disorders, known as ICHD-3 ¹¹
• Le mal de tête est souvent :
  
  • Of moderate to severe intensity
  • On one side only
  • Pulsating, with a sensation of throbbing in the head
• Headaches can worsen with everyday activities, such as walking or climbing stairs, and may force you to stop what you're doing
• Présence de :
  
  • Nausea or vomiting
  • Sensitivity to light and noise

So it’s not just the severity of the headache that determines whether it’s a migraine. You can have a very severe headache without it being a ^migraine11 ( see our guide to headaches and cephalalgias).

What is a migraine with aura?

A migraine with aura involves temporary changes in vision, sensation, or speech. The aura then goes away. Some people with migraines experience it, while others never do.

Aura symptoms often begin before the headache, but they can also occur during the headache or without a headache. A typical aura symptom usually lasts 5 to 60 minutes. Several symptoms may occur in succession, which extends the total duration. ¹¹ Vision loss, weakness, or difficulty speaking may also indicate a medical emergency. Do not assume on your own that these are signs of an aura; the signs that require urgent care are described below.

Here are some examples of aura symptoms that people may experience:

• Seeing black spots, flashes of light, stars, or even temporarily losing your vision
• Numbness in the face or elsewhere in the body
• Difficulty speaking or finding the right words

Migraine with typical aura is often treated the same way as migraine without aura, due to a lack of sufficient data on a different response. However, the choice of treatment must take into account the type of aura, the associated risks, and the limited data on treatments specific to aura. ¹²

How is a migraine diagnosed?

A healthcare professional can diagnose a migraine by asking you about your symptoms and examining you. Brain imaging can be helpful in certain situations.

An MRI, or magnetic resonance imaging, and a CT scan produce images of the brain. These tests do not directly show a migraine. They are usually not necessary if the symptoms are consistent with a migraine, the neurological examination is normal, and there are no unusual or concerning signs. However, they can help rule out other causes when symptoms change or when certain signs warrant further investigation. ¹³

How can physiotherapy help with migraines?

Physical therapy can help manage migraines and associated neck pain through exercises, advice, and, as needed, manual therapy. It can also help with headaches that originate in the neck, known as cervicogenic headaches. This condition is distinct from migraine. ¹⁴

People with migraines often have areas of the neck and head that are more sensitive to pressure. This phenomenon is also seen with tension headaches. ^{15, 16} (See our guide to headaches and cephalalgia.)

Applying pressure to certain sensitive points in the neck muscles can reproduce pain felt in the head. This is known as referred pain: the pain is felt somewhere other than where the finger is applying pressure. ¹⁷ These observations do not allow us to determine the extent to which the neck contributes to a person’s migraines. The exact role of these tender points remains unclear. ¹⁶

What are the results of the interventions studied for migraine?

The interventions studied may reduce the duration, frequency, or intensity of migraines, but these benefits remain uncertain and vary depending on the treatment.

A trial involving 104 participants compared three groups. The first group received a specific chiropractic manipulation of the spine—a brief, rapid movement applied to a joint. The second group received a sham treatment. The third group continued taking their usual medications alone. The sham treatment replicated manual contact without the specific manipulation being studied. The manipulation did not reduce the number of migraine days any more than the sham treatment. However, secondary outcomes—including attack duration and a composite score combining the number of days, duration, and intensity of pain—were more favorable than in the standard medication group toward the end of the follow-up period. These benefits were not demonstrated compared with the sham treatment. ¹⁸ This trial does not evaluate all manual approaches used in physical therapy.

In a review of studies on migraine, treatments were primarily based on endurance activities that increase breathing rate or on therapies combining physical and psychological approaches. The review reported a reduction in the duration of migraines. The results regarding migraine intensity and frequency became more clearly favorable after excluding the trials with the highest risk of error. The treatments and study populations varied widely, and overall confidence in the results remained low. Studies on cervicogenic headaches—which originate in the neck—focused primarily on neck mobilization and therapist-guided movements, and also reported benefits. These results pertain to a different diagnosis and do not demonstrate the same effect on migraines. ¹⁴

How does an examination of the neck help determine the cause of a headache?

Examining the neck also helps distinguish between different types of headaches. One study found differences in movement, manual joint examination findings, and muscle control, particularly in people with cervicogenic headaches. ¹⁹

In certain situations, a specialist may perform a diagnostic nerve block—an injection that temporarily numbs a nerve. The specialist compares the responses to the injections according to a specific protocol and uses imaging to guide the needle. This procedure can confirm whether a headache originates from a structure in the neck. ²⁰ Relief following a standard injection is not, by itself, sufficient proof of this cause. This specialized test is not necessary for every migraine.

When to consult a physiotherapist for a migraine?

Physical therapy is an option when your migraines occur frequently, limit your activities, or are accompanied by neck pain. A doctor can help clarify the diagnosis and treatment options for your attacks, especially if the pain is severe, is getting worse, or is becoming difficult to manage.

You can schedule an appointment directly with a physical therapist. The physical therapist will refer you to a doctor if the evaluation warrants it. However, the emergency signs listed below require immediate medical attention—do not wait for a physical therapy appointment.

When does a headache require urgent care?

A sudden, extremely severe headache—or one accompanied by certain symptoms affecting vision, speech, or movement—requires urgent medical attention.

Call 911 or go to the emergency room if you experience any of the following symptoms:

• A headache that starts suddenly and becomes extremely intense.
• Difficulty speaking or remembering things, loss of vision, blurred or double vision.
• Drowsiness, confusion, or a seizure, with involuntary movements or a loss of consciousness.
• Weakness or paralysis on one side of the face or body.
• A very high fever with possible signs of meningitis—an infection of the membranes surrounding the brain—such as a stiff neck.
• A rash that doesn't fade under pressure, even without a fever.
• A headache following a recent head injury.

If you suspect meningitis, seek immediate medical attention. Don't wait until all the symptoms appear before calling 911 or going to the emergency room.

Demandez un avis médical urgent si une crise de Migraine dure plus de 72 heures, si un symptôme d’aura dure plus d’une heure à la fois, ou si vous avez une crise pendant la grossesse ou peu après un accouchement. N’attendez pas ces délais si un des signes d’urgence précédents est présent. Ne conduisez pas vous-même à l’urgence. Ces repères proviennent du service de santé britannique, le NHS. Consultez ses pages sur la Migraine²¹ et sur la méningite²².

What are the physiotherapy treatments for a migraine?

Physical therapy treatments include exercises, advice on activities, and, if necessary, manual techniques for the neck. The choice depends on your symptoms and the assessment of your neck. The physical therapist will examine, among other things:

• Possible movements of the joints in your neck
• Depending on your symptoms, how your nerves respond to movements of your neck and arms
• Your Postural Habits
• The quality of your movements
• Your strength and your ability to control your movements

What types of treatment can a physical therapist provide?

• Manual manipulation of the neck joints and muscles, or exercises that stimulate the nerves—if warranted by the evaluation—to help reduce pain and improve range of motion.
• Home exercises to relieve symptoms and improve functional abilities identified as limited during the evaluation.
• Tips for adjusting the duration, frequency, and intensity of your daily activities and leisure pursuits.
• Tips on your posture and movements to help you feel more comfortable.
• Ways to manage headaches during an attack, in addition to the medical treatment plan.

What to do at home for a migraine?

At home, the treatment plan includes recommended medications, appropriate physical activity, and ways to relieve symptoms. Take your migraine medications as directed by your doctor and pharmacist.

Regular physical activity may help reduce seizures, although study results vary. ²³

Dans un essai de 91 adultes, un programme de 40 minutes d’exercice trois fois par semaine pendant 12 semaines a été associé à une baisse moyenne de 0,93 crise par mois. La baisse était de 0,83 avec la relaxation et de 0,97 avec un médicament préventif, le topiramate. Ces changements comparent le dernier mois du traitement au mois initial. L’étude n’a pas montré de différence certaine entre les groupes pour ce résultat, ce qui ne prouve pas leur équivalence dans toutes les situations. Le médicament réduisait davantage l’intensité moyenne de la douleur pendant la période de traitement. Les personnes déjà actives régulièrement étaient exclues de l’essai. Un programme progressif s’adapte donc à votre situation, notamment si l’effort déclenche vos symptômes. Consultez l’essai de Varkey et ses collègues²⁴.

What measures can improve your comfort?

Le froid peut soulager certaines personnes. Un essai mené auprès de 55 participants ayant terminé le protocole a observé moins de douleur avec une enveloppe froide sur l’avant du cou qu’avec la même enveloppe à température ambiante. Les participants savaient si l’enveloppe était froide, et le suivi immédiat durait une heure. Le résultat porte sur cette enveloppe froide et sur un soulagement à court terme. Consultez l’étude sur le refroidissement du cou²⁵.

The posture and movement tips below are primarily intended to promote neck comfort and are not intended to correct the cause of migraines:

• Try applying cold to the upper part of your neck if it provides relief, for short periods of time, with a towel between the ice and your skin. Stop if the cold increases the pain or irritates your skin.
• Gently move your neck in directions that feel comfortable.
• Soutenir les épaules et les omoplates, les os plats à l’arrière des épaules :
  
  • With a cushion under the armpits
  • With the armrests of a chair or sofa
  • By putting your hand in your pants pocket
• Limit the amount of time you spend in the same position while using a computer, watching TV, or reading a book. Get up regularly to move your neck and shoulders.
• Support the small of your neck with a comfortable pillow while you sleep. Avoid sleeping on your stomach if this position causes stiffness or pain during the night or upon waking.
• Loosen a hat or glasses that are too tight on the head. Prolonged pressure can cause a headache and sometimes trigger a migraine in people who are prone to them ²⁶. A compression headache usually subsides when the source of the pressure is removed.

If your symptoms do not improve, see a physical therapist or the healthcare professional who treats your migraines. Seek immediate medical attention if you experience any of the emergency signs described above.

Who gets migraines?

Migraines affect both children and adults, and women more often than men. ²⁷

Where can I learn more about migraines?

The podcast *Parle-moi de santé*, hosted by physical therapist Alexis Gougeon, discusses migraines and headaches in Episode 12 with Sylvain St-Amour.

Episode #12 of Parle-moi de santé (headaches)

Écouter l'épisode 12 de Parle-moi de santé sur les maux de tête, sur YouTube, Écouter l'épisode 12 de Parle-moi de santé sur les maux de tête, sur Apple Podcasts et Écouter l'épisode 12 de Parle-moi de santé sur les maux de tête, sur Podbean.

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