Migraine

WHAT IS A MIGRAINE?

This is a chronic condition that causes episodes of headaches, often very intense.

What are the causes of migraines?

MIGRAINES ARE CAUSED BY A PROBLEM WITH BLOOD CIRCULATION IN OUR BRAIN, WHICH LEADS TO MALFUNCTIONING CONNECTIONS IN THE BRAIN. A hormonal issue can also contribute to the cause of migraines.

The exact cause of migraines is not known, and the trigger for migraines will vary greatly from one individual to another. Here is a list of some elements that may contribute to or trigger migraines:

• Neck or jaw problem
• Diet
• Stress
• Hormones
• Genetics
• Poor sleep

What are the symptoms of a migraine?

The main symptoms are:

• Headache that lasts between 4 and 72 hours
• The headache is often:
  
  • Of moderate to severe intensity
  • On one side only
  • Pulsating (feeling our heart beat in the head)
• The headache often leads to an inability to continue our usual day
• Presence of:
  
  • Nausea or vomiting
  • Sensitivity to light or noise

Therefore, it is not only the intensity of the headaches that determines whether it is a migraine. You can have a very, very intense headache without it being a migraine (see the section HEADACHES OR CERVICOGENIC HEADACHES)

What is a migraine with aura?

Some people will experience migraines with aura, meaning they will have what we call ''sensory'' symptoms that accompany their migraines.

OFTEN, THESE SYMPTOMS WILL LAST FOR 20 TO 60 MINUTES AND WILL OCCUR JUST BEFORE THE MIGRAINE, A BIT LIKE A WARNING SIGN THAT THE MIGRAINE IS COMING.

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

• Seeing black dots, flashes of light, stars, or even temporary vision loss
• Numbness in the face or elsewhere in the body
• Difficulty speaking or finding your words

The management and treatment of migraines with aura are no different from other migraines.

How to diagnose a migraine?

Diagnosis is made based on a review of your symptoms and a clinical examination.

IT IS IMPORTANT TO KNOW THAT NO BRAIN OR HEAD IMAGING CAN SHOW A MIGRAINE. Therefore, it is useless to do an X-ray, MRI, or CT scan to diagnose a migraine unless another disease or problem related to the brain is suspected.

How can physiotherapy help with migraines?

Almost 100% of headaches caused by migraines also have a component that comes from the neck (SEE THE SECTION HEADACHES AND CERVICOGENIC HEADACHES).

Often, it is the combination of neck dysfunction and the migraine that triggers the symptoms. So, if we fix the neck dysfunction, the migraine component may not be enough to trigger the headaches. Here is an image to better understand:

The contribution of neck dysfunction to migraine

THEREFORE, IF WE TREAT THE NECK, WE CAN SIGNIFICANTLY REDUCE MIGRAINE SYMPTOMS AND OFTEN MAKE THEM DISAPPEAR COMPLETELY!

A problem with eye movement coordination can also contribute to migraines. The physiotherapist can assess and treat this problem.

When to consult a physiotherapist for a migraine?

You should consult a physiotherapist if you have symptoms such as You should consult a physiotherapist if you have symptoms as described above or if your doctor has already ruled out any other cause that could explain your pain.

You do not need to see a doctor before consulting a physiotherapist. If your condition requires you to see a doctor, your physiotherapist will be able to tell you.

What are the physiotherapy treatments for a migraine?

Your physiotherapist will perform an assessment to determine the cause of your migraines and will assess the cervical spine. To do this, they will assess the following elements:

• Your joint mobility
• The gliding of your nerves
• Your postural habits
• The quality of your movements
• Your strength and stability
• The coordination of your eye movements

Based on the assessment results, your physiotherapist will:

• Mobilize the joints, muscles, and nerves in your neck to reduce pain and improve movement
• Give you specific exercises to do at home to address the cause of the problem and relieve pain
• Teach you how to properly manage your daily activities and hobbies to optimize healing
• Give you advice for your postural habits and movements
• Give you tips to reduce the headache when the migraine arrives

What to do at home for a migraine?

Take your anti-migraine medication as recommended by your doctor and pharmacist.

Here are some other tips that may help at home:

• Apply ice (wrapped in a damp towel) to the upper neck for 15-20 minute intervals.
• Move your neck in the movements that don't cause any pain at all
• Support your shoulders and shoulder blades
  
  • 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 spent in the same position (computer, television, reading). Get up often, for a few minutes, to move your neck and shoulders a little.
• Make sure your neck is well supported while sleeping with a pillow that fills the hollow of your neck. Sleeping on your stomach should be avoided (especially if you have stiffness or pain in the morning or during the night).

If you do not see any improvement, you should consult a physiotherapist.

Did you know?

• Women are three times more affected by migraines than men.
• Approximately 15% of the population suffers from migraines.

Sources

• Goadsby PJ. Pathophysiology of migraine. Annals of Indian Academy of Neurology. 2012 Aug;15(Suppl 1):S15.
• Dalkara T, Nozari A, Moskowitz MA. Migraine aura pathophysiology: the role of blood vessels and microembolisation. The Lancet Neurology. 2010 Mar 1;9(3):309-17.
• Burstein R, Noseda R, Borsook D. Migraine: multiple processes, complex pathophysiology. Journal of Neuroscience. 2015 Apr 29;35(17):6619-29.
• Weatherall MW. The diagnosis and treatment of chronic migraine. Therapeutic Advances in Chronic Disease. 2015 May;6(3):115-23.

To learn more...

You can listen to the podcast produced by one of our physiotherapists, Alexis Gougeon. Episode #12 discusses headaches and migraines.

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

Find the episode on YouTube :

Click below to listen to episodes on podcast platforms: