A form of headache that is quite disabling. The pain can really interrupt an individuals ability to function through the day and lead to loss of days from work. Furthermore, it can put a halt to social plans that the individual was looking forward to. Migraines are complex in nature and develop over hours to days and are commonly recurrent in nature.

The exact mechanism of a migraine is still not fully understood, however is considered to be multifactorial involving the peripheral and central nervous systems. It primarily is thought to be the result of abnormalities in brain function, which leads to changes in the interpretation of sensory input. This misinterpretation may lead to normal sensory information, being interpreted as pain. Similar to a cervicogenic headache the trigeminocervical nucleus (TCN) may be involved, where the trigeminal sensory nerves are sensitised and activated effectively causing a headache. There is also thought to be a pro-inflammatory component involving the trigeminal sensory nerves, which results in higher brain centre changes. This is believed to alter the function of the brains pain relief centre, therefore reducing the ability to control the pain.

Migraine’s are classified as being a migraine with aura (classic migraine), and a migraine without aura (common migraine). Aura are neurological symptoms which precede the headache. This can include visual disturbances like flashes of light, dizziness/vertigo, paralysis to one side of the body (hemiplegia), and tingling in the hands or face (paraesthesia). Common symptoms that migraine sufferers of both forms may experience are nausea, vomiting and diarrhoea.

A migraine without aura is known as the common migraine as it is reportedly is the migraine type more then 70% of the time. According to the International Headache Society, the two most common form of migraines can be classified as:

Migraine without aura is a recurrent headache attack of 4 to 72 hours; typically unilateral in location, pulsating in quality, moderate to severe in intensity, aggravated by physical activity, and associated with nausea and light and sound sensitivity (photophobia and phonophobia).

Migraine with aura has recurrent fully reversible attacks, lasting minutes, typically one or more of these unilateral symptoms: visual, sensory, speech and language, motor, brainstem, and retinal, usually followed by headache and migraine symptoms.

What is the cause of a migraine?

There seems to be a genetic link involved with migraine development. If one parent has a history of migraine attacks, then the reported risk is around 40%. It has been shown to increase in prevalence during and after puberty, with it a decreasing prevalence in the 40s and onwards. This leads us to believe that hormones may influence migraine onset. Everyone has a unique presentation for their migraine and their triggers are different. Common triggers reported include; stress, disturbed sleep, skipped meals, odours (like perfumes), neck pain, light exposure, alcohol intake, food (chocolate is often reported although not proven), smoking, heat and even exercise induced.

As you can see this list is quite lengthy and the evidence on all these triggers is not conclusive.

What are the best treatment options?

Treatment needs to be individualised to the individual. We will work together to understand your triggers and provide a management plan At The Reform Lab Osteopathy. Working out what you respond the best to is key to your individual management. Manual therapy through osteopathy can provide relief, as we are aiming to de-sensitise the TCN which could be referring the headache sensation. Aerobic exercise has been researched and found to help migraine sufferers. With this in mind and exercise being fundamental to good health and independence, we will look to advise you on strategies to include exercise into your life.