Migraine Headaches


Migraine Headache via openDemocracy (Flickr) CC

How do I know if I have a migraine?

Migraines are an awful, unwanted condition that nobody wants to experience. They can be short-lived (a few hours) or persistent (multiple days!).  Depression, irritability, neck stiffness, visual flashes of light, pins and needle sensations, sensitivity to sound and light, nausea and vomiting, and of course, severe headache are all examples of symptoms that may come with a migraine. Yikes. Here are a few more, too. Sometimes these symptoms appear before the headache (premonitory symptoms and aura), during the migraine, and/or after the headache (postdromal symptoms).

But migraines usually have a few typical characteristics. According to ICDH-3 classification, migraines can either occur with or without an aura (more on that later). To properly diagnose these forms of migraine, patients have to experience a headache within the confines of a standard migraine description:

  1. At least five attacks fulfilling the following,
  2. Headache lasting 4-72 hours
  3. Headache with at least two of the following four:
    1. Unilateral Location (one-sided)
    2. Pulsating quality
    3. Moderate to severe intensity
    4. Aggravation by or causing avoidance of routine physical activity
  4. At least one of the following two
    1. nausea and/or vomiting
    2. sensitivity to light and sound

An aura is a complex of symptoms that usually occur before a migraine begins. (These are complicated neurological phenomenon, and could take several blog postings to themselves!) Most of the time (90% of patients) aura symptoms are visual (generally a bright spot with visual disturbance), but they can also be sensory (usually pins, needles, or numbness), speech, or motor symptoms — however these types of symptoms are less common. Linked is an excellent video describing the symptoms of migraine aura, from the Mayo Clinic. Once again, the ICDH-3 classifications require at least two of the following four characteristics:

  1. At least one aura symptom spreads gradually over 5 minutes, and/or two or more symptoms occur in succession.
  2. Each unique aura symptom lasts 5-60 minutes.
  3. At least one aura symptom is unilateral.
  4. The aura is accompanied, or followed within 60 minutes, by a headache.

But what IS IT exactly?

There is little evidence that blood flow changes are occuring at the brain cortex if you do not experience aura symptoms. For migraines with aura symptoms however, there is clear evidence that blood flow changes at the cortex are occuring

Migraines without aura and migraines with aura are complicated biological processes, with what appear to be distinct differences between them. For example, it was long believed that poor blood flow to the brain (vascular supply to the cortex) was a key element in the reason for both types of migraines. However, if you don’t have an aura, this no longer appears to be the key factor. Instead, chemical disturbances, sensitization of pain pathways, and central nervous system involvement are suspected to be the primary players — there is little evidence that blood flow changes are occuring at the brain cortex if you do not experience aura symptoms.

For migraines with aura symptoms however, there is clear evidence that blood flow changes at the cortex are occuring. Regional blood flow usually becomes diminished in the back of the brain first, gradually spreads towards the front, and is followed by a period of excess blood flow to the same areas later. These changes are closely related to the time at which aura and migraine symptoms are experienced.


Headache via threephin (Flickr) CC

Am I suffering Alone?

Using Statistics Canada information from 2010/11, Ramage-Morin and Gilmour (2014) state that 8.7% of Canadians (2.7 million) reported being diagnosed with a migraine by a health professional. Females reported greater prevalence than men, at 11.8% vs 4.7%, and the highest prevalence was among people aged 30-50 (17% of women; 6.5% of men).

The authors also note how migraine sufferers are impacted at work. They suggest that 36% of migraine sufferers missed at least one day of work in the most recent 3 months due to their migraine, and nearly one in five needed to change their work activities for at least three month due to their migraines (type, duration, all activities)! This supports previous investigations suggesting that it is the lost productivity while at work that impacts people more than true absence from work. (So generally it’s not that migraine prevent people from going to work, it’s that workers are significantly impaired in their productivity once they get there because of their migraine).

How do I Stop or Prevent Migraines?

Obviously, migraines are a big problem a lot of people. With problems of this size and complexity, we often can’t limit our treatment strategies to a single source. As such, here are five unique avenues you might consider exploring to help manage your migraines.

1> Chiropractic Care

Seeking treatment from any health professional is always advisable when trying to find options to eliminate a health concern. When visiting a chiropractor, parts of your body that may be contributing to migraine symptoms can be addressed, usually with muscle massage, joint mobilization, adjustments, and other therapeutic tools like electrical stimulation. A Cochrane review from 2004 compared chiropractic treatment for migraines (specifically SMT and electrical modalities) directly to a commonly used drug for migraines (amitriptyline). This review established that chiropractic treatment delivers similar successful outcomes to the prescribed drug treatment — making it clear that chiropractic is an effective and viable option to manage migraines.

2> Acupuncture

Similarly, the effect of acupuncture treatments on migraines have also been studied. Another Cochrane review from 2009 reviewed the effectiveness of acupuncture for migraine prophylaxis (prevention), concluding that “there is consistent evidence that acupuncture provides additional benefit to treatment of acute migraine attacks only or to routine care[…]” and “acupuncture is at least as effective as, or possibly more effective than, prophylactic drug treatment, and has fewer adverse effects.”

That’s a pretty strong indication that for people with migraines, acupuncture may be a very useful tool for limiting the number of future occurrences.

3> Self-Regulation Strategies

Self-regulation strategies are beginning to play a more prominent role in patient management for a number of health conditions. Migraines are well suited to be managed in part by mindfulness based interventions (like meditation, deep breathing, and self-awareness activities) as promising findings are being recorded with diminished migraine duration and migraine-related disability. Furthermore, mindfulness based interventions are also exhibiting positive outcomes for stress, depression, anxiety, and insomnia — all common secondary distresses for those suffering from migraines. (Smitherman et al. 2015)

4> Using Caffeine as a Boost

We’ve previously discussed caffeine as an adjuvant (booster/beneficial additive) to medication use to decrease painful conditions, and it appears this applies to migraines too. Using caffeine in combination with medication consistently shows improved resolution of painful symptoms as they relate to migraine or migraine-like symptoms. (Derry et al. 2012)

Of course, medication interactions are something that should be avoided if possible — so before you start consuming a cup of coffee with each of your medications, be sure to speak to your doctor or pharmacist first. Safety first!

5> Magnesium Supplementation

There is a theory that at least some migraine sufferers may be deficient in magnesium, and that this deficiency may contribute to their migrainous symptoms. To this end, the impact of magnesium supplementation on migraine prophylaxis has been studied, and although the results are at least promising, they are largely inconclusive.

A recent review of magnesium supplementation for migraine prevention notes that while magnesium intakes are below the estimated average requirement levels for nearly 50% of the United States, and a deficiency could lead to neuronal injury and/or altered chemical activity in the brain (possibly leading to migraine symptoms), the evidence supporting magnesium supplementation for prevention of migraines remains limited at this time. They do, however, note that “limited evidence” means dietary supplementation of magnesium may still be advised if patient’s are looking for preventative measures. (Teigen & Boes, 2015)

Where can you find magnesium in food? Green leafy vegetables like spinach and kale, beans, grains, seeds, nuts, and some seafood all contain magnesium in more significant quantities — so it is pretty easy to find! For a more complete list, follow the link here (Dietitians of Canada, 2015).

BONUS idea – Menthol (Peppermint)

Another intervention we have previously talked about, menthol has demonstrated effectiveness for managing migraine symptoms as well. In particular, a 10% ethanol solution of menthol applied to the forehead and temples was used. So there you go — peppermint, not just for the holidays! (Borhani Haghighi et al. 2010)


Dr. Jim GilliardDr. Jim Gilliard is a chiropractor in Burlington, ON at Endorphins Health and Wellness Centre— located in the Burlington Professional Centre at 3155 Harvester Road, Suite 406. If you have questions, comments, or wish to book an appointment, please feel free to contact him at your convenience.

Website: drjimgilliard.com 
Email: drjimgilliard@gmail.com 
Phone: (905) 634 – 6000

Primary References:
  1. Borhani Haghighi A, Motazedian S, Rezaii R, Mohammadi F, Salarian L, Pourmokhtari M, et al. Cutaneous application of menthol 10% solution as an abortive treatment of migraine without aura: A randomised, double-blind, placebo-controlled, crossed-over study. Int J Clin Pract. 2010;64(4):451–6.
  2. Bronfort G, Haas M, Evans R, Goldsmith C, Assendelft W, Bouter L. Non-invasive physical treatments for chronic/recurrent headache (Review). Cochrane Database Syst Rev. 2004;(8).
  3. Derry CJ et al. Caffeine as an analgesic adjuvant for acute pain in adults. Cochrane Database Syst Rev. 2012;(12).
  4. Köseoglu E, Talaslioglu A, Gönül AS, Kula M. The effects of magnesium prophylaxis in migraine without aura. Magnes Res. 2008;21(2):101–8.
  5. Linde K, Allais G, Brinkhaus B, Manheimer E, Vickers A, White A. Acupuncture for migraine prophylaxis (Review). Cochrane Database Syst Rev. 2009;(1).
  6. Olesen J et al. The International Classification of Headache Disorders, 3rd edition. Cephalagia. 2013;33(9):629–808.
  7. Ramage-Morin PL, Gilmour H. Prevalence of migraine in the Canadian household population. Health Reports. 2014;25(6):10–6.
  8. Smitherman TA, Wells RE, Ford SG. Emerging behavioral treatments for migraine. Curr Pain Headache Rep. 2015;19(13).
  9. Teigen L, Boes CJ. An evidence-based review of oral magnesium supplementation in the preventive treatment of migraine. Cephalalgia. 2015;35(10):912–22.

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