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Migraine

Migraines are more than a simple headache, they are vascular in origin and often present with a multitude of other symptoms including neurological symptoms. They affect a broad spectrum of individuals from children under 10 years old to OAP's. It has been reported that migraines decrease productivity and cost the British economy £200 million a year (Longmore et al, 2001).

Common presentations include:

  • A headache that is often sharp, pulsating, and in a unilateral temporal region, which may become bilateral or spread to the suboccipital region.
  • Visual symptoms; e.g. flashing lights, spots on the visual field or possible decreased vision.
  • Sensory changes; e.g. pins and needles and/or numbness
  • Nausea/vomiting
  • Extreme cases can result in dysphagia
  • Vertigo

The visual and sensory changes in a migraine are temporary and fully reversible.

Diagnosis relies on the diagnostic criteria outlined by The International Headache Classification ICHD-2:

Migraine without aura: There must be a history of 5 attacks which include the symptoms below:

  • A headache with a duration of 4-72 hours.
  • The inclusion of vomiting/nausea and/or photophobia or phonophobia.
  • And at least 2 of the following- unilateral location, pulsating quality, worse with activities of daily living and pain rated between moderate and severe.

Migraine with Aura: Presentation of 2 attacks, which must contain at least a visual or sensory change or dysphagia, which are fully reversible.

  • Each symptom lasting a minimum of 5 minutes up to 1 hour.
  • Aura developing within 5 minutes and gradually progressing.
  • The headache should develop during or within 60 minutes post aura.
  • Lastly there must be no other causes noted for the onset of symptoms for it to be diagnosed as a migraine
    (Information adapted from the International Headache Classification website).

Precipitating factors include;

  • Stress
  • Endocrine changes e.g. pregnancy
  • Medication- E.g. Glyceryl trinitrate, indomethacin. The contraceptive pill is contra-indicated in people with a history of migraines with focal neurology.
  • Food/drink- coffee, alcohol, chocolate, cheese
  • Metabolic changes
  • Blood pressure changes
  • Familial link (50%)
  • Females>males (2:1)
  • Unstable nervous system (Longmore et al, 2001; Brukner and Khan, 2010).

Treatment
Effective treatment completely depends on the triggers involved, but can include:

  • Sleep
  • Staying in a dark room.
  • Medications can be prescribed such as a high-dose Aspirin (ASA), which is favoured by some for acute treatment of migraines (Brukner and Khan, 2010).
  • Cesation of medication eg. the contraceptive pill is not advised if the migraine is present with aura.
  • Hydrotherapy
  • Massge, to include trigger point therapy.
  • Manipulation of the cervical and thoracic spine to reduce dysfunction (72% effective).
  • Relaxation can be suggested especially if the individual is a type A personality (Carnes and Vizniak, 2007).

What the Blackberry Clinic can offer?

The Blackberry Clinic has a highly experienced team of Osteopaths, Chiropractors and Physiotherapist's who are all trained in a range of manual therapy techniques including soft tissue massage and spinal manipulation. They are able to administer a variety of treatment techniques to speed up recovery and reduce reoccurrences. Tuchin et al (2000) conducted a study investigating the effects of manual therapy on 123 individuals aged between 10-70 years who suffered with migraines. Statistically significant improvements were reported in the duration, frequency and disability of the migraine. A reduced use of medication was also noted.

Contributing Author:
Louise Barrett, BSc Osteopathic Medicine

References
Brukner P., and Khan K., (2010). Clinical Sports Medicine. Revised 3rd Ed. Australia: McGraw-Hill Australia Pty Ltd. 210-211.

Carnes M., and Vizniak N., (2007). Quick reference conservative care conditions Manual. Canada: Professional Health Systems Inc. 34-35.

The International Headache Society (IHS). (2003-2005). Migraine. Available: http://www.ihs-classification.org/en/02_klassifikation/02_teil1/01.02.01_migraine.html. Last accessed 22nd Aug 2013.

Longmore M., Wilkinson I., Torok E., (2001). Oxford Handbook of Clinical Medicine. 5th ed. New York: Oxford University Press Inc. 332.

Sánchez-del-Rio M., Reuter U., (2004). Migraine aura: new information on underlying mechanisms. Current Opinion in Neurology. 17 (3), 289-93.

Theoharides T, Donelan J, Kandere-Grzybowska K, Konstantinidou A . (2005). The role of mast cells in migraine pathophysiology. Brain Research Reviews. 49 (1), 65-76.

Tuchin P.J., Pollard H., and Bonello H., (2000). A randomized controlled trial of chiropractic spinal manipulative therapy for migraine. Journal of Manipulative and Physiological Therapeutics . 23 (2), 91-95.