What is Migraine?
Migraine is a chronic neurological disorder characterised by episodic attacks of head pain and associated symptoms.
Migraine pain will always present on one side only (although the side can change between attacks). The pain is often described as throbbing and is of moderate to severe intensity. The pain will cause avoidance of everyday activities such as attending school or going to work.
Migraine sufferers will usually have one or more of:
- photophobia (hypersensitivity to light),
- phonophobia (hypersensitivity to noise).
Migraine headaches will usually last between four hours and, in extreme cases, up to three days.
What is Migraine with Aura?
Some migraine sufferers also experience an Aura. This aura typically consists of a combination of visual, sensory, and sometimes movement disturbances. These symptoms will be completely reversible and occur up to 60 minutes BEFORE the onset of a migraine.
Visual symptoms can include seeing spots and lights or being aware of blind spots. Tingling, pins and needles or numbness may be your sensory signs. Movement problems can reduce coordination, dizziness and speech disturbance.
What Causes Migraine?
The truth is that we don’t know with absolute certainty what causes migraines. One current theory is that a phenomenon known as cortical spreading depression is responsible for the disorder. In cortical spreading depression, electrical activity reduces over an area of the brain’s cortex (grey matter). Specific cells released irritate nerves in the brain stem, causing headaches.
Researchers feel three main factors contribute to a migraine and headache. They are:
- Pain causing structures in the head;
- Pain causing structures in the neck; and
- Serotonin – the chemical.
Perhaps the many different presentations of migraine and headache resulting from these three factors in different proportions. Supporting this is that the presenting features of the other headache types overlap, and it is difficult to make a diagnosis from these features alone.
Research has shown that sufferers of a common migraine (without an aura, for example, visual or speech disturbances) and cervicogenic headache share similar symptoms. (Sjaastad O et al. Laterality of pain and other migraine criteria in common migraine. A comparison with cervicogenic headache. Funct Neurol 1992;7:289-94)
What are the Signs and Symptoms of a Migraine?
While the theory is yet to be proven, several signs and symptoms help us diagnose migraines. These can include:
- Headache attacks lasting 4 to 72 hours.
- A one-sided headache, although a headache can shift sides within and between attacks.
- Pulsating or throbbing headache.
- Moderate to severe intensity, which limits daily activities.
- Physical activity aggravates.
- Sensitivity to light or sound.
- Nausea and or vomiting
- The development of disturbance of your vision or an aura. This usually comes before the migraine starts and commonly lasts about 60 minutes.
The diagnosis of a migraine is an umbrella term. There are many different versions of a migraine. They are all grouped under the same umbrella migraine diagnosis. Your migraine may exhibit all of the symptoms listed above, or you may have four or five symptoms.
Migraines are individual, and because of this, your treatment must also be specific to you. Please consult your health professional for their professional opinion.
How is Migraine Diagnosed?
Migraine misdiagnosis can result from a focus on only one symptom. To be sure of a diagnosis, you should notice two or more of the mentioned symptoms. It is important to remember that not all symptoms associated with migraine diagnostic criteria are required.
Your GP can refer you to a Neurologist who specialises in migraines.
Common Causes of Headache & Migraine
Specific Migraine - Headache Types
- Neck Pain
- Bulging Disc
- Wry Neck
- Text Neck
- Pinched Nerve
- Cervical Radiculopathy
- Facet Joint Syndrome
- Neck Sprain
- What Causes Cervicogenic Headache?
- How Do You Get Rid Of A Neck Headache?
- When Should You Be Concerned About A Headache?
What's Causes Cervicogenic Headache?
Your neck headache originates from a variety of musculoskeletal and neurovascular structures. These structures include the upper three neck joints, C2/3 disc, spinal cord coverings, and neck muscles. Dysfunction in these areas can trigger pain signals that travel to your trigeminocervical nucleus (TCN) in your brainstem. This information is then transmitted into your brain and interpreted as a headache (Bogduk 2003).
Upper Neck Joints
The most likely source of your neck headache is a dysfunction of your upper neck joints. Your neck muscles or nerves become involved from pain signals that travel to your trigeminal nucleus in your brainstem, where you interpret the pain signals as a neck headache.
The most common cause of a neck headache is the dysfunction of your upper three neck joints. The most common neck joints involved are your:
- atlantooccipital joint (O-C1),
- Atlanto-axial joint (C1/2), and
- C2/3 cervical spine joints.
In simple terms, your neck joints can cause a neck headache or pain if they are either too stiff or move too much (e.g. wobbly and unsupported by weak muscles) or locked in an abnormal joint position, e.g. a locked facet joint or poor neck posture. Once your neck joint becomes stressed and painful, the pain signals refer to the trigeminocervical nucleus in your brainstem. You start to feel a neck headache or, in some cases, face pain!
Your neck and headache physiotherapist can assess and correct neck joint dysfunctions that result in a neck headache. Their professional diagnosis and treatment are essential for neck headache sufferers.
Your neck and shoulder blade muscles that originate from your neck will cause pain if they are overworking, knotted or in spasm. Some of your neck muscles overwork when protecting injured neck joints. Other neck muscles become weak with disuse—this further demands your overworking muscles resulting in muscle fatigue-related symptoms. Your deep neck flexors are frequently weak or lack endurance. Your neck muscles work best when they have healthy resting tension, length, strength, power and endurance.
Your skilled physiotherapist assesses and helps you correct any muscle imbalances that result in a neck headache.
Cervical and Occipital Nerves
Nerves in your upper neck may become pinched by extra bony growths, e.g. arthritis, disc bulges or swelling. The results can result in nerve irritation or a reduction in the neural motion known as neuromechanosensitivity or abnormal neurodynamics. Irritation of your upper neck structures refer to pain messages along the nerves and cause your headache. In simple terms, your neck is the "switch", nerves are the "power cords", and your headache is where the "light" comes on.
Your headache physiotherapist can assess your neuromechanosensitivity.
How Do You Get Rid Of A Neck Headache?
Quality neck physiotherapy can have a speedy and effective result for relieving your neck headache—the key to better treatment response in confirming your diagnosis. After your assessment, your physiotherapist will start you with treatment techniques that address your problems.
Your neck headache treatment may include all or some of the following techniques:
- Stiff neck joints may need to be loosened or unlocked via joint mobilisation (gentle gliding techniques), joint traction or, in specific cases, a gentle and localised joint manipulation technique.
- Hypermobile (or dynamically unstable) joints may require specific deep neck muscle strengthening exercises to stabilise, control and limit the joint movement available.
- Tight or overactive muscles may require muscle stretching, neck massage, acupuncture, dry needling, trigger point release or other relaxation techniques.
- Weak muscles may require specific strengthening exercises. This weakness may include your postural shoulder blade and neck muscles.
- Nerve dysfunction identified by your physiotherapist will depend upon your specific examination findings. Neurosensitivity is a common finding that needs addressing with attentive, professional care.
- Posture correction via specific posture exercises, posture awareness techniques, posture taping, or a brace.
- Provide helpful advice on preventing neck dysfunction in the future, e.g. workstation setup, ergonomics, awkward neck positions and postures to avoid.
Who Treats Cervicogenic Headaches?
In addition to relieving your neck headaches, your physiotherapist aims to address why you are experiencing neck headaches. After all, helping you to avoid future neck headaches is a crucial component of your rehabilitation. Chronic headache sufferers typically resolve their neck headaches within days or weeks.
Relief of your neck headache is quite often immediate! If a neck headache solely causes your trouble, it is common to experience instant relief as you walk out of the clinic.
Depending on the severity and the specific underlying causes of your neck headaches, most sufferers will experience a reduced headache after your initial consultation.
For more information, please consult your neck headache physiotherapist.