Well, no headache today! In this post we are going to have a look at migraines. I have suffered from migraines all my adult life having gone through a period in my 20’s and 30’s were they were quite common and debilitating. I would wake in the early morning with a burning feeling in my stomach and start throwing up. It would be like that for the next 15 hours. The only thing I could do was lie down in a dark room and stay as still as possible as every time I moved I would be sick!
As I’ve got older the migraines have sub-sided but I still get them but not to the extent I had before.
So what are migraines?
A migraine is a recurrent headache that strikes after, or along with sensory disturbances known as an aura. It usually affects only one side of the head and appears gradually. It feels pulsating or throbbing pain and can include flashes of light, blind spots and other vision changes, or tingling in your hand or face. Nausea, vomiting, along with a hypersensitivity to light and noise are also common symptoms.. A migraine can last between 2 to 48 hours (sometimes longer). It can be of moderate to severe intensity, and can be aggravated by routine physical activity.
Migraines affect around one in 10 people. They are three times more common in females and tend to affect young people who are otherwise healthy. Migraines can be genetic with most people who get migraines will have a family member with the same problem, although researchers are not sure how genetic factors cause migraines.
A migraine is thought to be a neurovascular pain syndrome meaning it involving nerves and blood vessels. The electrical activity in the nerves in the brain stimulate the surrounding blood vessels to release painful inflammatory chemicals, but very little is actually known about it. The pain is often so bad that it makes it very hard to drive or concentrate. An aura typically consists of a combination of disturbances:
- Visual – including seeing spots and lights or being aware of blind spots
- Sensory – include tingling and pins and needles or numbness
- Movement problems – include reduced coordination, dizziness and speech disturbance.
These symptoms tend to happen up to 60 minutes before the onset of a migraine, almost like a warning sign but disappear when the migraine ends.
HOW IS MIGRAINE DIAGNOSED?
As we are all individual, everyone can present differently and may have features of other headache types which can make diagnosis difficult. Most headaches can be diagnosed and classified according to your history and an examination by a Doctor. Unfortunately, there is no one specific test, scan or examination that can confirm or differentiate a migraine from another type of headache. In some cases you may be referred to a neurologist who specialises in migraines, who can help with medication prescription.
WHAT ARE TRIGGERS FOR MIGRAINES?
There are many causes or ‘triggers’ for migraines and being able to identify them in yourself will help to keep your migraine episodes at bay. I have found my main triggers to be sunlight (a pain when you love the sun!), not drinking enough water and problems with my neck.
You may find keeping a diary of what you have done, or eaten and drunk during the day will help you to identify any patterns or triggers that set off your migraines and then you may be able to avoid these triggers.
We have dealt with a lot of people who suffer from different types of headaches and have a Headache Diary Sheet that we use with our clients. If you are interested in a headache diary you can email us on firstname.lastname@example.org and we will send one out to you.
Triggers may include:
- Vasodilators (medication that widens the blood vessels)
- Skipping meals
- Changes in the weather (some people can tell if there’s going to be a thunderstorm)
- Dehydration – not drinking enough water
- Sleep deprivation
- Excessive afferent stimuli (eg. flashing lights, strong odours)
- History of head trauma and/or underlying neck problem
- Hormonal changes, monthly cycle, contraception, menopause
- Certain foods – chocolate, caffeine, aspartame (artificial sweetener), sugar, processed meats, foods containing lots of colorants and preservatives
- Genetics – there is a family history of migraines in about 60% of cases, suggesting a hereditary factor exists.
HOW CAN PHYSICAL THERAPY HELP MIGRAINES?
You may present with a few or all of the above symptoms, with or without an aura. Each treatment needs to dealt with on an individual basis, because what works for one person, may not work for you. Contacting your Remedial Massage Therapist, Doctor, or an Allied Health Professional is a step to finding what works best for you. Most people believe migraines are only managed through medication and avoidance of triggers. Yes, medication does play a vital role in migraine management, however there are many benefits from Massage Therapy and Reflexology can also help. With migraines, muscles around your head and neck can become very tender and present with spasm. Combined with any stress or underlying neck pain, massage therapy may be key to reducing the pain and intensity of your migraine episode as well as decreasing the frequency and duration of each episode.
- Massage has been shown to be as effective as some medications in reducing the pain and intensity of a migraine. Regular massage has also been shown to
be a good preventative measure for migraine management substantially reducing the frequency of migraines.
- Cold cloth or gel ice packs can be applied at the onset of a migraine, and can significantly reduce the pain.
- Exercise has been shown to be an important part in the management of migraines. In some people activity can be a trigger for their migraines, and avoiding physical activity during a migraine is normally necessary. However, regular exercise has been proven to reduce the intensity and frequency of migraines. Gradually build up your level of physical activity under the guidance of a personal trainer can help. In addition, specific neck exercises and stretches can be used to reduce tension and stress between episodes and even during an attack.
- Acupuncture has been shown to be effective in reducing pain intensity with migraines. Long term regular treatment has shown a decrease in the need of medication necessary to manage the migraine.
- Relaxation techniques – relaxation and deep breathing techniques that may be used during or preceding a migraine can help reduce its intensity and improve your coping mechanism during an attack.
WHAT CAN YOU DO DAY TO DAY?
There are some simple ideas you can implement at home which can help you manage a migraine:
- Lie quietly in a cool dark room
- Place a cold flannel or cold pack on your forehead or neck
- Do not drink tea, coffee, orange juice or alcohol or anything with caffeine
- Avoid moving around too much
- Use meditation and relaxation techniques
- Listen to quiet soothing music, providing noise is not a trigger for you
- Do not read or watch TV, avoid any screen time
- Do not drive
- Some people find relief from ‘sleeping off’ an attack
- Take medication as directed – the earlier you start treatment the better, don’t leave it and wait to see how you go. Take medication as prescribed as soon as you know the migraine is coming on.
Other tips that may reduce the frequency or intensity of your migraine include:
- Wearing sunglasses regularly, possibly transitional glasses that can reduce the glare even indoors. I have been known to wear sunglasses around the house when it’s sunny.
- When commuting wear ear plugs or listen to relaxing music to drown out loud noises that may be triggers.
- Daily schedule and regular sleep routine can help regulate your migraines
- Stress or anxiety management – know what you can cope with at work and home and plan accordingly. This may include using tools that work for you to relieve stress including exercise, regular massage, reflexology, meditation or a yoga class, and mindfulness.
- Reduce screen glare – try and cut down screen time where possible. Wear rosetinted glasses (yes they do really exist) to reduce the blue tint from the screen which can be harsh and is thought to be a possible migraine trigger. Purchase an anti-blue light screen protector.
70% of individuals with PTSD, suffer from migraines. Advice and counselling may improve the symptoms of both conditions. In people who suffer frequent (more than 15) migraines a month, 25% have depression, and up to 50% have anxiety. Or is it that the anxiety and depression bring on the migraine? Either way migraines are a serious condition that can affect your daily life and so the more you can do to mitigate the symptoms and make surviving them a bit easier, the better.
When to get medical advice
According to the NHS website ‘you should see a GP if you have frequent or severe migraine symptoms. Simple painkillers, such as paracetamol or ibuprofen, can be effective for migraine. Try not to use the maximum dosage of painkillers on a regular or frequent basis as this could make it harder to treat headaches over time. You should also make an appointment to see a GP if you have frequent migraines (on more than 5 days a month), even if they can be controlled with medicines, as you may benefit from preventative treatment.
You should call 999 for an ambulance immediately if you or someone you’re with experiences:
- paralysis or weakness in 1 or both arms or 1 side of the face
- slurred or garbled speech
- a sudden agonising headache resulting in a severe pain unlike anything experienced before
- headache along with a high temperature (fever), stiff neck, mental confusion, seizures, double vision and a rash
These symptoms may be a sign of a more serious condition, such as a stroke or meningitis, and should be assessed by a doctor as soon as possible.
All information contained in these post are for general guidance and information only. It should not be relied as a basis for planning medical care or as a substitute for specialist medical advice in each individual case.