Migraine is a neurological disease characterized by recurrent moderate to severe headaches. A migraine headache is described as a throbbing, pounding, or pulsating pain and is often associated with specific and characteristic autonomic nervous system (ANS) symptoms. Typically, headache affects half of the head (hemicranial) but may occur on both sides or oscillate from side to side. Migraines generally last from 2 to 72 hours. The pain can be made worse by movement, coughing, straining, or flexing the head.
Associated symptoms may include nausea, vomiting, and sensitivity to light, sound, or smell. The pain is generally made worse by physical activity. Up to one-third of people with migraine headaches perceive an aura - a transient visual, sensory, language, or motor disturbance that signals that the headache will soon occur (aura). A migraine without an aura (common migraine) may be preceded by mental fuzziness, mood changes, fatigue, and an unusual retention of fluids. Occasionally, an aura can occur with little or no headache following it.
Causes of migraines
According to the ‘Migraine Trust’, the exact cause of migraine is not fully understood. Migraine has long been observed to run in families (about two-thirds of cases) so it is thought that there is a genetic component. In fact, recent research has identified genes for rare types of migraine. People who get migraines may have certain abnormal genes that control the functions of specific brain cells. Current research is focused around the notion that people who have migraine have a hyper sensitive or ‘hyper- excitable’ cortex as a result of aberrant neurones in the trigeminal cortex of the brainstem. The implications are that the sensitivity threshold is lower in this group than the normal population. This degree of sensitivity is possibly genetically determined, influencing the threshold for triggering attacks. The trigeminal nerve is long and has a cervical branch that loops all the way down to C3. En-route the nerve puts out branches that supply the joints, discs, ligaments and arteries. It has been suggested that any of the structures in these areas as well as muscular trigger points in the region may contribute to this ‘input’.
Migraine symptoms are also now thought to be due to abnormal changes in levels of substances that are naturally produced in the brain. Until fairly recently it was a commonly held view that an alteration in chemical substances such as serotonin and other vaso-stimulatory neurotransmitters affected the blood vessels in the brain (vascular system input), causing them to become inflamed and swollen, resulting in a migraine headaches. However, changes in blood vessels are now thought to be secondary to more important changes in brain chemistry.
We do know that people with migraines react to a variety of factors and events. These "triggers" can vary from person to person and don’t always lead to migraine. A combination of triggers — not a single thing or event — is more likely to set off an attack and each persons response to triggers can vary from migraine to migraine.
The four stages of migraine
Typically migraines go through four distinct phases:
1. The prodrome, which occurs hours or days before the headache (60%)
2. The aura, which immediately precedes the headache visual disturbance (99%), sensory effects (50%) lasting for about an hour
3. The pain phase, also known as headache phase. Classically throbbing with moderate to severe pain and aggravated by physical activity. Frequently associated with nausea and vomiting, photophobia, phonophobia and sensitivity to smell. Swelling or tenderness of the scalp may occur as can neck stiffness.
4. The postdrome - the effects experienced following the end of a migraine attack. The effects of migraine may persist for some days after the main headache has ended. The patient may feel tired or ‘hung over’ and have head pain, cognitive difficulties, gastrointestinal symptoms, mood changes, and weakness.
Trigger Points and Migraine
We recently published a blog detailing a number of research studies that have identified the connection between migraine and trigger points. In one recent study (Calandre), trigger points were found in 94% of migraines. The number of individual migraine trigger points varied from zero to 14, and was found to be related to both the frequency of migraine attacks, and the duration of the disease. Approximately 75% of the total detected trigger points were found in temporalis and/or suboccipital (obliquus capitis) areas. Other locations were mainly found in patients showing more than four trigger points and included the orbicularis occuli and occipitofrontalis.
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