Updated: May 6, 2021
How to combat headache or migraine symptoms and see lasting relief
This blog post is about migraines and since I have them I know them better than most. Let's start with headaches then move specifically into migraines and the debilitating migraine symptoms and end with effective treatments.
There are currently 150 types of classified headaches and I will concentrate on the types with musculoskeletal and/or cervicogenic origins. Here is a small list of the most common types of headaches: Tension, allergy or sinus, caffeine, cervicogenic, exertion, hypertension, rebound, hormone, post-traumatic, medication, migraine, cluster headache and medication. Conservative treatment utilizing manual therapies can manage tension, cervicogenic, migraine and post-traumatic/whiplash related headaches.
A brief breakdown of headaches:
Sinus headache - a deep and constant pain/pressure in the cheekbones, forehead or bridge of the nose. The pain increases with strain and changes the position of the head. Runny nose, a feeling of fullness in the ears, fever or swelling in the face.
Caffeine headache - a withdrawal symptom (sorry, you most likely knew this). It normally occurs on the weekends when the routine of Monday through Friday involves coffee drinking. On Saturday, the headache begins and grows worse throughout the day. Drinking caffeine or tea takes the headache away.
Tension headaches - 10 or more headaches lasting 30 minutes to 7 days with 2 of the 4 symptoms. Bilateral, not pulsing, mild or moderate intensity, not aggravated by routine physical activity. No nausea or vomiting, sensitivity to light and/or sound and not attributed to another disorder.
Migraine headache - 5 attacks or greater lasting 4 to 72 hours with 2 of the 4 symptoms. Unilateral, pulsating, moderate to severe intensity, aggravated by routine physical activity. One or both of sensitivity to sound and/or light and not attributed or caused by another disorder.
Here is where science and art of practice begin to mix. The above criteria was established by the IHS and gives a set criteria for diagnosing a migraine vs tension headache.
41% of patients report bilateral headache pain instead of only on one side. 50% of the time there is no pulsatile sensation and ⅓ of the patients have an aura. Neck pain is present in 75% of migraines and finally stress. Other factors including family history of migraine, predictable timing around menstruation, characteristic migraine triggers, motion sickness or episodic vomiting can make the diagnosis easier.
For the best diagnosis, the following criteria are used:
Nausea - are you nauseated or sick to your stomach when you have a headache?
Disability - has a headache limited your activities for a day or more in the last 3 months? Photophobia - does light bother you when you have a headache?
If you have 2 out of 3 symptoms it is 93% and if you have 3 out of 3 symptoms it jumps to 98%.
After all this information about migraines, I hope you are finally asking what can be done about them? Is there a treatment? These sound horrible. Yes, there are multiple treatments with quality research about reducing and even resolving symptoms. Graston Technique (instrument assisted soft tissue manipulation), cervical manipulation, dry needling and dry needling with electrical stimulation all have been shown to reduce the intensity of pain, shorten the time the migraine is present and reduce the frequency of attacks. For most patients, using a combination of these therapies along with medication is the best approach. The current mechanisms for why migraines happen can all be managed using manual therapies and medication.
I can use myself for this example of a combination approach. My migraines have been ongoing for 20 years plus and can be managed by manual therapy. They start with tension at the base of the skull on the right and slowly move to behind my right eye. The throbbing begins within 15-20 minutes and continues until the pain is so severe I have to lay down in a dark and quiet room.
Nausea is present with movement and managed by not moving. I take 2 Excedrin® migraine and seek treatment when I notice the pain. Treatment is dry needling to the upper cervical musculature at the base of the skull, traction mixed with Graston technique to the same musculature followed with manipulation of the upper cervical spine. I then take 2 more Excedrin® and use topical CBD cream. This formula usually resolves the migraine symptoms within an hour however I have had this not work and needed to take my prescription medication.
I hope you enjoyed reading about migraines and how they can be managed.
Headache Diagnosis and Testing - American Headache Society