Complementary Treatment for a Patient with Migraine Headaches

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Complementary Treatment for a Patient with Migraine Headaches

In 2017 The Lancet - Global Burden of Disease study, listed migraine headaches as one of the leading cause of disability worldwide (GBD Neurological Disorders Collaborator Group 2017). 

Globally physicians, now more than ever are recommending complementary treatment options (ie. manual therapy, acupuncture, mindfulness stress based reduction (MSBR), pain neuroscience education and exercise) as part of a multi-modal approach to decrease the individual’s headache frequency, intensity, duration and acute medication requirements.

It is encouraging to see so many medical centers and clinical practice guidelines embracing a non-pharmacological approach for migraines

If a patient is interested in using acupuncture to manage migraine symptoms there is supporting evidence from The Cochrane Collaborative (Linde et al. 2016), Canadian Medical Association (Busse et al. 2017) and other high quality Systematic Reviews (Yang et al. 2016) and Randomized Control Trials (Zhao et al. 2017).

Medical acupuncture is an approach that is based upon a theory that is inline current scientific understanding of how the body works. Using occam's razor the insertion of an acupuncture needle is a form of novel stimuli, that functions by sending anti-nociceptive input to the neuroimmune system (Chen et al. 2017).

Preferential sites for acupuncture stimulation are associated with areas rich in specialized sensory receptors such as muscle spindles, Golgi tendon organs, ligament receptors, Paciniform and Ruffini’s receptors (joint capsules), deep pressure endings (within muscle belly), and free nerve endings (muscle and fascia). All of these areas are highly innervated and as a result there are a number of physiological responses that help modulate the experience of pain.

Soft Tissue Irritation & Nerve Sensitization

For migraine suffers soft tissue irritation and subsequent nerve sensitization may be a major contributor to symptoms (Ferracini et al. 2017, Palacios-Ceña et al. 2017). This is where gentle manual therapy of the upper cervical spine may help avoid ongoing nociceptive input into the trigeminocervical complex (Luedtke et al. 2017).

A biopsychosocial framework helps put into context the interconnected and multidirectional interaction between: physiology, thoughts, emotions, behaviors, culture, and beliefs. In terms of clinical responses to massage therapy there are a couple of proposed mechanisms of action, including but not limited to: neurodynamics, contextually aided recovery, neuromodulation, social grooming and mechanotherapy.

Treatment Plan Based on Patient Tolerance

My first recommendation for those who suffer from migraines is to work with a physician to develop strategies to manage symptoms. Then a treatment plan can be implemented based on patient-specific assessment findings and patient tolerance. 

Structures to keep in mind while assessing and treating patients suffering from migraine headaches may include neurovascular structures and investing fascia of:
• Upper Cervical Spine (Suboccipitals, Upper trapezius, Splenius Cervicis, Splenius Capitis)
• Levator Scapula
• Rhomboids
• Temporalis
• Occipitofrontalis
• Corrugator Supercilii
• Masseter
• Sternocleidomastoid
• Temporomandibular Joint
• Scalene Muscle Group

More to Explore

Books
Migraine Brains and Bodies - C.M. Shifflett
Migraines: More than a headache - Elizabeth Leroux
The Migraine Brain - Carolyn Bernstein

Research
Arendt-Nielsen, L., Castaldo, M., Mechelli, F., & Fernández-De-Las-Peñas, C. (2016). Muscle Triggers as a Possible Source of Pain in a Subgroup of Tension-type Headache Patients? The Clinical Journal of Pain.
https://www.ncbi.nlm.nih.gov/pubmed/26550960

Ashina, M., Hansen, J.M., Á Dunga, B.O., Olesen, J. (2017). Human models of migraine - short-term pain for long-term gain. Nat Rev Neurol.
https://www.ncbi.nlm.nih.gov/pubmed/28984313

Berchtold, V., Stofferin, H., Moriggl, B., Brenner, E., Pauzenberger, R., Konschake, M. (2017). The supraorbital region revisited: An anatomic exploration of the neuro-vascular bundle with regard to frontal migraine headache. J Plast Reconstr Aesthet Surg.
https://www.ncbi.nlm.nih.gov/pubmed/28712884/

Borea, P. A., Gessi, S., Merighi, S., & Varani, K. (2016). Adenosine as a Multi-Signalling Guardian Angel in Human Diseases: When, Where and How Does it Exert its Protective Effects? Trends in Pharmacological Sciences.
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