There is widespread agreement that the underlying disorder in Migraine is a sensitised brainstem. The brainstem lies at the base of the brain and extends down to sit inside the upper vertebrae of the neck.
The brainstem receives information from structures within the head and the structures of the upper cervical spine (top of the neck) and can become sensitised from the presence of a disorder within these areas.
It has long been assumed that the throbbing pain associated with Migraine is due to the dilation of blood vessels in the head. However, with the advancement of technology, research clearly shows that this is not the case. The amount of blood vessel dilation present during a Migraine is minimal and not significant enough to elicit the severe pain of a Migraine.
Migraines are often categorised into Migraines with aura and Migraines without aura, the most common type being without aura.
An aura is the gradual development of neurological symptoms prior to the onset of Migrainous head pain. These symptoms are typically present for 20 to 45 minutes prior to the onset of pain. Symptoms can include changes in sensation (tingling, numbness, pins and needles), altered vision (blurring, blind spots, lights, colours, lines or shapes), slurred speech or loss of coordination.
Less common is the diagnosis of Silent Migraine. This is the presence of an aura (as described above) but without the development of head pain.
Migraine pain is commonly described as throbbing or pulsating and is typically located on one side of the head. The side of pain may change within or between episodes. The pain intensity ranges from moderate to severe and can last from 4 hours to 3 days in duration.
Symptoms can also include sensitivity to light, sound and smell, neck pain or stiffness, dizziness, nausea, vomiting and disturbance of vision.
Medication is the most common form of treatment for Migraine. Triptans have been found to provide relief in approximately 70% of migraineurs. In New Zealand, sumatriptan and rizatriptan are typically prescribed. Triptans act by temporarily desensitising the brainstem. Unfortunately as the cause of this brainstem sensitisation has not been addressed the brainstem becomes sensitised again as the medication wears off.
In order to achieve long-term relief from Migraines, the source of the sensitisation needs to be identified.
Recent research considers the upper cervical spine to play a significant role in the sensitisation of the brainstem. This is further strengthened by the knowledge that as many as 80% of migraineurs have stiffness or pain in the cervical spine during or before a Migraine.
A skilled assessment of the cervical spine is critical to determine its role in the sensitisation of the brainstem in Migraineurs.
At The Headache Clinic, our clinicians work exclusively in this field and are home to some of New Zealand's most experienced practitioners using The Watson Headache Approach. This groundbreaking approach is world-renowned and is a targeted technique used to identify subtle dysfunction in the upper cervical spine.