What can help with my migraine headaches?

A migraine has for a long time been considered to be a headache disorder. Severe, debilitating headaches can undoubtedly be one of the most noticeable symptoms, but they are not “the problem”. It is important to realise that as our understanding of the migraine condition has progressed over the years, research has discovered that a migraine is a genetic disorder which involves problematic brain chemistry.

Migraine sufferers have an increased sensitivity to a series of “triggers”, which can launch a migraine attack. One of the most commonly seen triggers is a change in sleep behaviours. Less sleep than usual, more sleep than usual, disturbed sleep or changes to daily bedtime or waking time have all been implicated in bringing on migraine attacks.

Studies have shown that sufferers of a migraine may be deficient in their ability to produce a chemical called Melatonin, which plays a role in regulating the sleep-waking cycle. It also has anti-inflammatory effects inside the body.

It has also been shown that people with impaired sleep have more sensitivity in a part of the brain called the “Caudal Trigeminal Nucleus”. This increased sensitivity can produce “allodynia” which means an increased sensitivity to pain.

Interestingly, nerve pathways from the upper neck also join into this same nucleus, and mechanical irritation to those nerves can add stress to an already struggling system.

This combination opens up the opportunity to treat the patient from two perspectives. Chiropractic adjustments delivered specifically to the upper neck can restore better movement and reduce painful signalling through those nerves. Also, ensuring that the person has adequate levels of melatonin can serve to minimise background sensitivity even further. Both of these factors are important because the further away from the threshold we can get, the less likely we are to initiate a migraine headache attack.

Both animal and human studies suggested that taking 3 mg of melatonin before bedtime had a positive effect on preventing migraine attacks, and was in many cases superior to commonly used migraine headache medications.

If you are a migraine headache sufferer, your chiropractor can discuss your specific case details with you, and explore the possibility of whether chiropractic adjustments, melatonin supplementation or a combination of both would be beneficial to help you manage your migraine syndrome. Please bear in mind that given the genetic nature of the migraine syndrome, a complete cure is not something we expect to occur, but like someone suffering from asthma, there are ways it can be managed to minimise the impact on your quality of life.

I’d like to acknowledge Dr Matthew Long for his work in providing this information on his clinical clarity blog.


References:


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2. Seidel, S., Hartl, T., Weber, M., Matterey, S., Paul, A., Riederer, F., et al. (2009). Quality of sleep, fatigue and daytime sleepiness in a migraine – a controlled study. Cephalalgia, 29(6), 662–669. doi:10.1111/j.1468-2982.2008.01784.x


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6. Lovati, C., D’Amico, D., Bertora, P., Raimondi, E., Rosa, S., Zardoni, M., et al. (2010). Correlation between presence of allodynia and sleep quality in migraineurs. Neurological Sciences, 31 Suppl 1, S155–8. doi:10.1007/s10072-010-0317-2


7. Tanuri, F. C., Lima, E., Peres, M. F. P., Cabral, F. R., Graça Naffah-Mazzacoratti, M., Cavalheiro, E. A., et al. (2009). Melatonin treatment decreases c-fos expression in a headache model induced by capsaicin. The journal of a headache and pain, 10(2), 105–110. doi:10.1007/s10194-009-0097-3


8. Peres, M. F. P., Zukerman, E., da Cunha Tanuri, F., Moreira, F. R., & Cipolla-Neto, J. (2004). Melatonin, 3 mg, is effective for migraine prevention. Neurology, 63(4), 757.


9. Peres M, Gonçalves AL. Double-blind, placebo controlled, a randomized clinical trial comparing melatonin 3 mg, amitriptyline 25 mg, and placebo for migraine prevention. Program and abstracts of the American Academy of Neurology 65th Annual Meeting, March 16-23, 2013; San Diego, California. Abstract S40.005.


10. Lu, WZ, Gwee, KA, Moochhalla, S, Ho, KY (2005). Melatonin improves bowel symptoms in female patients with irritable bowel syndrome: a double-blind placebo-controlled study. Alimentary Pharmacology and Therapeutics, 22(10), 927–934. doi:10.1111/j.1365-2036.2005.02673.x


11. Romanello, S., Spiri, D., Marcuzzi, E., Zanin, A., Boizeau, P., Riviere, S., et al. (2013). Association between a childhood migraine and history of infantile colic. JAMA, 309(15), 1607–1612. doi:10.1001/jama.2013.747

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