Migraine Headache and Upper Cervical Specific Chiropractic Care

Migraine trigeminal nerve upper cervical chiropractic care

 

INTRODUCTION TO MIGRAINES

 

This is my personal perspective on migraine headache combining what I know with what I have seen clinically while helping many patients with this condition.

 

Migraines are horrible things.  They are not mild tension headaches.  They cause pain, but also a whole host of other symptoms like numbness, vision problems, speech problems, nausea etc.  They will typically cause not only severe pain and symptoms to the point of having to go to bed for a day or so, but they often leave the sufferer groggy and hungover for another day or 2.  Often people who are chronic migraine sufferers would report to me that they lose 3-4 days of normal life with every single migraine.  Now that is debilitating.

 

 

Who gets migraines?

 

They are actually very common.  A study in 2018 in Australia[i] found:

  • 20% of Aussies suffer migraines
  • Most (71%) were females
  • About 5% of those sufferers were very debilitated, affecting 15 or more days out of every month. That’s half the year out of action.
  • Only 4% of those people had seen a chiropractor.

 

My own personal experience I would add a few things to who gets them.  I’ve noticed they often begin in girls once puberty kicks in, so there is a hormonal component.  They nearly always seem to run in families, so there could be genetic risk factors.  In fact if you’ve had even 1 migraine in you’re life you are predisposed and could get another if triggered.  They are very very commonly triggered by tension headaches which are caused most commonly by poor posture, neck strain, and sometimes eye problems.

Hardly any sufferers are seeing chiropractors, perhaps only 4%, so what are they doing for relief?  Medical care is the most common with various pain killing medications, nerve blocking injections and muscle paralyzing injections such as botox.  While these strategies offer relief they do not address root causes and are not risk free.

 

 

What are the root causes?

 

 

The exact cause is not well understood, but its commonly accepted that migraine pain is neuro-vascular, meaning there are nerves involved and blood vessels.

What nerves are involved?  The nerves most commonly involved are:

 

  1. The trigeminal nerve (see picture). This nerve has 3 branches, 1 which runs through your head and face to above the eye and forehead, the 2nd along your cheek, under your eye and the upper jaw and the lower branch runs down past your jaw along your jawline to your chin

 

  1. Occipital nerves. There are 2, the small one which is around the back of your head and the big one which goes from the base of your skull up over your head to right in behind your eye.

 

 

These nerves process all their incoming information in the brainstem.  Migraine sufferers have a particular problem with these nerves that they are very sensitive to sending pain signals.  Far more than the same nerves in people who don’t suffer migraines.

 

 

 

THE OVERFLOWING BUCKET ANALOGY

 

For a nerve to send a pain signal it needs to reach a threshold of stimulation.  Its like the overflowing bucket.  Think of all the “bad” information that is received by these nerves as water coming in.  Bad information (referred to as dysafferentation) is when the nerve sends information from a part which is injured, infected, damaged, under too much strain etc.  A little bit of bad information the body can process without pain but will begin to fill the bucket.  If enough bad info comes in to the processing centre, the bucket overflows and the painful migraine is triggered.

 

 

 

CAN THE BUCKET SIZE MATTER?

 

Yes. The healthier you are the bigger the bucket.  In this analogy a person with a big bucket will not be as susceptible to triggering a migraine.  The person with a big bucket is healthier and can handle more stressors before the bucket fills and spills.  Someone with a small bucket is not as healthy, and can easily cause it to overflow and trigger a debilitating migraine.  Why would the bucket be small?  The less healthy you are the smaller the bucket.  For migraines there also usually a genetic susceptibility to migraine.  It will be someone whose general health is not as good as it could be.  Poor health shrinks the bucket.  Stress will fill the bucket making it overflow.

 

 

How do I grow my bucket?

 

Can my bucket be bigger?  Yes.  If your health is improved you will have a bigger bucket.  It doesn’t mean a lot of bad information coming into the bucket will not overflow it, but you will be less likely to suffer migraines with better health and a bigger bucket.

 

 

WHAT ARE THE TRIGGERS THAT FILL THE BUCKET AND MAKE IT OVERFLOW?

 

Understanding this is the key to managing migraine.

 

Let’s simplify what is a really complicated condition and focus on the main nerve responsible for migraine pain.  The trigeminal nerve.  Imagine the trigeminal processing centre in the brainstem is a bucket.  If too much “bad” information comes in then the bucket overflows and pain signals are sent out triggering a migraine.  This nerve is responsible for pain in the head, face and jaw.  The trigeminal nerve gets DIRECT information that it processes from the face, teeth and jaw.  But it also receives a huge amount of INDIRECT information from other body parts whose processing centres converge in the brainstem.  “Bad information from any or all of these body regions could fill that trigeminal bucket.

 

What are the triggers that could fill the trigeminal nerve bucket and cause it to spill over into a painful migraine?

 

  1. NECK PROBLEMS:

 

 

  • In my experience this is the most common trigger for a large % of migraine sufferers. Often in these patients the migraine begins with a tension headache, or neck pain or stiffness.  This explains why studies suggest 75% of people who have chiropractic care focusing on the upper cervical spine experience relief.  The upper neck protects the 1st 3 spinal nerves which all converge in the brainstem at the trigeminal nucleus.  The same trigeminal region which transmits migraine pain.  Those nerves carry all the information about the body between the base of the skull to the 3rd  So the joints, the muscles, the ligaments, the glands etc If any of those structures are irritated or damaged or painful that will constantly fill the trigeminal nucleus bucket potentially causing it to spill over into triggering a migraine.    Irritation and damage to the upper neck is arguably the most common place in the entire body.  Bad posture, whiplash, falls, concussions, sports injuries, looking down at a phone or screen, weak muscle holding a heavy head.  All these will transmit “bad” info into the trigeminal nucleus which could cause the bucket to spill and migraine to be triggered.

 

 

 

  1. Head, face and jaw:

 

Bad information (injury/infection/trauma etc) from the head, face and jaw.  Perhaps bad information from the teeth if there was a cavity or abscess, or a cracked tooth from grinding the teeth at night, or really sore jaw muscles.  Ask any dentist and they know that in some patients any one of those things could trigger a migraine in a susceptible patient.

 

 

 

  1. Gut and digestive system.

 

The gut nerves converge in the same part of the brainstem as the trigeminal nerves.

 

  • The gut nerves process their incoming info right next to the trigeminal nucleus. The information coming from the gut feeds right into the trigeminal nerve processing centre.  Problems in the gut will contribute to filling up the trigeminal “bad info” bucket. I’ve seen a lot of migraine sufferers who are triggered by different food and drink, like red wine, or chocolate or orange juice, even 1 lady who lettuce would give her a migraine.  Things that aggravate the gut (and this will be different for each individual) can fill that bucket with “bad” info.

 

 

  1. Hormones:

 

The body is constantly sampling the blood to check in real time that the hormone chemistry is appropriate.  This information is relayed back to nerve centers in the brainstem.  The same region as the trigeminal bucket.  Hormone imbalance then causes another potential drip into the bucket.  A good example of “bad” hormone information being a trigger is a young female who gets monthly migraines around the time of her period and also has hormone imbalance which may present as painful periods, PMS, acne, etc.

 

 

  1. Eyes:

 

Straining whilst looking at screens or reading or long drives in glary or dark conditions which strain the eyes. These are all examples of “bad information” from the eyes which gets relayed back through the brainstem and the trigeminal bucket which in some people is enough to fill that bucket and trigger a migraine.

 

 

FIX THE TRIGGERS AND THE BUCKET WILL NOT OVERFLOW.  HOW TO MANAGE A PATIENT WITH MIGRAINE HEADACHE:

 

  1. Remove the triggers so the bucket is not going to overflow. The triggers need to be addressed from the: Neck/Gut/Hormones/teeth/Jaw/head/eyes

 

  1. Improve healthy habits to increase the size of the bucket. These include good habits for posture/diet/exercise/sleep/stress management/nutritional supplementation.

 

 

UPPER CERVICAL SPECIFIC CHIROPRACTIC CARE

 

For many people chiropractic is not the first port of call.  Migraines can be caused by problems in the head that can be life threatening such as tumors and aneurisms.  Those scary things are ruled out with head scans which usually come back normal.  While important to rule those things out, when those scans come back normal it does not mean there is nothing wrong, or that nothing more can be done.  It simply, and reassuringly means that there is no scary life-threatening cause.

So what else should then be investigated?

 

 

  • Neck problems
  • Dental problems
  • Hormone problems
  • Gut problems
  • Eye problems

 

Because of just how common neck problems are let’s focus on how chiropractic can help.  And a niche technique approach within chiropractic which is focused exclusively on correcting neck problems.  Upper cervical specific chiropractic care.

 

WHAT IS UPPER CERVICAL CHIROPRACTIC CARE

 

Most chiropractic techniques will be able to improve the neck function.  But there are specific techniques which focus exclusively on the upper neck.  These are the upper cervical specific chiropractic techniques.

 

 

HOW IS UPPER CERVICAL SPECIFIC CHIROPRACTIC DIFFERENT?

 

Upper cervical chiropractic techniques focus exclusively on the alignment of the head and top 2 vertebrae, the atlas and the axis.  These techniques, such as the Blair, Nucca, Atlas orthogonal, grostic (there are a bunch of them) meticulously analyze the precise alignment of the upper cervical spine using imaging, then gently adjust to realign the head and top 2 vertebrae without any twisting, clicking or popping.

 

  1. No twisting, clicking or popping. Upper cervical adjustments are very gentle.  There is no “pop/click/crunch” noise often associated with chiropractic adjustments.
  2. Precise analysis often with xrays of the cranicervical junction and scanning of the neck for heat readings
  3. Less adjustments are given. Upper cervical chiropractors go to great lengths to assess your pattern (unique presentation of postural, neurological and alignment findings) that are only present when you need an adjustment.  If this pattern is not present you will not need an adjustment.  Much like a dentist will congratulate you if you have no cavities.
  4. The focus is on the neck. Upper cervical chiropractors focus is to optimize the alignment of the head and upper neck vertebrae.

 

Normalising the upper cervical spine alignment removes or reduces “bad information” from this region that would be filling up that migraine bucket.

 

What problems do misalignments of the upper neck cause that could trigger migraine?

  1. Spinal cord, brainstem, nerve pressure and irritation. Misalignments can reduce the space where the spinal cord comes out of the skull.  This can irritate the spinal cord and nearby nerves.  Upper cervical adjustments reduce this mechanical pressure.

 

  1. The fluid that surrounds the brain (cerebrospinal fluid) can be obstructed from flowing out of the head. This causes fluid to build up in the head and cause increased pressure.  This phenomenon also prevents some brain waste products getting out and nutrition coming in.  Proper alignment allows CSF fluid to drain, reducing pressure inside the skull.

 

 

  1. Blood vessels can be kinked and obstructed. Like stepping on the garden hose.  This can result in less blood flowing into the brain or less blood leaving the brain depending on the affected vessel.  Proper alignment allows normal blood flow to the brain and also prevents pooling of blood back up into the skull.

 

  1. Posture can be affected. A misalignment in the upper cervical spine will tilt the head, even if only slightly.  The body then compensates to keep the eyes level by twisting the shoulders, curving the spine and hiking the pelvis.  This can result in strains and wear and tear over time in muscles and joints throughout the body.  Normal alignment of the head and upper neck improves posture.

 

SUMMARY:

 

Migraines are debilitating and common.  They tend to not have 1 cause and cure but management involves removing the triggers.  1 very important trigger is problems in the upper neck.  The upper neck shares nerve pathways with the trigeminal nucleus, thought to be responsible for the migraine head pain.   Upper cervical specific chiropractors focus on the alignment of the head and upper neck to reduce misalignments and restore normal function.  This approach has been found to provide relief to many migraine sufferers.

References:

  1. Migraine in Australia Whitepaper, Deloitte Access Economics Report, 2018
  2. J Manipulative Physiol Ther2011 Jun;34(5):274-89. doi: 10.1016/j.jmpt.2011.04.008.
  3. "Upper cervical chiropractic care for a patient with episodic migraine headaches: a case study" by Cooperstein, R., Gleberzon, B. J. (2002). Journal of Vertebral Subluxation Research, 6(2), 1-9
  4. "Upper cervical chiropractic care for headaches: a prospective, multicenter, cohort study" by Elster, E. L. (2005). Journal of Manipulative and Physiological Therapeutics, 28(4), 289-294
  5. "A pilot study of upper cervical chiropractic care for chronic migraine" by Murphy, B. A., Dawson, N. J., Snook, G. A., et al. (2015). Journal of Manipulative and Physiological Therapeutics, 38(8), 537-543.