Hello all, Shania here!
As I’m sure I have told you before, I am a migraine sufferer. Luckily, they come infrequently, but I am well used to the panic that follows that small flickering light in the corner of your eye. If you’ve had a migraine before, you’ll understand the sudden urgency to find medication – Migrelief for me – within the next 5 minutes and get yourself home to a dark, quiet room.
My partner had a migraine last week and one thing he said really stuck with me: “This is terrifying. If I had broken my leg, I could understand it, but I don’t understand why this is happening. Is something seriously wrong with me? Do I need to go to A&E?”
And honestly, I think that sums up how scary migraines can feel. When you don’t understand what is happening in your body, it can feel so much more alarming.
I am a lover of pathophysiology and the latest research and, personally, I feel much better when I understand what is actually going on. So, I’ve spent the past week doing as much research on migraines as I can, and here are my results.
Some facts first!
Migraines are now considered a complex neurological condition, rather than simply a “headache”, according to the World Health Organisation.
They are also the second most disabling condition in the world, according to the Global Burden of Disease Study 2019 — second only to low back pain. So, if you suffer with migraines and feel like they completely wipe you out, you are absolutely not being dramatic!
Let’s start with genetics.
Multiple genes have been associated with migraines, including CACNA1A on chromosome 19p13, ATP1A2 on chromosome 1q23, and SCN1A. These genes are involved in the transport channels for calcium, potassium, and sodium within the brain. Another gene, SLC4A4, is associated with a protein that helps transmit calcium in the brain.
All of that is a very scientific way of saying that there are migraine-related genes which can interfere with essential pathways in the brain that help it work properly. So, you might just be a bit unlucky in that sense, and you can also politely ignore anyone who says, “you just need to hydrate…” (insert eyerolling emoji here! ;))
Then we have triggers.
We all know about these: citrus, stress, hormones, changes in the weather, lack of sleep, certain foods – the list goes on.
However, migraines seem to work on more of a threshold basis. This means it is not always one single trigger. Often, a few things stack up, and then one small thing sends you over the edge into a migraine.
The key is not to live your life in fear of every possible trigger, but just to do your best to keep them to a minimum where you can.
Migraines affect around 12% of the population. They are more common in women, affecting around 17%, compared with around 6% of men.
There are several different types of migraine, and they do not all look exactly the same.
Migraines often happen in phases, although not everyone will experience every phase every time.
There are also some symptoms related to migraines that you might not immediately think of.
The brain is weird and wonderful – and sometimes very annoying.
The honest answer is that we still don’t fully understand migraines. This is probably the most frustrating answer, but lots of research is currently being done and we are getting closer.
This is the current proposed method – and feel free to mentally skip over the sciencey names if they make your brain switch off.
A certain channel in the brain is opened, and then a nerve signal is sent through. This involves something called the neuronal pannexin-1 mega channel and subsequent activation of caspase-1.
The trigeminal nerve then becomes fired up and unhappy. The trigeminal is the nerve that supplies sensation to the face and head.
This leads to the release of pro-inflammatory mediators, including nuclear factor kappa-B and calcitonin gene-related peptide, also known as CGRP.
Inflammation is then sent to the trigeminal nerve, as well as areas such as the brainstem, cortex, and pain-sensitive meninges in the brain.
This means that the cortex can be activated, which may cause aura if you experience one.
The brainstem can also be activated, which may affect your autonomic system and cause things like changes in blood pressure, slowed digestion, nausea, and other delightful symptoms you did not ask for.
Finally, the trigeminal nerve is activated, causing that horrid headache.
Essentially, there is a huge network of nerves in the brain that come alive and start sending pain signals, plus a whole load of other annoying signals that you really do not want them to send.
For example, if you get balance issues before a migraine, it could be because the cerebellum is affected. If you get a stiff neck beforehand, it could be because the motor nerves to the neck are involved.
This is where we talk about the transition from episodic to chronic migraines.
Inflammation of the nerves again and again can cause them to become sensitised. This means they become super sensitive and much more responsive, so only a tiny thing can set them off – like the sniff of an orange.
This creates a bit of a vicious cycle. The more irritated and sensitised the nervous system becomes, the easier it is for a migraine to be triggered.
There are a few other factors being researched, although they are still not fully confirmed.
Serotonin is one of them. This is still debated, but it seems that serotonin levels may decrease between attacks. As serotonin plays a role in pain inhibition, lower levels may mean migraine symptoms are felt more intensely.
Calcitonin gene-related peptide, or CGRP, is another. I touched on this earlier, but when CGRP is released, it can sensitise the trigeminal nerves and dilate the cerebral and dural blood vessels. This may increase inflammation and pain, potentially contributing to the migraine itself.
Treatment options can include:
As always, speak to your GP or pharmacist about what is appropriate for you.
Because migraines are complex neurological conditions, osteopaths cannot directly stop a migraine. However, we may be able to help reduce some of the factors that play a role in causing one, and reduce some of the symptoms experienced around them.
One way we may help is by improving musculoskeletal dysfunction. Osteopathic techniques often target areas such as the neck, thoracic spine, skull, and shoulder girdle. These areas are linked to migraine through cervical and trigeminal nerve pathways.
Another way is by reducing muscle tension. Manual therapy may help decrease myofascial trigger points and neck muscle hypertonicity — in other words, muscles that are holding too much tone or tension.
These factors can contribute to migraine initiation or make symptoms feel worse.
So, while osteopathy is not a magic migraine cure, it may be a useful part of managing the wider picture — especially if neck tension, stress, posture, or musculoskeletal discomfort seem to play a role in your migraines.
Migraines are complex, strange, and sometimes really scary. But understanding what might be happening can make them feel a little less mysterious — and hopefully a little less terrifying.
And if you are a fellow migraine sufferer, I see you.
