Migraine headache – myofascial therapists see the entire range! With any given occurence, a true migraine sufferer is devastated. Over time, chronic migraines can destroy their lives.
If you have headaches that are especially severe or are on one side of your head, you probably refer to it as a migraine headache – myofascial therapy can probably help! For more information on headaches in general, please see this intro.
You may have had some other types of headaches that are similar so it can be confusing.
In fact, doctors have changed their definitions of migraine headache over the years too. So don’t feel bad if you aren’t sure!
For our purposes, migraines are throbbing, severe headaches. They may be on both sides or one side of your head.1. They have a sick quality that is much like a bad hangover. Generally, it is not responsive to OTC medication
Unfortunately, traditional treatment, including primarily drug therapy, has limited success. For treatment of migraine headache pain – myofascial factors can be a powerful tool for relief.
Migraine Headache Characteristics
The pain of your migraine often starts on one side, often behind or around your eye or temple. It is usually on the same side. It can also be on both sides.
Most days, it seems like it comes on gradually for you. Then, as it becomes more severe, you experience a throbbing feeling and physical activity makes it worse. You used to get an “aura” before it started, but that doesn’t happen all the time anymore. Something seems to ‘trigger‘ your headaches. Lately, you’ve been making a list.
Your sister gets migraines too, but hers are on both sides and seems to involve her neck more than yours. However, she doesn’t get the aura that you do. But you don’t get the pain in the back of your head and on the top that she gets.
Unfortunately, your nephew gets them too, but they only last an hour or two.
Other Migraine Symptoms
Even worse, all three of you get nauseated during your migraines. In fact, you and your nephew even vomit sometimes. Bright light and loud sounds are a problem for both you and your sister.
Sometimes, you also have blurred vision, nasal stuffiness, diarrhea, frequent urination, or sweating.
Well, no wonder you just prefer to go to your bedroom, close the door and draw the curtains!
The pain of your migraine will typically last 4 to 72 hours in adults. However in young children, it often lasts less than 1 hour.
The frequency of your attacks can vary from a few in a lifetime to several a week.
In our experience, migraine attacks are likely to last multiple days and occur several times a month.
Medications are more effective if used earlier in an attack. The frequent use of medications may result in medication overuse headache, in which the headaches become more severe and more frequent. This may occur with triptans, ergotamines, and analgesics, especially opioid analgesics. Due to these concerns simple analgesics are recommended to be used less than three days per week at most.
Recommended initial treatment for those with mild to moderate symptoms are simple analgesics such as nonsteroidal anti-inflammatory drugs (NSAIDs) or the combination of acetaminophen, aspirin, and caffeine. Several NSAIDs, including diclofenac and ibuprofen have evidence to support their use. Aspirin can relieve moderate to severe migraine pain, with an effectiveness similar to sumatriptan. Ketorolac is available in an intravenous formulation.
Triptans such as sumatriptan are effective for both pain and nausea in up to 75% of people. When sumatriptan is taken with naproxen it works better. They are the initially recommended treatments for those with moderate to severe pain or those with milder symptoms who do not respond to simple analgesics. The different forms available include oral, injectable, nasal spray, and oral dissolving tablets. In general, all the triptans appear equally effective, with similar side effects. However, individuals may respond better to specific ones. They are not addictive, but may cause medication-overuse headaches if used more than 10 days per month.
Ergotamine and dihydroergotamine are older medications still prescribed for migraines, the latter in nasal spray and injectable forms. They appear equally effective to the triptans and experience adverse effects that typically are benign. In the most severe cases, such as those with status migrainosus, they appear to be the most effective treatment option. They can cause vasospasm including coronary vasospasm and are contraindicated in people with coronary artery disease.
Intravenous metoclopramide, intravenous prochlorperazine, or intranasal lidocaine are other potential options. Metoclopramide or prochlorperazine are the recommended treatment for those who present to the emergency department. Haloperidol may also be useful in this group. A single dose of intravenous dexamethasone, when added to standard treatment of a migraine attack, is associated with a 26% decrease in headache recurrence in the following 72 hours. It is recommended that opioids and barbiturates not be used due to questionable efficacy, addictive potential, and the risk of rebound headache.
Topiramate and botulinum toxin (Botox) have evidence in treating chronic migraine. Botulinum toxin has been found to be useful in those with chronic migraines but not those with episodic ones. The anti-CGRP monoclonal antibody erenumab was found in one study to decrease chronic migraines by 2.4 days more than placebo.
Migraine Headache – Myofascial Therapy
We focus on history, lifestyle, pain patterns and other symptoms to sort out your myofascial pain. There is a myofascial component to many types of headaches.
Notably, myofascial pain is not caused by contracted or ‘tense’ muscles. They have no electrical activity.
Chronic Headache – Myofascial TriggerPoint Referral Patterns
We can clearly see how referral patterns of head and neck muscles evoke the pain patterns of migraines, tension headaches, cervicogenic headaches. They even overlay the symptoms of cluster headaches and TMJ headache pain. Some of the factors that activate those muscles may not covered by doctors. Those activation factors are things we care a lot about.
Myofascial activations are a part of most headache patterns!
Sometimes, when people are in chronic pain, medical history reveals problems with body mechanics. Body mechanics includes all the various ways that hold ourselves and move as we do things. Sometime is it how we hold ourselves when we are NOT doing things, like sitting.
When ever we are making repetitive movements, we should be mind of using proper body mechanics. This will help minimize repetitive stress injuries and myofascial activations. For instance, lifting in a stooped posture and then twisting is always ill-advised. Doing it repetitively is worse. Therefore, if this type of lifting is required, we should rethink the task and try to organize it in a way that reduces stooping and twisting.
However, even simple movements matter. For instance, what if your desk is arranged phone on the wrong side. In fact, with every call, you have to twist your head and neck and reach over with your arm to the wrong side of the desk This is poor body mechanics. Fixing it might be as simple as moving the phone.
It pays to think about basic body mechanics in this common sense way each time we engage in a repetitive activity. Fortunately, we’re starting to teach this important skill to young people, as in this student guide at University of Michigan.
We can experience chronic overload when we do things like wear high heels, carry a heavy bag or lean into our work.
However, acute overload happens when we decide to lift, push, pull or otherwise move something that is too heavy for us. Most often, we overload our muacles with an eccentric contraction.
For example, lifting a heavy box, correctly using your legs instead of your back, requires concentric contractions of your quads. However, setting that same heavy box down, slowly and with control, require eccentric, lengthening contractions. These should be done carefully.
Of course, if you have a diagnosis from your doctor, we need to know. If you have recent imaging or other test results, even better!
We’ve all been knocked around a bit. We’d like to know everything you can think of about prior accidents, injuries, surgeries and other treatments.
It is important to know about previous or current medical conditions that could impact our treatment. Anything from high blood pressure to TMJD to disc problems are vital information.
Hopefully, medications align with your diagnosis. Sometimes, certain medications will also modify our reatment options. Some drugs interfere with nutrient absorbtion.
Increasingly, supplement use is common. Typically, we’re on the look out to make sure you whether you taking certain supplements.
Migraine Headache – Myofascial Referrals Overlap
Surprisingly, There are several common patterns that are similar to the pain patterns of migraine headaches. For example, the patterns of the SCM, upper trapezius and temporalis muscles all refer pain strongly to the side of the head and the area above and behind the eyes.
In addition, trigger points in some of these muscles can also cause nausea, blurred vision, vertigo, sensitivity to light and other hearing and visual disturbances. Sound familiar?
Where Exactly Is Your Pain?
First, take a moment to consider where your own pain is during a migraine attack. We will usually have you draw it. Pay more attention to the location and how it radiates than how good your art skills are. Of course, knowing the location accurately is more important.
Where Does The Pain Refer?
Next, we take a look at referral patterns for that part of the body.
Sometimes, there is more than one referral pattern that seems to match your pain.
Myofascial referrals may explain most of your pain pattern!
From the outset, education is important. It is our job as therapists to educate you about our assessment and our process. Then, throughout our treatment, we continue this education process.
Trigger Point Therapy can get at some aspects of myofascial pain that you might not have thought of!
Unfortunately, sleep posture and sleep disturbances contribute to many myofascial pain syndromes. However, this is especially important for relief from chronic headaches. Because of this, we always have a thorough discussion about how you sleep during an initial assessment.
Diaphragmatic breathing is at the foundation of myofascial trigger point treatment. But, if you don’t know how to do it, we will teach you. On the other hand, if you already know about it, we will help you deepen the technique.
Of course, the medications and supplements you are taking matter too. Usually, reducing drug consumption is a good thing. However, it should be done gradually and in consultation with your physician.
Keeping a headache diary is an important tool for understanding headaches. Also, it is how we clearly see things that improve our headaches – or not.
Structural variations need to be explored and understood. Once treatment begins, they can be accomodated or corrected in various ways.
It is surprising, but most of us our not taught proper body mechanics. Whether we are at home or at work, we need to learn how to use our body correctly.
Most people are self-conscious about their posture. But, identifying the postural aspects that should be improved is a challenge. Even harder, is understanding how they vary with movement. Ultimately, devising a strategy for improving them is essential.
However, it usually takes more than hands on work to really erase the pain and keep it away.
First, the chances are that we were not your first stop. As a general rule of thumb, the longer you have experienced headaches, the longer it will take to make them go away.
Secondly, there are usually at least some factors that might be part of your headache picture that are out of our scope of practice.
In contrast, if we are treating someone for tennis elbow, we can work on the muscles at play. We can talk with you about some modifications for your game and your lifestyle. Then, we can tell you that if you feel the OTC pain reliever you are taking isn’t needed anymore that you can stop taking it. Finally, we can offer you stretches and other self-care advice that are pretty straightforward
However, if you are suffering from serious headaches, you may have some other more complex factors at play. Often, you may be working with other providers on vascular (blood vessel), neurological, psychological and other issues. You may be taking prescription medications that you should discuss with your doctor.
Chronic headache treatment is often inter-disciplinary.
Myofascial tigger point therapy – it’s how you work this!
Education is the first step in the myofascial treatment protocol.
Sometimes, we may not be good enough at explaining how myofascial pain works and how it activates your headaches.
However, we believe that people can make more progress when they know more about their condition. So, we try to understand what your learning style is give you as much information as you want – but hopefully not too much!
Typically, we performing series of miniature cycles of test/assess, treat and test/assess again. It is an informed exploration for both of us.
We have an initial assessment from your history, postural and range of motion exams, etc. Then, we use various treatment techniques before testing and assessing again.
Manual Therapy Techniques
First, we specifically expertly use manual pressure release therapy, neuromuscular techniques, and deep stroking, friction, skin rolling. When indicated, we also use fascial stretching. Sometimes, we use less common techniques like cupping, spray and stretch and acoustic compression.
In addition, we may also use active and passive muscle activation techniques. This includes reciprocal inhibition, postisometric relaxation, contract/relax, strain/counter-strain and muscle energy techniques. Sometimes, we also use hot/cold therapy.
Range of Motion/Testing
Finally, routinely run the muscle we are treating through its entire, pain-free range of motion. This is part of your treatment. However, it also the start of a new test/assess cycle.
We learn together whether your range of motion has increased and whether your pain is reduced. We may have you get up and use your body in the way that causes pain to ‘test’ more dynamically.
As we finish our hand-on work, we transition into learning new movement strategies and self-care.
Myofascial tigger point therapy – it’s how you work this!
First of all, vigorous stretching of your neck can cause problems. At first, we only engage in limited, gentle stretching of the neck.
Migraines and Blood Flow
Besides, part of the idea is that the pain of migraine is caused by swelling and inflammation of blood vessels in your brain. Reducing the blood pressure within the brain seems like a good idea. This can happen by either reducing the flow and pressure to the brain (as in biofeedback, for instance) or improving venous drainage from your head.
Myofascial treatment can get at some root causes of migraine than you might not have thought of!
For instance, your pec minor can restrict blood flow to your arm. Releasing this muscle, stretching it and facilitating better blood flow to your arm can reduce incidence and pain of migraines. Our article on Opening The Chest might be helpful.
In addition, we can also treat the subclavius muscle to improve venous drainage. This small muscle runs between the lower edge of your collarbone and rib cage. Taut bands can restrict the veins that drain blood from your head.
In myofascial treatment, we usually passively run the muscles we’re working on through their full pain free range of motion. So, that means that you don’t use the muscle to move it. Either someone does it for you or you use props to minimize active use of the muscle. However, we don’t just gently stretch it. Importantly this means we also shorten the muscle
Myofascial treatment can get at some root causes of migraine than you might not have thought of!
What we do for ourselves during an attack is quite different from what we may do in between attacks. You will want to approach any type of treatment cautiously during an attack. When you have recovered from the attack, more engaged self-care approaches work better.
Frankly, you are not going to feel like stretching or other exercise during a migraine attack. If you could muster the motivation and energy, it would probably make you feel worse anyway.
Therefore, we recommend avoiding stretching and strength training during this time. Instead, focus on self-compression of key muscles in the head and neck that you have worked on with your therapist.
Awesome tools like the Backknobber can be used lying down during an attack. This way, there are no worries about vertigo or nausea and you can completely relax.
The leverage of the tool and pinning it between your body and floor allows access to quite a number of posterior neck muscles. This approach can also be used with some large chairs, recliners and couches when sitting.
There are other approaches to passive self-compression for muscles of the head.
This is the time for well needed stretches of your pecs, SCM, upper traps and levator scapula. It is the time to explore problems with the muscles of your TMJ more thoroughly. In addition, this is the time to strengthen your deep cervical flexors, serratus anterior, lower traps and other postural muscles.