There are 3 stages of a migraine headache which are caused by changes in the rate of flow of blood inside and outside of the skull/brain.
(Stage 1) At the beginning of a migraine these vessels decrease in size (vasoconstrict), reducing blood flow into the brain. This results in visual changes and flashing lights (aura).
(Stage 2) The body then responds by releasing serotonin and increasing the size of these blood vessels (vasodilate) to increase blood flow. This results in the throbbing sensation and inflammation causing the headache.
(Stage 3) Following the headache there is swelling (odema) and tenderness over the scalp where the headache was.
Types of Migraines
There are two main types of migraine headaches, Classic and Common.
In classic migraines there are visual disturbances and flashing lights in stage 1. In stage 2 there is a headache across half of the head and there may also be nausea, occasional vomiting, vertigo, photo phobia (aversion to light), chills, perspiration which can last for several minutes to hours. Following the headache in stage 3 there is a tight and tender scalp on the side of the attack.
While in the common migraine there aren’t usually any visual disturbances during stage 1. Stage 2 is usually longer and more intense than a classic migraine and there is no post headache scalp tenderness.
Triggers for migraine headaches include-hot humid weather, fatigue (lack of sleep), stress, hunger, menstruation, bright lights, food, among others and they very commonly occur upon waking in the morning.
Treatment of migraines is difficult and most treatment options focus on reducing the severity and frequency of attacks and Chiropractic care combined with acupuncture can be very beneficial at doing this. With research showing that Chiropractic care (Spinal Manipulation Therapy) produced statistically significant improvements in migraine frequency, disability and medication use.
Research also shows that acupuncture may have an effect on preventing migraines as well as being beneficial in the early treatment of an acute migraine attack.
Pharmacology Treatment Options For Migraine Headaches
Current pharmacological options focus either on acute migraine care (medication to alleviate the headache and symptoms) or on longer term migraine specific management (medications which try to reduce the severity and number of migraine attacks).
Acute care non-specific agents include:
Aspirin, Non-Steroidal Anti-Inflammatory Drugs (ie. Nurofen), Opiates (ie. codeine) and combination analgesics.
Migraine specific agents include:
Ergotamine, Dihydroergotamines and Triptans (which is a first line drug). Most trials show that Triptan only out performs placebo by 25-35% at 2 hours of treatment and Triptan is used as an acute care agent). Most trials also show only 50% of subjects experience more than 50% reduction in their headaches after three months of treatment when using the longer term Migraine Prophylaxis.
New first line drugs include:
TPM-in the largest ever double blinded, randomised trial undertaken for migraine prevention results showed a significant reduction in the frequency of migraine headaches, number of migraine days and use of acute care agents. Side effects though included, paresthesia (tingling, numbness), fatigue, loss of appetite, nausea, diarrhoea, weights loss and taste prevention.
Petasites-is an extract from the plant Petasites hypridus. A small double blinded, randomised trial showed at low doses it significantly reduced the number of attacks per month and the number of migraine days per month. A larger double blinded trial showed a 48% reduction in 4 month mean attacks. There were no side effects.
Bigal, M.E. (Phd, MD), et.al, Emerging Drugs for Migraine Prophylaxis and Treatment, Medscape General Medicine, 2006, Volume 8 (2)