“Migraine” is a complex, chronic neurologic disorder characterized by recurrent moderate to severe headaches. The diagnosis of migraine is subdivided into “migraine without aura” (formerly common migraine), and “migraine with aura” (formerly classic migraine). (1) “Aura” is the collection of autonomic nervous system symptoms that occur immediately prior to the headache. (2) Aura symptoms may include visual disturbances, extremity paresthesia, nausea, vomiting, and hypersensitivity to light or sound.

Early explanations for the genesis of migraine focused on cerebrovascular vasoconstriction with subsequent vasodilation. (3) Migraine is now recognized as a more complex series of neurologic and vascular events wherein vasodilation may or may not be present. (4-8) Evidence suggests that a migraineur’s brain is hyperexcitable and uniquely predisposed migraine headaches in much the same way that an epileptic is susceptible to seizures. (8,9) Migraineur’s also demonstrate changes in the performance of functional tasks, suggesting early motor control deterioration. (87)

Worldwide, the lifetime prevalence of migraine is 14%. (10) The one-year prevalence of migraine is 10% and shows little variance worldwide. (11) Over 30 million Americans suffer at least one migraine headache each year. (12) The condition affects 18- 21% of females and 6-10 % of males and is the leading cause of “severe” headaches. (12,88) One in six American women suffers from migraine headaches. (13) Migraine headaches cause more work-related disability and lost productivity than any other common type of headache. (121,124) Over 80% of migraineurs miss work as a result of their headaches, with an average of 4-6 absences per year. (14) The economic cost of migraine due to lost workdays is estimated at over 13 billion dollars per year in the United States.

The incidence of migraine without aura peaks in boys at age 10 and in girls age 17. (13) Interestingly, the incidence of migraine with aura peaks almost 5 years earlier for both sexes. (13) Before puberty, migraine is more common in boys. (15) At puberty, this ratio flips, and adult females are three times more likely than their male counterparts to experience migraine. (15) Migraine prevalence peaks in the third decade, and attacks generally decrease in severity and frequency after age 40. (15,81) The onset of a new migraine headache after age 50 is rare. (15)

Various risk factors have been identified for the development of this disorder. Migraine headaches demonstrate a strong genetic component. Having a first-degree relative with migraine increases one’s risk fourfold. (16) If one parent has migraines, the child has a 50% risk of developing the disorder. If both parents are affected, the risk climbs to 75%. (17) Overweight patients are more susceptible to migraine. (18,119) Low cardiovascular fitness increase risk. (102) Vascular risk factors include hypertension, hypercholesterolemia, impaired insulin sensitivity, coronary artery disease, and a history of stroke. (18)

Medication overuse is one of the more important risk factors for migraine progression. (19) Migraines tend to become “chronic” following overuse of acetaminophen, naproxen, aspirin, opiates, barbiturates, and triptans. (19) One study demonstrated that NSAIDs were beneficial when used less than 10 days a month but induced migraine progression to a chronic state when used at a higher frequency. (19) Hypocalcemia and vitamin D deficiency are associated with an increased risk of migraine attack. (97)

The (hyperexcitable) migraineur brain is susceptible to various “triggers.” Migraines develop when the number of triggers exceeds a critical threshold for a given patient. Known triggers include: stress, smoking, strong odors (i.e. perfumes), bright or flickering lights, fluorescent lighting, excessive or insufficient sleep, head trauma, weather changes, high humidity, motion sickness, cold stimulus (i.e. ice cream headaches), lack of activity/exercise, dehydration, hunger or fasting, and hormonal changes, including menstruation, and ovulation. (20,99) A recent study concluded that environmental & behavioral triggers play a more important role in migraines than dietary triggers. (142) Upper cervical tension or the presence of a cervicogenic headache may be a trigger for a migraine. (59,65)

Certain medications, including estrogen, oral contraceptives, vasodilators, nitroglycerine, histamines, reserpine, hydralazine, and ranitidine are known triggers. (21) Food triggers are inconsistent among migraineurs, but the following foods are regularly implicated: alcohol (especially beer or red wine with tannins), excessive caffeine, artificial sweeteners, MSG, soy sauce, watermelon, citrus foods, papayas, avocados, red plums, overripe bananas, dried fruits with sulfites (figs, raisins, etc.), sour cream, buttermilk, nuts, peanut butter, sourdough bread, aged meats and cheeses, processed meats, and anything fermented, pickled or marinated. (22,23,133) It is unclear whether chocolate is a trigger to migraine, or a craving brought on at the onset of an attack. (22)

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What we do in our office to help this condition:

1. Perform a detailed exam, assessing the alignment of the spine. Due to the fact that the nerves exiting the spine in the cervical region (neck) branch off and go to the head, face, neck, shoulders, and arms, improper alignment in any of these areas may be detrimentally affecting the structures in the head. This can compromise proper function and lead to potential symptoms.

2. As indicated, adjust areas of spinal subluxations (misalignments), restoring proper nerve system function which facilitates healing.

3. Apply electrical stimulation and heat to the muscles of the upper back and trapezius muscles. Applying an electrical current helps strengthen muscles, block pain signals, and improve blood circulation.

4. Perform laser therapy which penetrates to the cellular level of the soft tissues surrounding the head and neck. This promotes better oxygen and nutrients to these tissues, which can relieve pain and facilitate the healing process.

5. Prescribe stretches and exercises in conjunction with chiropractic care to strengthen the soft tissue of the neck and shoulders.