Non-pharmacologic Treatment for a Patient with Migraine Headaches
In 2017 The Lancet - Global Burden of Disease study, listed migraine headaches as one of the leading cause of disability worldwide (GBD Neurological Disorders Collaborator Group 2017).
Globally physicians, now more than ever are recommending complementary treatment options (ie. manual therapy, acupuncture, mindfulness stress based reduction (MSBR), pain neuroscience education and exercise) as part of a multi-modal approach to decrease the individual’s headache frequency, intensity, duration and acute medication requirements.
It is encouraging to see so many medical centers and clinical practice guidelines embracing a non-pharmacological approach for migraines
For migraine suffers soft tissue irritation and subsequent nerve sensitization may be a contributor to symptoms (Ferracini et al. 2017, Palacios-Ceña et al. 2017). This is where gentle manual therapy and acupuncture of the upper cervical spine may help avoid ongoing nociceptive input into the trigeminocervical complex (Luedtke et al. 2017).
Acupuncture: An Introduction
If a patient is interested in using acupuncture to manage migraine symptoms there is supporting evidence from The Cochrane Collaborative (Linde et al. 2016), Canadian Medical Association (Busse et al. 2017) and other high quality Systematic Reviews (Yang et al. 2016) and Randomized Control Trials (Zhao et al. 2017).
Medical acupuncture is an approach that is based upon a theory that is inline current scientific understanding of how the body works. Using occam's razor the insertion of an acupuncture needle is a form of novel stimuli, that functions by sending anti-nociceptive input to the neuroimmune system.
Preferential sites for acupuncture stimulation are associated with areas rich in specialized sensory receptors such as muscle spindles, Golgi tendon organs, ligament receptors, Paciniform and Ruffini’s receptors (joint capsules), deep pressure endings (within muscle belly), and free nerve endings (muscle and fascia). All of these areas are highly innervated and as a result there are a number of physiological responses that help modulate the experience of pain (Chen et al. 2017).
Massage Therapy: An Introduction
The responses to massage therapy are multifactorial - physiological and psychological factors interplay in a complex manner. The biopsychosocial model provides a practical framework for investigating the complex interplay between massage therapy and clinical outcomes.
Based off the biopsychosocial model, investigation into mechanisms of action should extend beyond local tissue changes and include peripheral and central endogenous pain modulation. An observed favorable outcome may be explained by a number of overlapping mechanism in the periphery, spinal cord, and brain represented in the image below.
Treatment Plan Based on Patient Tolerance
My first recommendation for those who suffer from migraines is to work with a physician to develop strategies to manage symptoms. Then a treatment plan can be implemented based on patient-specific assessment findings and patient tolerance.
Structures to keep in mind while assessing and treating patients suffering from migraine headaches may include neurovascular structures and investing fascia of:
• Upper Cervical Spine (Upper Trapezius, Splenius Cervicis, Splenius Capitis)
• Levator Scapula
• Corrugator Supercilii
• Temporomandibular Joint
• Scalene Muscle Group
More to Explore
Migraine Brains and Bodies - C.M. Shifflett
Migraines: More than a headache - Elizabeth Leroux
The Migraine Brain - Carolyn Bernstein
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