Migraines are a complex neurological disorder affecting an estimated 4.9 million people in Australia. Around 70% of persons affected by migraine are female, and most are of working age. This widespread condition costs the Australian economy over $35 billion per year due to lost productivity and healthcare costs. Despite this high prevalence, migraine is considered under-diagnosed in the community and under-treated too!

Migraines can range from an episodic relatively mild condition, all the way to a chronic recurring condition that can be extremely debilitating for those affected. Because it is an “invisible” condition it can also be very invalidating for those affected as they interact with work, family, and wider society. This can lead to feelings of isolation and distress.

What are migraines?

Migraines are a neurological disorder with an established genetic cause. It is best conceptualised as a form of sensory processing disorder. In response to an overload of sensory information a cascade of neurochemical reactions takes place. Blood vessels in the head dilate (open up) and nerves release particular neurotransmitters and other chemicals that promote pain. Areas of the brain effectively become sensitised, and the result is a migraine. Many factors can contribute to trigger migraines such as stress, hormones, sleep disorders, high blood pressure, foods, and mental health conditions.

There are many different types of migraine, some of which even involve no headache! But most forms of migraine include a one-sided throbbing pain that gets worse with activity and lasts from 4-72 hours. Other common symptoms include nausea, sensitivity to light and sound, as well as visual disturbances. Less common symptoms include dizziness. Many people experience a “prodrome” phase 1-2 days before the onset, where they notice changes in mood, energy, or appetite. The “postdromal” phase occurs 1-2 days after the migraine and also commonly produces feelings of fatigue and low mood.

Treatment

Because this is a complex condition, treatment is best if it’s multi-faceted. Input from a general practitioner or neurologist is often required as medications can be very effective. For people who experience chronic, debilitating symptoms there are other medical treatments available such as botox injections.

Physiotherapy is non-invasive and can be very beneficial. A physiotherapist will take a thorough history to identify any possible triggers for migraine episodes. They can then guide you on how to make behavioural modifications to your routine to avoid bringing on a migraine – this can make a big difference for many people and bring a sense of control back into a persons life. A physio can educate you about the physiology involved, this serves to de-mystify the condition and increase a sense of understanding. This is important to reduce fear and fear-related behaviours that can limit someone’s life and increase pain. Education has been shown to reduce migraine frequency and intensity.

Neck and jaw pain can contribute to the excess sensory input that can lead to a migraine, due to the connections from these nerves in these regions to the brain. Treating neck and jaw pain with massage, manual therapy, dry needling, and specific exercises can be beneficial. Prescribing appropriate aerobic exercise is also very important as it positively impacts chemicals in the brain and body that reduce pain. This has been shown to reduce migraine frequency and severity. Physiotherapy can also help the less common symptom of dizziness by prescribing specific exercises involving head and eye movements as well as balance training – although research into this is in an early stage.

Other professions that can also be involved in treating migraine include dieticians to help with a healthy diet. Psychologists can also help to treat mood issues, insomnia, and to help learn more effective ways to handle stress in your life.

All in all, physiotherapy is an important component in a holistic picture of migraine treatment. It can reduce the impact of migraine on a person’s life and reduce the frequency that they occur. Physiotherapy can provide a sense of self-efficacy to live life on your own terms. Get in touch with our team if you would like to learn more.

References:

Carvalho GF, Schwarz A, Szikszay TM, Adamczyk WM, Bevilaqua-Grossi D, Luedtke K. Physical therapy and migraine: musculoskeletal and balance dysfunctions and their relevance for clinical practice. Braz J Phys Ther. 2020 Jul-Aug;24(4):306-317. doi: 10.1016/j.bjpt.2019.11.001. Epub 2019 Nov 29. PMID: 31813696; PMCID: PMC7351966.