A question we are continually asked is how physiotherapy can help a Menstrual migraine. About 7-10% of women suffer from menstrual migraine, and it has commonly been associated with the decrease in Estrogen causing dilation of the blood vessels in the head. This is actually something that has been measured clinically using blood dopplers and MRI scans and we can say without a doubt that the blood vessels increase in diameter by about 6% as estrogen levels drop. However there are 2 problems with linking this dilation and migraines.
Firstly, ALL women's’ blood vessels dilate when estrogen levels drop, not just migraine sufferers. 90-93% of people have dropping estrogen levels and dilation of blood vessels without a migraine. Secondly, there are no pain receptors in the blood vessels in your brain. There are no pain receptors anywhere in your brain so the pain you feel can’t be coming from the blood vessels because they literally cannot feel pain.
The nerve that regulates blood vessel dilation is a small branch of the much larger trigeminal nerve which actually has its origins in the brainstem. The trigeminal nerve and all of the nerves that look after the muscles and joints and discs in the neck all share the same processing centre in the brain stem. What we have found with our menstrual migraineurs, is that the input from the blood vessels is being distorted by input from the neck and the end result is the brain can’t distinguish where the pain is coming from and attributes it to the area you are most likely going to do something about it, which is usually a headache! This means we need to assess your neck to determine whether it is a contributing factor.
Unlike other migraines, a menstrual migraine is quite predictable when it is going to arrive (usually 2 days before your period) so it is quite easy to determine the role of the cervical spine in your migraine. You can find more detail about actual migraine treatment here, but if we can treat your neck and change the intensity and/or the duration of your next menstrual migraine, we can determine exactly the actual cause of your migraine. There is no guess work.
Treating migraine is not like any other physiotherapy. Not all migraines can be treated by physiotherapists and not all physiotherapists can treat migraines. Accurate and safe assessment of the upper cervical spine determines exactly whether each individual migraine has a musculoskeletal origin.
To treat a migraine, we have to understand the properties of the migraine. We need to be able to accurately understand how frequent you are getting a migraine, how long it usually lasts and how intense it is. We need to determine whether you have multiple different headaches i.e. a daily regular headache that you feel every day but can put up with and a bad headache that breaks your concentration that you get semi regularly and a third all conquering migraine that wipes you out for 3 days at a time.
Understanding the Behaviour of a Migraine
Frequency: We need to determine the longest you can go without a migraine to determine whether our treatment is effective. Some people may only get a migraine every 3 months, others might not be able to go 3 days without a headache. A major treatment goal is to extend the minimum time you can go without a migraine.
Duration: It is important to understand how long your different headaches last. If you are usually a 3 day migraineur and with treatment the headache is done and dusted in 24 hours, that is considered a significant improvement and justifies continued treatment.
Intensity: We need to know how you rate the intensity of your migraine, normally on a pain scale out of 10. It is possible to suffer from multiple different headaches and migraines either at the same time or at different times. The regular daily headache you get may only rate a 2 out 10 but when you get a migraine, this may escalate to 10 out of 10 in the same or even a different area of your head. With treatment, we track the intensity of your background headaches and migraines independently and expect your worst headache to be less intense and more manageable.
Our goal is to eradicate your migraines, but even if we were to make your migraine occur half as often, lasting half as long with half the intensity, it would have an unmeasurable positive impact on your life.