Migraine could be a pain in the neck

 

If you have ever had a migraine you’ll know how debilitating the symptoms can be: headache, nausea and maybe even not being able to tolerate light. And you are not alone. According to the Migraine Association of Ireland, about 12-15 per cent of the population of Ireland are “migraineurs”. But what is science telling us that could help? A meeting being hosted in Galway this weekend by the Irish Pain Society will discuss how to avoid and manage pain in migraine, which is a neurological condition, as well as other types of headache.


One emerging approach is to look slightly south of the head for the trigger – many people with migraine experience neck pain, according to Julie Sugrue, a senior physiotherapist at Beaumont Hospital who works with the headache and migraine team there. “Around 60 per cent of people with migraine get neck pain as one of their symptoms,” she says. “In some people, that is just a symptom of the migraine, it might not mean that the neck is triggering it. But because of the anatomical connections that go between the brain and the neck, it means that the neck can be a trigger.” At the conference, Sugrue will outline how physiotherapists can play an important role in identifying the neck as a source of trouble. “I’m going to provide evidence that every pain consultant or neurologist, or GP with a special interest in headache, should have a physio as part of their team,” she says.

Once the physiotherapist has identified the neck as a potential trigger, the treatment can include hands-on work on the muscles or joints. “It’s very individual to each person,” says Sugrue. And importantly, the physiotherapist can also help the person improve their posture to reduce the risk of further problems. “Posture is often a big driving factor when we see people with neck pain, whether it stops below the head or progresses into the head,” says Sugrue. “Someone might be sitting badly at their computerin work or in front of the TV, and correcting that is an important part of the all-round management of their pain.”

If the neck is a trigger, treatment can help, but the person will still need to avoid other factors that could spark their migraine, she adds. “Common triggers include hormones, lack of sleep, stress, dehydration and skipping meals. But if the neck is involved, at least treating it can remove it from the trigger list.” If a person does develop migraine, the key is to treat it quickly and with the appropriate medication, according to Dr Rami Burstein, professor of anesthesia and neuroscience at Harvard Medical School.

Burstein has carried out research into migraine triggers, and why people with migraine can be sensitive to light and who will respond to therapies. At the conference this weekend he will focus on the changes that happen in the nervous system in a migraine, and how that can inform treatment options. “In the past we thought that the part of the nervous system that is involved in migraine headache is hard-wired – that there is a part of the nervous system that if we target with medicine we will be able to calm it down and abort the headache,” he says. “What we know today is that it is a very dynamic system – in other words there is plasticity to the nervous system. What has happened in the peripheral and central parts of the nervous system in the first five minutes when the migraine begins is very different to what happens in the nervous system 20 minutes later, and that is very different to what happens in the nervous system four hours later.”

People with migraine should talk to their doctors about appropriate treatment options, says Burstein, who stresses the need to address the pain early and with the right medication, because as the pain wears on it could become harder to treat. “Those who treat early should treat with drugs that act on the part of the nervous system that maintains or is the cause of the headache,” he says. “But if they don't treat for several hours, it becomes a moving target and the parts that need to be treated are very different to the parts that need to be treated early on.”

Irish Times