Many people with headaches wonder: what makes a migraine a migraine? What makes migraines different from other causes of headache?
Migraine is one of the most common disorders causing head pain
Migraine is one of the most common recurring disorders which create head pain. Migraines affect over 15% of the population with over 35 million suffering from migraine attacks annually in the United States.
Because they happen so often, and because headache sufferers will often experience more than one kind of headache, there are many questions patients have about migraine pain.
Here are the most common questions that we encounter in chiropractic practice:
- Do migraines respond to chiropractic adjustments?
- What are the common symptoms of migraine?
- Is migraine hereditary?
- Is it possible to have a migraine without a headache?
- Does migraine have a known cause?
- What can trigger a migraine?
- Is my headache actually a migraine or is it another kind of headache?
Do migraines respond to chiropractic adjustments?
Let’s jump to the good news right away. In my personal experience , migraine headache pain and other migraine symptoms often respond positively to working with a chiropractor, especially chiropractors using upper cervical chiropractic procedures.
Research has found Migraine is also one of the most common types of headache that positively respond to chiropractic care. (1)
What are the Common Symptoms of Migraine?
According to the International Headache Society (HIS), patients are diagnosed with migraine if they are experiencing headache with the following features:
- Unilateral location (one side of the head)
- Pulsating quality
- Moderate to severe intensitya
- Aggravated by physical activity (why most migraine patients simply want to lay down and isolate themselves)
Other symptoms include: nausea, vomiting, sensitivity to light (photophobia), and/or sensitivity to sounds (phonophobia).(2)
Migraine comes in two major forms: migraine with aura and migraine without aura.
Aura is defined as a group of neurological symptoms that occurs before or during a migraine attack. Symptoms of aura may include visual and sensory disturbances like a glowing halo or distorted halo in the visual field. It can also include a prickling or tingling sensation about the head and face, numbness, and speech difficulties.
Is migraine hereditary?
Based on several studies the risk of developing migraine is believed to be strongly attributed to hereditary factors. Migraines are more likely if a family member also have migraines.
Those predisposed to the condition by their genetics usually experience their first headache before the age of 30.
Is it possible to have a migraine without a headache?
Yes, it’s possible to have a migraine without the classic headache.
These are sometimes called ocular migraines or silent migraines, or migraine with aura. Head pain may not be felt while the patient experiences visual disturbances and other sensations in the head, like tingling in the face, loss of taste and smell, and a foggy-headed feeling.
Some people even experience disruption in speech without head pain, and the first time this happens it can be mistaken for a stroke. I have personally had two patients who experience migraine without headache, which also affected their ability to speak words. Both responded positively to care.
Does migraine have a known cause?
The definitive cause of migraine is still unknown according to medicine.
However, we can say this: many, many cases of migraine are accompanied by findings (other problems) in the musculoskeletal system where significant pain originates. (3)
In other words, inflammation and pain in the bones, muscles, or ligaments of the spine seem to aggravate or make migraine pain worse.
Some believe that migraine has a central origin: this means there’s an issue in the brain-stem or higher brain structure.
Others believe that migraine starts in the periphery (not in the brain and central nervous system), especially in the joints or other structures of the neck.(4)
Peter Tuchin (a chiropractic researcher) and his colleagues found that migraine headaches might be potentially caused or aggravated by cervical spine conditions.(5)
Patients may present with irritated nerves or inflamed muscles due to misalignment of the spine, and that addressing these dysfunctions through chiropractic adjustment tends to improve and reduce the occurrence of migraine attacks.
What can trigger a migraine?
Migraines are often associated with triggers, and trigger can vary widely from hormonal changes to some sort of stimulation to the body’s sensory system (think irritating sounds, flashing lights, weird smells etc).
Physical and emotional stress, foods and food additives, sleep disturbances, neck pain, and certain medications can also trigger migraine attacks.
Patients may experience different symptoms based on whether their symptoms are actually central or peripheral in origin.
Is my headache pain actually migraine pain?
Migraine headache is one of several kind of headaches called primary headaches. Tension-type headaches are well known by most in the general public. Cluster headaches are another primary headache that are less well-known but still may be mistaken for a migraine.
Here are some guidelines for determining if you’re dealing with real migraine pain.(6)
Migraine versus Tension-type headache
When they happen and how long they last (frequency and duration):
Tension-type headaches can happen frequently, often many times per week, and they may last for a day to days or longer. A persistent daily headache is possible with a tension-type headache.
On the other hand, migraines happen in episodes of once every few weeks to months, and rarely last for days, although multi-day migraines are possible.
How intense is the pain?
Tension-type headache pain is rarely disabling to the point that patients have to isolate themselves. Most tension-type headache, while extremely annoying, will not drive patients to seek emergency care.
On the other hand, migraine headache pain can be moderate to severe, and may even require temporary hospitalization in very severe cases.
What other symptoms come with the pain?
Most migraines come with some autonomic symptoms (like runny nose, and visual disturbances like aura), where tension-type headaches don’t have these symptoms.
Migraine versus cluster headaches
Sometimes migraine headache pain is confused for the pain caused by cluster headaches.
- Migraines might have a few autonomic symptoms, cluster headaches have very noticeable autonomic irritations.
- Cluster headaches are generally shorter than a migraine, and happen in short bursts of multiple headaches.
- Whereas migraine can be moderate to severe in terms of intensity, cluster headaches are all typically severe.
What causes other kinds of headaches?
Tension-type headache: may be caused by tension in the neck or facial muscles. Other precipitating factors include poor posture, eyestrain, stress, anxiety, and neck injury among others.
Cluster headaches: can be triggered by cigarette smoking, alcohol intake, and certain medications like nitroglycerin. Similar to migraine, the cause is not yet known.
The cervicogenic headache
Sometimes headaches may be called a cervicogenic headache, which means “originating in the neck.”
Tension headaches and migraine may often start in the neck structures, but may not be labelled as starting in the neck. Generally a headache is diagnoses as cervicogenic if the headache is initially felt from the neck or cervical spine structures and the pain worsens when moving the neck.
1. Wells RE, Bertisch SM, Buettner C, Phillips RS, McCarthy EP. Complementary and alternative medicine use among adults with migraines/severe headaches. Headache. 2011;51(7):1087-1097. doi:10.1111/j.1526-4610.2011.01917.x
2. Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders: 2nd edition. Cephalalgia. 2004;24 Suppl 1:9-160.
3. Lewit K. Manipulative Therapy: Musculoskeletal Medicine. Edinburgh ; New York: Churchill Livingstone/Elsevier; 2010:38.
4. Levy D. Migraine pain and nociceptor activation–where do we stand? Headache. 2010;50(5):909-916. doi:10.1111/j.1526-4610.2010.01670.x
5. Tuchin PJ, Bonello R. Classic migraine or not classic migraine. That is the question. Australas Chiropr Osteopathy. 1996;5(3):66-74.
6. Marcus DA, Ready DM. Discussing Migraine with Your Patients: A Common Sense Guide for Clinicians. New York: Springer; 2017.