Migraine Headaches: A Comprehensive Guide

Migraine headaches are complex.

Migraine headaches are quite complex, causing symptoms such as mild to severe head pain of a pulsating quality, nausea, vomiting, photophobia (sensitivity to light), phonophobia (sensitivity to sound) as well as unusual sense of smell, sight, and hearing right before the migraine, referred to as aura. Approximately a third of all migraine sufferers experience this aura.

Jaw and neck pain are common as well.  Furthermore, the extremities may feel cold and clammy.  Sufferers of migraines also report mood disturbances, as well as difficulty with concentration.  Neurological symptoms such, as vertigo, ringing in the  ears, and difficulty speaking may also occur.

The cause of migraine headaches is unknown.

It’s commonly thought that migraines arise from a vascular, hormonal, or neurological disturbance within the brain itself.

However, the fact that bodywork such as massage, shiatsu, chiropractic adjustment, acupuncture, acupressure, and craniosacral therapy all are effective in reducing the severity, duration, and frequency of migraines suggests that there might be external causes as well. Such external causes or triggers might be trauma, old or new, to the head, neck, or spine.

Injury or inflammation of the trigeminal nerve might also trigger migraines.  The trigeminal nerve innervates all the muscles of chewing, as well as the skin of the face.

When tight and short (tense), the muscles of mastication (chewing), the temporalis muscle, the masseter muscle, and the pterigoid muscles, can cause TMJ (temporo-mandibular jointL) syndrome and also put pressure on the trigeminal nerve.  Moreover, tension in these muscles can certainly cause a shifting, and locking up, of the facial or head bones, to which they attach.

As for the vascular component, the culprit of migraines appears to be the common or external carotid artery, rather than vasodilation of arteries within the skull.  While the pulsating quality of the headache does imply a vascular component, the neurological effects appear to be more a response rather than a cause of the migraines.

The cause of migraine headaches may be of a physical, mental, or emotional origin.

As with pain in general, the cause of migraines may be emotional, mental, or physical.  Often it is a combination of the three.

Let’s look at the “anatomy” of migraines.  To do so we need to examine the structures involved in this type of headache.

All the muscles of the anterior neck are suspect.  The major ones are the anterior and mddle scalenes, as well as the sternocleidomastoid (SCM) muscle on either side of the neck.  The SCM attaches to the mastoid process of the temporal bones right behind the ears and also to the sternum and clavicle.  The anterior and middle scalenes have attachments to several neck vertebrae and the first rib.

A tight SCM muscle or tight scalenes can cause head pain.

The pain is easily explained by the fact that the tightening (shortening) of the SCM muscle, pulls on the cranial bones (head bones), shifting them and temporarily locking them up.  The cranial bones are joined by connective tissue (cranial sutures) that contains blood vessels and nerves.  Compression of these bones therefore can cause mild to severe pain until these bones unlock, as the SCM muscle lengthens again with relaxation.

Although the anterior and middle scalene muscles attach to several neck vertebrae, as well as the first rib, they do not directly attach to the head.  However, through their fascial (connective tissue) connections with the muscles and all structures around them, their shortening and tightening can create a pulling effect on the head bones as well.

Moreover, the fascia that envelops them may become “matted” with the fascia that wraps around the SCM muscle, which crosses over the anterior and middle scalenes.  Thus, tension in the scalene muscles can trigger tension in the SCM and the other way around.

Tight neck muscles can reduce blood circulation to the head.

When the sternocleidomastoid muscle (SCM) becomes tight, it may also put pressure on the carotid sheath, which partially lies underneath it.  The carotid sheath contains the internal jugular vein, the common carotid artery, deep cervical lymph nodes, and the very important vagus nerve (one of twelve cranial nerves).

Compression of the internal jugular vein reduces the outflow of blood from the head, potentially causing intracranial pressure to increase, with resultant pressure on, and dysfunction of, various brain structures.

Compression of the common carotid artery, on the other hand, reduces blood flow into the internal carotid artery which supplies the brain, as well as the external carotid artery which brings blood to the anterior neck, throat, larynx, and thyroid, as well as the face and scalp.

Blood carries oxygen and nutrients to all tissues of the body, including the brain.

Less blood to any tissue reduces the amount of oxygen and nutrients to these tissue.

Feedback to the brain stem via the carotid bodies (baroreceptors) results in an accelerated heart rate to pump more blood into the body, as well as rapid breathing to oxygenate the blood.  This is the body’s attempt to maintain adequate blood and oxygen supply to the tissues.

Auras might be explained by the temporary diminished supply of oxygen and nutrients to the cerebral cortex areas that interpret sight, smell, and hearing.  Venous congestion inside the head due to impaired blood outflow may put pressure on various brain tissues (nerves) to cause similar symptoms.

Moreover, irritation of the common or external carotid artery may cause  flushing of the face and neck, as well as perspiration in that area.

A tight SCM may irritate the vagus nerve.

As the vagus nerve is contained within the carotid sheath, along with the common carotic artery, the internal jugular vein, and the deep cervical lymph nodes, it too can become compressed by a tight SCM.

Compression of the vagus nerve (cranial nerve 10), also called CN X) may cause it to dysfunction in numerous ways because the vagus nerve innervates so many different types of tissue and organs.

The dysfunction may manifest in symptoms such as problems with speech (vocalization),  difficulty swallowing, disturbed heart rate, disturbed breathing rate, disturbed digestion, nausea, vomiting, and diarrhea.

Basilar migraines are less common than other migraine headaches but are more frightening.

Basilar migraines, so called because they involve the basilar artery, are not nearly as common as other migraines.  However, the symptoms are more frightening.  They may manifest as  dizziness, double vision, slurred speech, hearing difficulty, tingling of the body, temporary loss of vision, loss of balance, and confusion, as well as loss of consciousness.

Sufferers of basilar migraines also experience the more commonly known symptoms, such as mild to severe head pain, nausea, vomiting, sensitivity to light and sound, and cold hands and feet.  Aura may be part of the symptom picture as well.

The cause of basilar migraines is unknown.

As with the more common form of migraine, we do not know what truly causes basilar migraines.  However, the suspected cause of basilar migraines is of vascular origin, namely the basilar artery.

Let’s look at the anatomical structures potentially involved in the etiology of basilar migraines.  These are the muscles of the posterior neck, the vertebral arteries, the basilar artery, the brain stem, and the neck vertebrae, as well as the cranial bones (head bones).

As with the more common type of migraine, the head pain associated with basilar migraines can be explained by the shifting and locking up of the head bones (cranial bones) along the cranial sutures as the neck muscles tense up and shorten.  These neck muscles tense up when they are stressed (poor posture held for a long time), with injury, emotional strain, and even with local infections and inflammation.

The muscles in the back of the neck may play an important role in head pain and vascular flow to the brain stem.

The neck muscles involved are more likely to be the ones in the back of the neck, such as the levator scapulae, posterior scalene, splenius capitis, and the small muscles at the base of the head which form the subocccipital triangle, as well as the trapezius.

Tension in these muscles, especially in the muscles of the suboccipital triangle may also diminish the blood flow through the vertebral arteries, as they thread their way through the suboccipital triangle to enter the skull through the foramen magnum (large opening) and join to form the basilar artery.

The vertebral arteries bring blood to the brain stem.

The vertebral arteries arise from the subclavian artery, which itself is a branch of the aorta.  The left and right vertebral arteries join near the base of the head (occiput) to form the basilar artery.  Thus any pressure on the vertebral artery would diminish the blood flow to the basilar artery.

This would result in a decrease in the delivery of oxygen and nutrients to the brain stem (medulla and pons).  As too little oxygen and nutrients adversely affects the functioning of the brain stem we may experience numerous symptoms, some of which are the ones listed above associated with basilar migraines.

Injury to the brain stem can cause numerous symptoms and even death.

The brain stem is of vital importance as it is the exit point of most cranial nerves.  These nerves permit us to see, hear, smell, taste, swallow, and speak,  But that’s not all.

They allow us to move our eyes, tongue, raise our shoulders, and digest.  Moreover, one very important, life sustaining cranial nerve called the vagus nerve, sets the base heart  and respiratory rate.

Maintaining optimal blood supply to the brain stem is, therefore, of utmost importance.

What could compress the vertebral arteries?

The most common offenders are poor posture while reading, doing computer work, or watching TV.  The neck is being flexed for a long time while working with the lap top on your lap or a surface quite a bit below eye level.

This also occurs when reading a book that’s in your lap (on the bus, in the car, etc).  Conversely, the neck is being extended for long periods of time when working on a desk top computer or watching TV (or DVD, movie in a cinema) that is above eye level.

These head positions, if held for a long time, may compress the vertebral arteries which are threaded through the transverse foramina of the first six neck vertebrae on either side of the neck.

At the level of the first neck vertebra, right below the occiput (back of the head),the vertebral arteries weave through a set of muscles that form the occipital triangle.  They then enter the skull via the foramen magnum, the large opening, which is also the entry way and exit for the spinal cord.  Once inside the skull, the two vertebral arteries join to form the basilar artery.

The muscles of the suboccipital triangle may inhibit blood flow to the brain stem.

When the muscles of the occipital triangle shorten (contract) as the neck is extended (when looking up), or become stretched as the neck is flexed (when looking down), these muscles put pressure on the vertebral arteries, potentially reducing the flow of blood, bringing less oxygen and nutrients to the brain stem.

The larger,  more superficial, muscles of the neck, such as the trapezius, the levator scapulae, and the splenius capitis, as well as the posterior scalenes, also shorten when the neck is extended, or are stretched when the neck is flexed.

Misaligned neck vertebrae may inhibit blood flow through the vertebral arteries.

Trauma to the neck, or anywhere along the spine, as well as muscle tension, can cause subluxations (misalignment) of one or more neck vertebrae, which may compress or stretch the vertebral arteries, reducing blood flow to the brain stem.  This trauma may be recent or old.

Whether trauma or stress through poor posture, the subluxations and muscle contractions are often held in place for days, weeks, months, or years by the connective tissue, called fascia, which weaves through the muscle tissue, and envelops the muscles, blood vessels, nerves, lymph vessels, meridians (energy pathways), and organs, as well as the bony structures such as the vertebrae, linking them together.

This connective tissue is pliable when the body is healthy.  However, with injury and sustained stress, such as poor posture, it looses its pliability, becoming sticky and stiff, holding everything inside it in a stranglehold.  This results in pain, stiffness, tightness, decreased circulation, and impaired nerve conduction, as well as reduced energy and less resistance to disease, either locally, or systemically.

Craniosacral therapy and energetic unwinding can help with all migraine headaches.

Craniosacral therapy and energetic unwinding very gently and effectively help the body to release the fascial tension in all the muscles of the neck, as well as the chewing muscles, thus allowing the cranial bones to unlock and shift back into their normal position.

As the scalenes and the SCM (sternocleidomastoid) muscle relax and no longer put pressure on the common carotid artery, the internal jugular vein, and the vagus nerve, blood circulation into the brain and out of the brain improve, and proper nerve conduction resumes.

Furthermore, the relaxation of the posterior neck muscles improves blood flow through the vertebral arteries to supply oxygen and nutrients to the brain stem.

Thus, craniosacral therapy and energetic unwinding help to gently resolve the restrictions from old or new injuries that may lead to migraine headaches, sometimes years further down the road of life.

Note:  A sudden headache with no history of a previous headache like it may be caused by an aneurysm (bulging of an artery where the arterial wall is thinning; like a tire that’s ready to blow) in the brain and requires immediate medical attention.  Rupture of this aneurysm may result in permanent brain damage, or death.