Migraines: Causes and Treatment

Migraines 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 migraines 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-madibular joint) 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.

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.

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 scalene muscles attach to several neck vertebrae, as well as the first and second 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.

When the 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, and the very important vagus nerve.

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.

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.

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),  disturbed heart rate, disturbed breathing rate, disturbed digestion, nausea, vomiting, and diarrhea.

Craniosacral therapy can help with migraines.

Craniosacral therapy very gently and effectively helps the body to release the fascial tension in the SCM muscle, as well as the scalene muscles, thus allowing the cranial bones to unlock and shift back into their normal position.  Hence, no more pain and migraines go away.  Moreover, the common carotid artery, the internal jugular vein, and the vagus nerve no longer are trapped by the SCM.  This improves blood circulation into the brain, as well as out of the brain, and nerve conduction by the vagus nerve, resolving all the other symptoms as well.

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.