Migraine

Authors
Affiliations

Doctor of Physical Therapy

B.S. in Kinesiology

Doctor of Physical Therapy

B.A. in Neuroscience

Migraine is the most common primary headache.

Epidemiology

  • 15% of the population
  • Gender: 2:1 female-to-male

Pathophysiology

Note

Migraine and cluster headaches were previously termed “vascular disorders” but this term is innaccurate since it ignores the electrophysiological, inflammatory, autonomic, serotonergic, and neuroendocrine factors that impact their pathophysiology.

There is still the idea that there is a vascular component since caffeine helps to reduce migraines, presumably through vasoconstriction

FROM A LECTURE
  • Drop in serotonin levels causing the trigeminal nerve to release substances called neuropeptides, which travel to the brain’s meninges. Cause BV’s to become dilated and inflamed resulting in a HA
    • Can last 4-72 hrs, generally less than 24 hrs

Etiology

  • 75% of migraine patients have a family history of migraines, suggesting a genetic component.

Triggering and Precipitating Factors

Migraines can be provoked by:

  • Certain foods
  • Stress
  • Eye strain
    • Bright light
  • Noise
  • Menstrual cycle
  • Changes in sleep pattern
  • Exertion
  • And more

Clinical presentation

Precipitating factors

  • Stress
  • Exertion
  • Food
  • Bright lights
  • Noise
  • Menstruation

Preceding factors:

  • Possibley some of the triggering factors
  • Aura: warning symptoms (visual blurring, shimmering, scintillating distortions, or fortification scotoma)

Onset: Rapid onset, can awaken w ha, aura can proceed the HA

Area of symptoms:

  • Unilateral
  • Temporal
  • Frontal or retro orbital
  • Can change sides

Quality of symptoms:

  • Throbbing
  • Pounding
  • Moderate to severe

Associated symptoms:

  • Nausea
  • Vomiting
  • Photophobia
  • Phonophobia

DDX

  • Unilateral

Prevention

  • As soon as u have aura, take drug to limit severity
  • Excedrin: Contains caffeine
    • Caffeine can help by dilating blood vessels

Treatment

  • Botox in suboccipital area has been beneficial in cases

Physical Therapy

Recommendations for PT School
  • STM, MFR,
  • Joint mobility: Traction, mobs of C/s and T/s
  • Stretching
  • Strengthening
  • Cardiovascular endurance
  • Patient education

References

1.
Blumenfeld H. Neuroanatomical Basis of Consciousness. In: The Neurology of Conciousness. 2nd ed. Elsevier; 2016:3-29. doi:10.1016/B978-0-12-800948-2.00001-7
2.
Blumenfeld H. Neuroanatomy Through Clinical Cases. 3rd ed. Oxford university press; 2022.

Citation

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