LifeCare Chiropractic

The Best Chiropractic Care in Mesa, Arizona

Chronic Migraine Headache

My Biggest Frustration with Migraines

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chronic migraines as a progressive brain disorder
Chronic migraines as a progressive brain disorder

I have dedicated a significant amount of time to migraines.  From treatment in my office to hundreds of review articles of medical studies to publishing a book on Migraines And Epilepsy, I consider myself quite educated on the topic.

While there have been a few exceptions in my office (literally less than a handful over the past 18+ years), if patients are willing to make the changes I recommend, they get better.  My recommendations range from a course of treatment in the office to exercise to managing stress to major lifestyle overhauls.  If patients are willing to make these changes, I can almost guarantee that migraines will be history.

Why?  How can patients get better with my recommendations versus the neurologist that they’ve been seeing for years and practice out of a very well-known hospital system?

Because the “why” is far more important to me than suppressing the symptoms of a migraine.  It is VERY rare that I have a chronic migraine patients come into my office that has been educated on the underlying cause of his or her migraine headaches.

But before I get into the secret of migraine headaches I need to make a very important distinction.

By the time patients make it into my office they have accumulated multiple types of headaches.  The two biggest classifications are structural and migrainous.  And I can say, with a high degree of confidence, that every migraine patient has aspects of both.

The structural headaches are related to the soft tissues (ligaments, tendons, muscles and fascia) and joints.  While my opinion is strongly biased, these types of headaches HAVE to be addressed by a chiropractor that understands and treats the soft tissues.  Adjusting alone, exercises alone, Botox alone (and yes-if someone responds to Botox it is because they have been improperly diagnosed with migraines instead of a structural headache) or soft tissue work alone is not going to completely fix the problem.

But, as I mentioned, it’s my bias based on almost 20 years of treatment migraine patients who have not responded elsewhere.

The true migraine headaches, however, do not respond well to good structural care.  This is because the true cause is not one that can be addressed from outside the body.

If you experience chronic migraine headaches and you really, really want to get rid of your headaches, you’re going to have to address the health of your blood vessels.

Period.

Anything less will not guarantee a fix for your headaches.  And medications?  Not a damn one of them will fix your blood vessels.  Some will actually make it worse.  And even if medications control your headaches, they have not fixed the problem.

Poor blood vessel health, endothelial dysfunction, vascular dysfunction.  It goes by different names depending upon who you are speaking to, but they all mean the same thing.

The blood vessels of a true migraine patient have lost the ability to respond appropriate to changes in demand for blood supply.  This system—where the blood vessels open and constrict based on how much oxygen the tissues need—is an incredibly dynamic process, with changes occurring by the second.  If your blood vessel is no longer able to respond to needs of your brain cells your brain cells are not going to be happy with you and can trigger a migraine.

THIS is the key to understanding your migraines.  THIS is the key to lifestyle changes that will help your chronic migraine headaches.

I have certainly spent time on migraine message boards and there are a lot of headache patients who get pissed off at my suggestion that headaches can be fixed.  These patients, however, have not achieved ideal body weight.  They are stressing too much.  They are not eating the right foods (even if he or she thinks his or her diet is ideal).  They are not exercising.  They are smokers.

I would suggest that, as much as it may be offensive to some, patients with true migraine headaches have not made the correct choices for his or her blood vessels and brain.

The details of these changes are beyond the scope of this article, but are outlined very readily in my book Migraines and Epilepsy that can be purchased by clicking here.

While many migraine sufferers care about getting rid of or controlling headaches, there is a bigger problem looming.  Poor blood vessel health has everything to do with risk of heart attack or stroke in the future.  This is absolutely, unquestionable solidly demonstrated in medical research study after research study.

Most of these research studies, however, have focused on migraine with aura.  Most of the studies that have linked future risk of heart disease or stroke have been on migraine with aura.  This particular study is yet another one in the long list of studies linking heart disease risk and migraines, except this one covered ALL migraines, not just those with aura.  Here’s the details on this large study of 17,531 women with migraines who were followed up for 20 years:

  • Migraine was associated with a 50% higher risk for major cardiovascular disease.
  • They had a 39% higher risk of a heart attack.
  • There was a 62% higher risk of having suffered a stroke.’
  • Sufferers had a 74% higher risk of having chest pain or having had a coronary angiogram.
  • Furthermore, migraines were linked to a 37% higher risk of dying from heart disease.

The relationship is so strong that, in a linked editorial, the suggestion is that migraine should be viewed as a risk factor for heart disease just like high blood pressure and cholesterol.  This is a strong statement and one that is not entertained by the average treating neurologist or primary care doctor.

It also reinforces my concern that the vast majority of true migraine patients are not getting the education needed to understand and improve the condition.  Chronic migraine sufferers HAVE to address the underlying dysfunction of the blood vessels through lifestyle changes geared towards protecting the heart.  This include diet, stress management, exercise and focus on reducing exposure to environmental chemicals that damage the heart and blood vessels.

Anything less is only a band-aid.

Do Migraines Increase Your Risk of Dying?

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Let me clarify this once more.  Those experiencing migraines have something wrong with their physiology that just so happens to manifest as headaches.

The headaches are the downstream consequence of the problem, and are NOT the problem itself.  So to fix the problem, you need to look upstream and fix what is wrong.  If you experience migraines and your doctor has NOT talked to you about the absolute need to change your lifestyle, you should find a new doctor.  Period.

Just in case you think this is a strong statement, pay attention to this particular study.  In it, researchers looked at 18,725 men and women to see if migraine sufferers had a higher risk of dying from any cause (all-cause mortality).  Here’s what they found:

  • People with migraine with aura had a 21% higher risk of dying from any cause.
  • People with migraine with aura had a 27% higher risk of dying from heart disease.
  • People with migraine with aura had a 40% higher risk of dying from a stroke.

This is a pretty strong concern.  And let me clarify again that taking medications to control your headaches (even if they work) will do NOTHING to alter your risk of these conditions because they haven’t actually fixed the problem.

Chronic Migraine Relief Starts in Childhood

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chronic migraines and childhood abuse
dmitrimaruta/Dollar Photo Club

As a parent, it breaks my heart to think of any child having to worry about things like being loved, fed properly and treated with respect. Unfortunately, the effects of childhood maltreatment can last a lifetime.

This maltreatment can come in the form of nutritional abuse, sexual abuse, physical abuse or emotional abuse.  While I firmly believe that the damage from raising a malnourished child can be greatly reduced or even eliminated by better nutritional choices in the future, the other forms of abuse, however, leave scars that are worn on the inside.  These scars can’t be seen with an MRI, CT scan or bloodwork.  And far too often as the abused child grows into adulthood he or she may not even recognize the damage that has been done.

Or many may think that they have risen above it and it remains a dim memory.  Little does he or she think that being raised in an abusive household is now playing a major role in why he or she is depressed, obese, has high blood pressure and heart disease.  Or that abuse from decades ago may be a critical factor in the fact that he or she suffers from chronic migraines.

To understand just how strong these links can be, this particular study looked at the relationship between childhood maltreatment and headaches.  Researchers looked at  8,305 people who suffered from chronic migraines and 1,429 people who had episodic tension-type headaches to see if recalled adverse childhood experiences (ACEs) played a role in the headaches.  Here’s what they found:

  • 24.5% of migraine sufferers had ACEs and 21.5% of chronic tension headache sufferers also had ACEs.
  • Migraines were linked to emotional abuse (22.5%) as well as tension headaches (16.7%).
  • Sexual abuse in migraines was 17.7% and 13.3% in tension headaches.
  • Overall, migraine sufferers were 23% more likely to have reported emotional neglect, 46% higher emotional abuse and 35% more likely to have experienced sexual abuse than those with chronic tension type headaches.

Overall, both groups of chronic headache sufferers had strong relationships to adverse childhood experiences, but the migraine sufferers were much more likely to have experienced childhood abuse.

This was a very large study, encompassing about 10,000 headache sufferers.  It is astounding that almost 1/4 of this group had experienced childhood abuse.  Maybe psychologists out there that deal with past childhood experiences may not be as surprised as I am about just how common this is, but quite frankly it disgusts me.

Even worse, this damage carries forward and can drastically affect the health of the child as he or she grows up.  There is nothing fair at all to the adult who is suffering today as a result of abuse that happened in the past when it was well beyond his or her ability to control.

If you suffer from chronic migraine headaches and have been a victim of abuse as a child, it seems clear that developing a relationship with a skilled therapist to help you manage your health should be as essential as a part of your team as a chiropractor or neurologist.

 

2 Things Every Chronic Migraine Sufferer Should be Checked for

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This is one of those “I’m a chiropractor so this will be biased” articles. This bias is further accentuated by the fact that I’ve written a Migraines and Epilepsy book. This article describes that ONE thing that EVERY single headache sufferer needs to do, and yet rarely do.

I understand headaches very well. Migraines. Tension type headaches. Cervicogenic headaches. Sinus headaches. Unfortunately, many chronic headache sufferers actually experience many different types of headaches. Since most physicians have a single tool to use, they can only address a single type of headache at a time. This is why it seems like no treatment works—it’s rare that a single treatment that is going to help for more than one type of headache.

But there is a great place to start. It should absolutely begin in a chiropractor’s office. Why? (Other than my bias, of course…) Because the tension-type / cervicogenic headache is so extremely common and a chiropractor who also understands the soft tissues involved in these types of headaches is the ONLY type of provider who can address them.

In case you think I’m being a little biased, think for a second, what tools the typical primary care doctor, orthopedic doc or neurologist has to treat muscle problems. Note that I said “muscle problems” and not muscle spasms. True muscle spasms are pretty rare in these types of headaches. Injections do nothing to fix the problems and the medications may mask what’s really going on, but there just are not any medications that are designed to actually heal the soft tissue problems involved in these types of headaches.

One could argue that a well-qualified massage therapist can also address these soft tissue problems, and it is a strong argument. However, the other aspect that contributes to these headaches, improper movement of the joints at the very top of the neck, can only be addressed by a chiropractor.

So you can see that my bias does, in reality, have quite a bit of factual information to support it.

What does all of this have to do with this particular study? In this small study, researchers looked at 4 things in chronic migraine sufferers:

  1. Myofascial trigger points (MTrPs) in the SCM and upper trap muscles
  2. Forward head posture (FHP)
  3. Neck range of motion (ROM)
  4. Cervical facet joint stiffness

As I’ve mentioned, these aspects are all well within the range of conditions that soft-tissue oriented chriopractors can treat very effectively.

So what did they find when they compared this group of chronic migraine sufferers to a similar group that did not experience headaches?? They did not find any difference in the neck range of motion nor in forward head posture. They did, however, note:

  • There was increased stiffness of the cervical facet joints stiffness at Occiput-C1 (top of the spine and the skull joint) as well as at C1-C2.
  • There were more active and latent MTrPs in the right trapezius and SCM muscles.

So, with this study and others that have come before it, I would ask the perpetually unanswered question—why do we not see referrals from neurologists and PCPs to chiropractors at least for the evaluation of whether or not these 2 findings are present?

Will Your Infant Develop Migraines? 2 Things to Look For

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My near-mantra is that migraines are not a problem in the head. Rather, these headaches are a sign that something is wrong with your overall health. The evidence supporting this position is plentiful and some of this research can be found in a recent blog post that refers to migraines as a “progressive brain disorder.”

While migraines can begin at any age, it is not unusual to have them start as a toddler.  I recently had a patient whose migraines began as early as 2 years of age.  As a parent, I can think of few things more achingly painful than watching your innocent child suffer the debilitating pain of a migraine while all you can do is watch helplessly.  No wonder some parents who seek help from pediatric neurologists resort to neurotransmitter-altering medications given at a time when the brain is undergoing some of the most dramatic changes of his or her lifespan.

But what if there is another answer? What if there was an early warning sign that something was wrong with your little one’s system?

What if you could change it THEN, possibly derailing the chance that your small child will suffer with migraines?

As you can guess, I wouldn’t bring this up unless there was an answer.

This particular study looks at the relationship between an infant who experienced infantile colic and his or her later risk of developing chronic migraine headaches. Here’s what they found:

  • Children with migraine were 661% more likely to have had infantile colic.
  • If the child had migraine without aura the risk was still massive at 701%.
  • Migraine with aura 573% .
  • However, this association was not present with tension-type headaches.

In other words, somewhere there is an incredibly strong connection between infantile colic and migraines. There are several mechanisms that might explain the association.

One possible explanation is that the gut produces a very high level of neurotransmitters, which is why the gut is frequently referred to as the “second brain.”  An alteration in the production of these neurotransmitters in the gut could clearly affect brain function.

As an example, 2/3 of the body’s serotonin comes from the gut.  When the gut is inflamed, it will produce even more serotonin.  This could result in the infant’s brain being bathed in an unnaturally high level of serotonin, resulting in a lifetime of a sort of serotonin deficency. Serotonin clearly has an influence on the brain and some migraine medications (like amytriptaline) are used to treat migraines.

The other explanation can start with a personal story.  When my little Keegan was an infant, he experienced colic. As any parent can tell you, colic can be heartbreaking and frustrating, especially in the middle of the night when the parent is going on virtually no sleep.

While most cases of colic are said to last about 3 months, Keegan’s was handled in about 4 weeks through a combination of probiotics, a visit to a pediatric chiropractor and cutting dairy out of mom’s diet while she continued to nurse.

Food allergies.

There is absolutely NO doubt that food allergies can contribute to chronic migraine headaches.  The changes made for Keegan were designed to shift his immune system back into balance (probiotics for Th1 stimulation, allergen avoidance to tone down Th2 pathways).  An altered immune system can produce inflammation that is bad for the brain and bad for the blood vessels leading to the brain.

This study can give us further insight into what might cause migraines later in life. It may be that, in those who suffer from chronic migraine headaches AND had infantile colic, the identification and avoidance of food allergies and calming any inflammation in the gut may be a critical piece to the puzzle of solving migraine headaches for you or someone you care about.

Chronic Migraine Headaches as a Progressive Brain Disorder?

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chronic migraines as a progressive brain disorder
Chronic migraines as a progressive brain disorder

Sounds like a scary title, huh? Good, because if you suffer from migraines, you NEED to understand how serious this truly is.

And it is not about controlling the headache.  Although this may be the immediate need, this limited approach does nothing for protecting your brain.  And make no mistake–migraine sufferers have a greatly increased risk for things like heart disease, stroke and dementia.  Masking the headache with medication does not change your increased risk–it’s still going to happen unless you do something about it.

The current research on migraines follow two related pathways:  mitochondrial dysfunction and vascular dysfunction.  Both share aspects in common, but the best thing is that lifestyle changes to improve one also effects the other.  Here’s the basics.

The mitochondrial dysfunction model begins with, shockingly, the mitochondria.  Think way back to your high school biology class and the anatomy of a cell when you first learned about the mitochondria.  The little “powerhouse of the cell.”  That little organelle within the cell that helps to generate energy for a cell.  And the “energy currency” for every cell is adenosine triphosphate, or ATP.  There are some billion or so reactions that occur in our body EVERY SECOND, and each one of these requires a molecule of ATP to get the job done.  Some tissues, like fat, use very little energy.  Others, like the heart, our muscles and our brain, use much more.  At rest, the nervous system, which includes our brain, is the greatest utilizer of ATP in the body.  Once we start moving, the muscles take over and have the greatest need.

Imagine that.  As you sit here reading this, your brain is requiring mass amounts of energy just to process the information.  So what does this mean?  It means that each cell of the nervous system requires thousands of mitochondria just to generate the energy needed for a brain cell just to perform its basic functions.  And each of these mitochondria are little factories churning out ATP for the brain cell to use at an enormous rate.  Evidence has been present for several decades that the protection and nutritional support of the mitochondria needs to be an integral part of avoiding, reducing the severity of and reducing the long-term ramifications of migraines and seizures.

With this model, anything that harms the mitochondria and interferes with a brain cell’s ability to make energy will contribute to chronic migraine headaches.  Anything that helps the mitochondria can provide chronic migraine relief.

In the vascular dysfunction model, problems with the blood vessels, especially the very tiny blood vessels that feed the tissues of the brain, lead to the headaches.  Imagine the flow through a blood vessel becoming rapidly choked off or the flow at least becoming more turbulent and restricted.  The brain cells that depend on this blood flow are going to get pretty pissed off when it is cut off.  With this model, an anti-cardiovascular disease lifestyle is the best option.  Ironically, this lifestyle will also improve mitochondrial dysfunction.

With either model, typical medications used to treat migraine headaches do not fix anything.  And yet most of the migraine-oriented websites and online communities are still funded by drug companies and never promote real discussions about underlying pathology or how to improve brain function.  Without this open conversation about these two models of migraine headaches, migraine sufferers will continue to be at long term risk of cognitive decline, stroke and heart disease.  This particular article delves into the concept that chronic migraine headaches are a progressive brain disorder and should be addressed as such.

We need to wake up and start to realize that migraines CAN be improved or cured with the right lifestyle changes.

Chronic Migraine Relief Begins…HERE?

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migrane headaches and gluten linked
Migrane headaches and gluten linked

You suffer from headaches and have been searching for some type of chronic migraine relief; so your PCP should send you to a neurologist, right?

It sounds like a great place to start.  After all, your headache is in your head and deals with your nervous system, right?  If you’ve been reading the Rantings for any time now, you understand how flawed this method of thinking is.  Migraines may be felt in the head, but they are really a problem with your entire body.  Something is wrong, and your body is screaming at you to fix it in the loudest way possible.

If this is the case, it certainly makes medicating a headache without finding the root cause shortsighted, if not downright dangerous.  Dangerous because, in those who experience migraines (particularly with aura and in women), there is an increased risk for things like stroke and heart disease.  Merely treating the headache with medications does not lower this increased risk.

So what does all this have to do with this particular study?

There is a well established relationship between food allergies and neurological problems, most notably wheat allergies to gluten.  The list is quite long, but does include seizures, which I have written in a previous blog article that can be read by clicking here.

Given that I’ve written a book on the relationship between migraines and seizures, it should come as no big shocker to you that, if gluten is related to seizures, it just might be related to chronic migraines headaches as well.

Researchers looked at patients with gluten sensitivity and inflammatory bowel disease to see how many of them experienced headaches.  Here’s what they found:

  • Celiac disease led to a 379% higher risk of experiencing headaches.
  • Gluten sensitivity led to a whopping 953% increased risk of migraine headaches (Tweet this).
  • For inflammatory bowel disease, there was an increased risk of 266%.
  • 72% of celiac disease subjects graded their migraine as severe.
  • 30% of IBD graded their migraines as severe.
  • 60% of GS rated his or her headache as severe.

These are some very strong associations.  Strong enough so that any physician treating a patient with migraines should be asking about diet and, more specifically, gluten intake.  If they do not, and the first recommendations are medications, it’s probably time to run the other way.  It would be a strong indication that the physician does not stay current with medical literature.  This is not someone I would want taking care of my brain.

If you suffer from migraines, have you tried a gluten free diet?  If so, did it seem to help?

Migraines in Children: Do Meds Work? Are They a Good Idea?

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When ANY child has headaches, something is wrong.  They don’t just happen and they darn sure aren’t because that child is deficient in some medication.  And yet, we seem to think this is the case because the administration of medication seems to be the treatment of choice in mainstream medicine.

Even if a medication controls the headache for that moment, it has in no way, shape or form fixed what was causing the headache.  As a parent, it is your job to NEVER accept anything less than an answer.

Most often, the answer is not immediate.  I find that stress in children is a major contributor to headaches.  Even if you initiate stress management approaches (meditation, biofeedback using the Resperate, relaxation CDs, massage) these will take some time for the benefits to be noticed.

If the problem is structural, very commonly from carrying backpacks that are too heavy for the child, then they need structural work from a chiropractor that focuses on this aspect of treatment.

I cannot begin to describe the frustration we’ve had with patients here in the office.  We recently had a cheerleader who had several falls and had high stress levels and a “challenging” diet.  Despite a year of headaches and seeing virtually every other type of provider (including a neurologist at Barrow’s) there was never a suggestion of seeing a chiropractor.  After the first first, she didn’t have a headache for a week and they have been getting better managed since.  The patient is, needless to say, very pleased after just 4 visits.

I have another patient that was recently put on a triptan medication to manage his headaches.  He’s a very intelligent 11 year old boy, but he clearly stresses heavily over school.  There has not been any discussion about managing his stress.  It’s all been about medication.  Our office is working with his mother to get something type of relaxation program for his iPod and I’m very confident this will help greatly with his headaches.

Since I brought up the triptan class of medications (nice, segue, huh?), we should look at this particular study.

Researchers looked at multiple studies on the use of triptans for migraine headaches in children.  Here’s the catch:

The children’s placebo response rate was incredibly strong, with pain relief at 2 hours ranging from 53% to 57.5%.

Basically, because of this, none of the medications were more powerful than placebo in these trials.

So what does this mean?  It means that the brain is a powerful tool in managing migraine headaches–at least as powerful as commonly used medications.  This all points back to the ability of mind based therapies like meditation or biofeedback to control or eliminate migraine headaches in adolescents.

If this type of approach is NOT recommended in the care of any child with migraine headaches, I would personally pack up and run the other way.  If stress is a major contributor to headaches and this aspect is not addressed, the long term health consequences are going to be grave.

Medicine is NOT supposed to be about controlling the symptoms.  Medicine is finding the cause of a problem and fixing that cause so that the long term health of the patient is preserved.  Anything less is deficient.

If your child experienced migraine headaches, what did you find was the best therapy for them?