Migrains and Trigger Point Therapy

Migraine Headaches

Migraines usually first begin between the ages of ten and thirty-five and decrease after age fifty. Frequency varies greatly, from infrequent to several times per month. Approximately one in ten people get migraines, and about 75 percent are women (American Medical Association 1989). Some women experience symptoms just before or during their period (menses), indicating a hormonal role.
Symptoms of Migraine Headaches

A migraine headache is characterized by throbbing, pounding, or pulsating pain that lasts from hours to several days. Intensity of pain alone is not a symptom of a migraine, since tension headaches can be as painful or even more painful than migraines, and some migraines may not even have headache pain as a symptom. In some people, the pain may not be pulsating or it may vary in quality. Migraine pain is often only on one side, but it may occur on both sides or move from side to side. Pain can be intensified by movement, coughing, straining, or lowering your head.

Migraines are usually accompanied by one of more of the following symptoms: nausea, vomiting, depression, disturbed sleep, tenderness in the neck and scalp, cold and sweaty hands and feet, and/or sensitivity to light, sound, and smells. A migraine is sometimes accompanied by diarrhea, urinary frequency, fever, chills, facial swelling, irritability, and fatigue.

Migraines may be accompanied by an aura, but more commonly this is not the case. A migraine without an aura (common migraine) may be preceded by mental fuzziness, mood changes, fatigue, and an unusual retention of fluids. When present, auras are usually visual and precede the migraine by ten to thirty minutes. People often liken it to looking through a kaleidoscope, with zigzag lines, bright shimmering lights, wavy images, or hallucinations. They may experience blurred vision, eye pain, or temporary vision loss or blind spots. Auras may also be nonvisual, consisting of dizziness, vertigo, speech or language abnormalities, weakness of movement, or tingling or numbness of the face, tongue, or extremities. An aura may occur only on one side even when headache pain is located on both sides, or it may be on the opposite side of a one-sided migraine.

Symptoms of migraines are usually incapacitating, and people often feel weak, tired, and sometimes nauseated after the migraine has subsided. People with frequent migraines are more likely to have tension headaches between migraine attacks than those with infrequent migraines.
Causes of Migraine Headaches

Though there are theories about the causes of migraines, the mechanism is still unknown. Most studies have attempted to explain migraines in terms of one particular causative factor and have failed to provide an explanation for the complexity of the symptoms and clinical observations. It’s likely that a combination of factors provide input in varying proportional degrees and result in a particular set of symptoms for any type of headache. These input factors are trigger points in muscles, emotional stimuli triggering the limbic system (part of the brain) to increase muscle contractions, and substances (including biochemicals such as serotonin and other neurotransmitters) that affect the blood vessels and other tissues in the brain (vascular system input), causing them to become inflamed and swollen, and result in a headache.

It is theorized that the sum of the vascular system input plus the input from trigger points and emotional stimuli determines whether or not pain is a symptom, and if so, how intense the pain is. This could explain how some people can have trigger points or experience emotional duress without having headaches or migraines, while others get severe headaches. People who tend to have migraines and tension headaches that occur at the same time are likely to have a very strong input from emotional factors, or possibly abuse drugs (Olesen 1991).
Triggers of Migraine Headaches

Known triggers of migraines include alcohol, smoking or exposure to smoke, weather changes, allergies, altitude changes, jet lag, hormonal changes, stress, sun glare, flashing lights, constipation, some medications, birth control pills, hormone replacement drugs, strong smells such as petroleum fumes and perfumes or colognes, and foods that contain caffeine, monosodium glutamate (MSG), and nitrates (processed meats, bacon, and hot dogs). Insufficient food, water, sleep, or exercise can also cause migraines.
Trigger Points and Migraine Headaches

One study demonstrated that trigger points may play a far greater role in the perpetuation of migraines than previously thought (Calandre et al. 2006). The study compared patients at a headache clinic who suffered from frequent migraines with both nonclinic subjects with fewer migraine attacks and healthy control subjects who, at most, had infrequent tension headaches. The researchers examined specific muscles for trigger points and found that 93.9 percent of the migraine subjects had trigger points with referred pain patterns that reproduced the their migraine pain and other symptoms. By comparison, only 29 percent of the healthy subjects had pain referred to the same areas, and the pain was not migraine-like in quality. Pressing the trigger points of migraine subjects could reproduce the location of pain, the throbbing quality, light and sound sensitivity, and other symptoms that were common for that person. In 30.6 percent of migraine subjects, pressing muscles with trigger points actually caused a full-blown migraine that required immediate treatment.

The researchers discovered that the longer the history of migraines and the more frequent the attacks, the greater the number of trigger points the person had in their muscles. About 74 percent of the trigger points were found in the temporalis and suboccipital muscles. Other trigger points were usually only found in additional muscles when the subject had more than four trigger points and the condition had been going on for some time. This means that the longer migraines and trigger points are left untreated, the greater number of trigger points will form and the more migraines you will get—a self-perpetuating cycle. (Note: For some reason this study didn’t include checking the sternocleidomastoid muscle for trigger points, which would have revealed an even higher rate of correlation between trigger points and migraines and headaches. Also, the sternocleidomastoid would likely have been one of the muscles in which trigger points were more frequently found.)

The researchers theorized that the trigger points themselves could be responsible for the changes in the nerves and blood vessels in the brain, rather than the vascular system necessarily being a separate and distinct input system on its own. It is well-known that trigger points can cause symptoms other than referred pain, such as dizziness, vertigo, diarrhea, painful periods, colic, heart palpitations, and other conditions that wouldn’t normally be thought of as caused by trigger points in muscles. Their theory makes sense, given that palpation of trigger points can reproduce nonpain migraine symptoms and even evoke a migraine, that treating trigger points can prevent or stop a migraine if treatment is done early enough, and that a greater number of trigger points correlates to greater frequency of migraines and length of the condition.

So which came first? Did the trigger points in certain muscles lead to the development of migraines and then a self-perpetuating cycle began, or did the migraines come first and lead to development of an increasing number of trigger points? In any case, this discovery is very heartening, as it means treating trigger points can have a significant impact on reducing or eliminating migraines.
Other Types of Migraines

There are a few types of migraines that won’t likely be helped by trigger point self-help techniques, but even in these cases it would still be wise to read through the section on perpetuating factors and eliminate any factors that might apply. A headache-free migraine has an aura but no pain. An ophthalmoplegic migraine begins in the eye and is accompanied by vomiting, drooping eyelids, and paralysis of the nerves responsible for eye movement. Basilar artery migraine, which affects mostly young people, is characterized by a severe headache, vertigo, double vision, slurred speech, and lack of muscle coordination. Carotidynia, more common in older people, produces a deep, dull, aching and/or piercing pain in the jaw or neck, and usually tenderness and swelling over the carotid artery in the neck. A status migraine is a rare type characterized by intense pain that lasts more than seventy-two hours and may lead to hospitalization.

Great News: Treating Trigger Points Can Help!

Studies have shown that people who have headaches are almost twice as likely as healthy control subjects to have postural abnormalities, including head-forward posture, and to have trigger points in the back of the neck, particularly the suboccipital muscles (discussed in chapter 11). Interestingly, people with migraines were shown to have the same prevalence of postural abnormalities and number and location of trigger points as people with tension headaches, even when they tend to have one-sided migraines (Marcus et al. 1999).

People who suffer from both migraines and tension-type headaches are far more likely to have a greater number of active trigger points (Marcus et al. 1999). The greater the number of active trigger points, the more frequent and severe the headaches. With one-sided headaches, a greater number of active trigger points are located on the same side as the headache. Trigger points will be more tender during a headache and will probably be more tender just prior to and immediately after the headache.

This means that the probability of trigger points being part or all of the problem in the majority of headaches is likely to be high, and there are estimates that the majority of headaches are due at least in part to trigger points (Simons, Travell, and Simons 1999). So the great news is that you can probably relieve much or all of your headache pain with a combination of trigger point self-treatments [Chapters 10-18] and identifying and eliminating all the perpetuating factors [Part II] to the extent possible.
Treating Headaches with Trigger Point Therapy

If you have headaches, you are likely to have trigger points in your neck and head muscles that, when pressed, will refer pain to the areas where you normally feel your headaches. These areas will likely be tender, too. The intensity of your headaches will correlate with the intensity of the tenderness of the muscles causing the referred pain. In all likelihood, trigger points in more than one muscle of the neck and head are causing overlapping referral patterns, so it is important to locate all of the trigger points involved.

It is important to treat trigger points when you don’t have a headache. You will still be able to identify the trigger points, and treatments should help prevent the onset of a headache in the first place. Don’t wait until you start to feel preliminary headache symptoms; you won’t feel like moving once a severe migraine or other bad headache starts to manifest, let alone go to an appointment. Plus, the increased tenderness of the muscles during a headache will make treatments less tolerable.

Most people make the mistake of discontinuing treatments when their symptoms have subsided to a low level. This is too soon. Ideally, all of your symptoms should be entirely eliminated and you should experience a symptom-free period before you stop regular self-treatments or appointments with a practitioner. And if your symptoms start to return, don’t wait until they get intolerable before you start treatment again. Your condition will just get more complicated again and require a longer treatment period. If you do decide to see a practitioner, at the first visit schedule all of your appointments for the first six weeks. At the end of six weeks, your practitioner can make a recommendation for the next six weeks