Migraines
What is a Migraine?
A migraine is a transient, recurring neurological condition that occurs when a certain threshold has been reached—often due to too much of one trigger or a combination of triggers. When this threshold is exceeded, the brain temporarily changes how it functions (for example, through altered neural firing and neurogenic inflammation). As a result, this leads to symptoms such as headaches, dizziness, fluctuating hearing loss, ear ringing and pressure, light and noise sensitivity, sinus pressure, nausea, confusion, visual disturbances, and numbness.
Types of Migraines:
According to the International Classification of Headache Disorders (ICHD-3), there are two major types of migraines:
1. Migraine without aura
2. Migraine with aura
However, migraines are more than just headaches. They can be divided into four distinct phases:
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Prodrome – an early symptom indicating the onset of a migraine.
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Aura – neurological symptoms that may appear before or during the attack.
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Attack – the main migraine phase, often involving intense head pain and other symptoms.
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Postdrome – lingering symptoms that may last for hours or even days after the headache subsides.
It’s important to note that not everyone experiences all phases, and symptoms may overlap between stages.
Migraine Without Aura
A. At least five attacks fulfilling criteria B–D.
B. Headache attacks lasting 4–72 hours (when untreated or unsuccessfully treated).
C. Headache has at least two of the following four characteristics:
1. Unilateral location.
2. Pulsating quality.
3. Moderate or severe pain intensity.
4. Aggravation by or causing avoidance of routine physical activity (e.g. walking).
D. During headache at least one of the following:
1. Nausea and/or vomiting.
2. Photophobia and phonophobia.
E. Not better accounted for by another ICHD-3diagnosis.
Individuals who otherwise meet criteria for migraine without aura but have had fewer than 5 attacks can be considered: probable migraine without aura.
Migraine With Aura
Diagnostic criteria:
A. At least two attacks fulfilling criteria B and C.
B. One or more of the following fully reversible aura symptoms. Usually occurs before the headache, but it may begin after the headache phase has commenced, or continue into the headache phase:
1. Visual (over 90% of patients).
2. Sensory (usually pins & needles and/or numbness).
3. Speech and/or language (usually aphasia).
4. Motor.
5. Brainstem.
6. Retinal.
C. At least three of the following six characteristics:
1. At least one aura symptom spreads gradually over >5 minutes.
2. Two or more aura symptoms occur in succession.
3. Each individual aura symptom lasts 5–60 minutes.
4. At least one aura symptom is unilateral.
5. At least one aura symptom is positive.
6. The aura is accompanied, or followed within 60 minutes, by headache.
D. Not better accounted for by another ICHD-3 diagnosis.
How Physiotherapy can help:
Physiotherapy can play a key role in managing and preventing migraines. As part of a multidisciplinary approach, physiotherapy provides targeted treatments that go beyond addressing pain alone.
First, your physiotherapist will offer in-depth education about migraines, helping you understand potential triggers and how to avoid them. Additionally, they can guide you in promoting endorphin release—a natural pain reliever—and teach strategies to improve your sleep quality, which is essential for migraine prevention.
Moreover, relaxation techniques and manual therapy can help release tension in the neck and jaw, reducing tightness that may contribute to migraine symptoms. Finally, your physiotherapist can provide practical tools to manage visual and motion sensitivity, thereby empowering you to regain control over your daily life.
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