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What is a Migraine?

Dr. Scott Fuller, D.C., C.C.S.T.

Migraine headaches plague millions of Americans daily. This nasty disorder costs corporate America billions of dollars annually due to employee absence. How does one know when he or she is suffering from a Migraine headache? In addition to the obvious, there are other common symptoms that accompany the classic migraine headache.

Many patients experience spots in their visual field, tunnel vision, ringing in the ears, weird tingling sensations about their body, muscle twitches, and violent mood swings. These symptoms along with headache pain are consequences of a complex neurovascular disorder.

The migraine headache results from a decrease in regional cerebral blood flow (rCBF). In simple terms, migraines are vascular and have to do with the vessels that supply blood to your brain. Although the brain itself is unable to feel pain, the blood vessels within its core are highly pain sensitive. When the sympathetic nerves that control the diameter of the blood vessels are over stimulated, the blood vessels within the brain constrict. The result is a loss of blood flow to certain regions of the brain. Neurons in the brain are very sensitive to changes in oxygen. Because red blood cells carry oxygen to the brain cells, any reduction in blood flow to the brain will result in dysfunction of the nerve cells in that region. During an episode of migraine, the most common region of the brain to loose blood flow is known as the Calcarine Cortex. This is the area at the back of your brain that, when stimulated by your eyes, allows you to see. When these nerves are depleted of oxygen, they begin to fire spontaneously. The function of the calcarine cortex is to provide visual information, so patients often report spots or flashes of light in his or her visual field. Because different areas of the brain are responsible for diverse functions, the patient's symptoms will depend on which area of the brain is depleted of oxygen. For example, if the reduction of blood flow is on the side of the brain, know as the temporal lobe, ringing in the ears may result. Most of these symptoms precede the onset of the headache. The sympathetic nerves that control the diameter of the blood vessels rely on specific chemicals to do their job. These chemicals are called neurotransmitters. Not long after the visual disturbance, the amount of neurotransmitter available to aid in the constriction of the blood vessels are depleted. The result is a rapid opening or dilation of the blood vessel allowing blood to flow back into the brain. If this is so, then why does a massive headache ensue? When the blood vessels dilate, they are stretched by the force of the blood that is pumped by the heart. The outside of the blood vessel is surrounded by a pain sensitive network of nerves called a perivascular plexus. When the perivascular plexus is stretched, it stimulates pain. The result is the migraine headache. In fact, with every beat of the heart the blood further distends the vessel resulting in the "pounding" headache.

Why do the sympathetic nerves constrict the blood vessels? There are many reasons for abnormal sympathetic nerve output. Sympathetic nerves emanate from your spinal cord. These nerves are excited by nerves deep inside the brainstem. Brainstem nerves are in turn excited by the hypothalamus. For example, in order for your blood to flow through your arteries the hypothalamus must send signals to the nerves in your brainstem. Your brainstem in turn signals the nerves of the spinal cord that exit your spine to control blood vessels. This system runs automatically without direct control from the higher centers of the cerebral cortex (brain). After all, if you had to think to keep your heart beating, to breathe, or to control blood vessels you would surely live a short life. The fact that these processes run by themselves is truly amazing. However, these systems are not without fault. The higher brain centers still have a modulatory effect on this system in that they help to dampen sympathetic activity at the level of the brainstem to keep it under control. Infants lack much of this inhibitory control because it takes years for them to grow a specialized brain. They commonly show signs and symptoms of increased sympathetic nerve output (higher heart rate, higher breathing rate, faster GI tract, loose bowels, etc.) As infants become adolescents this changes and the higher brain centers inhibit the sympathetic activity and vital signs become more adult-like.

If the cerebral cortex functions at a lower metabolic rate, it's inhibitory effect on the sympathetic system will be adversely affected. This will allow the sympathetic nerves to fire at a higher rate than normal leading to vasoconstriction and potentially, a migraine headache. Because the function of the cerebral cortex is under the direct influence of the spine, it is imperative to address spinal abnormalities as the ultimate source of the migraine. Proper function of the complex nerve receptor network in the soft tissues of the spine is critical to health and in treatment of migraines. The chiropractor who specializes in neurology is one of the most qualified physicians to diagnose and treat the causes of the migraine headache.

If you suffer from migraine and would like more information, call me at (781) 933-3332

Created by: Dr. Scott Fuller, D.C., C.C.S.T.
Fuller Chiropractic
576 Main Street
Woburn, MA 01801

(781) 933-3332

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