Migraine Management: With a focus on Migraine Postdrome

Migraine Management: With a focus on Migraine Postdrome:

Overview

According to Migraine and Headache Australia, migraine is a neurological condition that can present as a one sided headache, that is of a throbbing nature that is considered an intense headache and is aggravated by physical activity. Close to 20% of the population suffers from migraine at some time in their life. The average age of someone likely to experience migraine is between 35 and 45 years. Migraines tend to effect Females more than Males. This is related to hormone factors. (Ref: Migraine and Headache Australia)

Migraine postdrome has been defined as “the time from resolution of troublesome headache to return to normal” (N. Gaffin, R. Lipton 2016 et al). Symptoms of the postdrome phase may include general fatigue, heightened sensitivity, body aches in multiple regions and specially neck tension and stiffness, mental fogginess or changes in concentration, changes in depressive mood and dehydration. Postdrome is considered the last stage of a migraine and has been shown to last up to 48 hours. There are three stages leading up to this starting with a Prodrome which may last for up to a few days. Sufferers can have symptoms that include changes in dietary habits, changes in concentration and mood, experience fatigue and general stiffness and sleeping habit changes. The second stage is known as aurora that can last up to an hour with symptoms including visual changes and sensory changes. The third stage is the headache pain that can last up two to three days, associated symptoms can include throbbing, burning, spike like pain with associated vomiting, giddiness and insomnia. Ref (American Migraine Foundation).

 Additional research According to (P Bose 2017) there can be a reduction of blood flow within the cerebrum of the brain relating to the effects of migraine postdrome. (K. Luedtke 2018) states that neck tension namely related to the trapezius muscle are an associated symptom of a migraine attack however not a direct trigger. The article indicated that multiple neck muscles may be involved in a similar way but more research is required. The study measured electrical activity from the nervous system to the trapezius muscle via (electromyography studies) and looked at the “level of muscle tension during voluntary relaxation and during mental and physical tasks as well as the ability to relax after periods of mental and physical stress” (K Luedtke 2018) and compared patients with migraine versus without. Results found that all groups showed increased activity under mental strain and physical activity however, the migraine sufferers showed up to a 28% increase in activity with the higher being chronic migraine sufferers. The article conclude that for migraines the muscle tension is a symptom of the migraine compared to tension headaches where muscle tension generally was the trigger.  Migraine management including a Myotherapy framework: Primary management of migraine would require appointment with a medical practitioner to prescribe any medication and special treatments or referral. Additional management would include making changes relating to lifestyle factors for example, changing work routine and environment to being more regular working hours, maintaining a migraine diary to track frequency and duration of symptoms, getting enough rest, hydration, improve sleep patterns, avoiding alcohol, improving ergonomics and posture, depression or anxiety (ref M. Eller, Goadsby 2019) and required level of “at least 30 minutes of moderate intensity physical activity on most if not all days”( Exercise and Sports Science Australia),  How Myotherapy treatment can assist in migraine management. Myotherapy will focus on the postdrome phase and also to collaborate in migraine management with other Health practitioners.

Our Myotherapist would take a patient’s history if presenting with the headache phase to determine an appropriate treatment approach, initially Myotherapy treatment would be to prevent exacerbation and the patient would be referred to the doctor if headache symptoms are intense and acute. Once acute headache symptoms have eased Myotherapy can be valuable in the Postdrome phase of migraine. Aims would include using soft tissue therapy and massage to stimulate the nervous system with the aim of easing nervous and muscle tension and promoting blood flow in general as well as releasing endorphins such as, dopamine and serotonin. Myotherapy treatment would focus on assisting in managing the patient with posture and ergonomics advice, improve muscle weakness and to decrease neck stiffness. Author: Mark Kelly (Registered Myotherapist and Exercise Professional) 18th December 2019.

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