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Migraine a neurological problem characterized by throbbing and pulsating  headache, which causing functional disablity.commonly they are unilateral and can radiate to opposite side of head, usually associated with  the symptoms like nausea,vomit ,vertigo,dizziness,diarrhea,sensitivity to light & sound,chills and sweating.Migraine can be  accompanied  with or without aura.

Triggering Factors –
Head injury
Sleeping issues
Hormone imbalance
Few types of foods

Patho-physiological mechanism (Foundation of osteopathy medicine 3rd edition ) -

The patho-physiological  mechanism of migraine  involves two events vasoconstriction & vasodilation  of cerebral  blood  vessels. The cerebral  blood  vessels are divided into two types one is innervated  system (Adrenergic ) & another one is non-innervated  system (Responds to local metabolic factors )

Vasoconstriction  phase -

Triggering Factors causes unilateral vasoconstriction through Adrenergic system . platelets  aggregates and serotonin  will be  released,cerebral blood flow reduces. At this stage aura developes.

Vasodilation  phase -

Vasoconstriction causes anoxia and acidosis,drop of serotonin and serotonin  sensitizes pain  receptors in blood  vessels. Due to anoxia  and acidosis  the non-innervated arterial system  gets activated and causes vasodilation and increases the  blood flow. There will be an  combined  vasodilation  of innervated system of external & internal  carotid arteries of same side, this vasodilation  along with pain sensitization  fibers will induce migraine  pain.

Trigeminal vascular reflex -

Afferent pain fibers from neocortex,thalamus,hypothalamus and cervical root of C1-C3 communicates with the spinal nucleus of the  trigeminal nerve.the impulse of these afferents  then travels  along facial  nerve and produces dilatation  of external  and internal  carotid arteries.

Migraine  Generator -

The migraine generator is an area in the brain stem, due to neuro chemical changes and when migraine  threshold  crosses. this area gets activated and it causes  neuronal depression,crosses neocortex and activates trigeminal afferents and vessels  it innervates. There will be a release  of neuropeptides, it causes inflammation of meningeal arteries and it associated with platelet aggregation and release of serotonin which enhance migraine. Due to biconductional nerve impulse,the impulse reverses into trigeminal nucleus then it passes  to neocortex  and thalamus. The upper  cervical cord C1-C3 gets involved through this  nucleus hence it causes neck  pain.brain stem reflex too gets activated and causes symptoms like nausea, vomiting and etc. The pain from migraine seems  to be  due to  cerebral  vasodilation.

Biomechanical Model -

The somatic dysfunctions of cranial bones,cervical,thoracic spine too having their role in migraine. The upper cervical  spine  somatic dysfunction may transfer afferent pain stimuli to trigeminal spinal nucleus, the upper  thoracic spine  dysfunction can increase sympathetic tone to innervated blood  vessels  of head, this causes  vasoconstriction  and decreases cerebral blood flow,as a consequence there will be anoxia  and hastens vasodilation . Cranial bone somatic dysfunctions such as dysfunction of sphenoid,temporal and occipital bone has profound influence on  migraine  patho-physiological mechanism.


Discussion -

The structures responsible for causing migraine is not confined with in cranium,there are structures extracranially too.

The osteopathic physician addressess migraine with OMT (Osteopathic Manipulative Therapy) and cranial manipulation,they use to correct the somatic dysfunction of cranial bones,cervical and thoracic spine.

The physiotherapist globally are too doing cervical and thoracic spine manipulations, most of these manipulative techniques are from osteopathic origin. Few orthopaedic manual physiotherapist is doing cranial works too,most of them following osteopathic cranial manipulation concepts.

Harry von piekratz PT,PhD Department of Orofascial Research and management,International Maitland Teacher Association(IMTA) ,Netherlands and Lynn Bryden PT of UK,on their book Craniofacial Dysfunction and Pain ,Manualtherapy Assessment and Management had described and discussed about the cranial works  for treating cranio-facial dysfunctions.this book provides a report on current knowledge and recent developments in neuro-orthopaedics. I think only these  two  physiotherapist designed there  own concept in cranial work and working in  it.

Based on the patho-physiological mechanism and somatic dysfunctions, why cant orthopaedic manual physiotherapist address migraine by doing cranial manipulation along with spinal manipulation. There is an scope for orthopaedic manual physiotherapist. how long it will take to travel the distance for orthopaedic manual physiotherapist to address cranial dysfunctions which is contributing to cause migraine. The distance  can be covered by bringing the cranial works into the  scope of orthopaedic  Physiotherapy because these cranial structures are osseous structures,they too have mobility  and articulating through sutures, so there is scope for orthopaedic manual physiotherapist.Few authors described migraine as primary migraine and secondary migraine, the one of the causative factors of secondary migraines are somatic dysfunction of cranial,cervical and thoracic spine.

References –

Foundation of osteopathy medicine,3rd edition, Antony chila

Craniofacial dysfunction & pain,manualtherapy,assessment and management,Harry von piekratzPT,Lynn Bryden

Greenmans principle of manual medicine,4th edition,lisa de stefano,DO.

Somatic dysfunction in osteopathic family medicine,second edition,Kenneth E.Oslon,Thomas Glonek



October 16, 2015


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