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 –
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.
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.
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