Physical (Non-Drug) Approaches for Treating Migraine

There are a number of ways to treat your headaches, using what Headache Researchers call Physical Approaches. The list below is not exhaustive but will give you an understanding of the more common physical treatments to control headaches or migraines

Acupuncture

Acupuncture is a form of alternative medicine, founded in China and widely used in Chinese Medicine. Tiny needles are inserted into "acupuncture points", known as trigger-points.

Acupuncture is currently used for pain relief and is sometimes used as an alternative to treat the pain and disability associated with migraine.

The most common method of pain control used in Traditional Chinese Medicine (TCM) is acupuncture. It is often used with other forms of pain relief. The topic of acupuncture is currently being debated by groups like the Canadian Medical Association. Scientific evidence is lacking as to its ability to be a treatment choice. However, some experts and many sufferers attest to its ability to control pain. 1

The medical community’s research and opinion on acupuncture is mixed. Some studies/trusted sources point out that "sham" (also called simulated) acupuncture works just as well as real acupuncture. Other studies affirm that acupuncture can give relief to people that experience chronic headache pain. The World Health Organization (WHO) has endorsed acupuncture as a promising treatment for pain since 1979. 2

Acupuncture studies in headache have concentrated almost entirely on the prevention of headache rather than acute treatment. A Cochrane systematic review first published in 2001 analysed 16 studies involving 1151 patients and concluded that ‘the existing evidence supports the value of acupuncture for the treatment of idiopathic headaches but called for further large-scale studies. Large, randomised controlled clinical trials involving several thousand patients have now been conducted, funded by German health insurance companies. These studies have compared acupuncture with standard treatment (drugs and advice given by physicians) and demonstrate persistent and clinically relevant benefits under real-life conditions and equivalence to specialist drug management. However, no convincing evidence of superiority to ‘sham’ acupuncture has been shown for headache. To skeptics, this suggests that ‘acupuncture doesn’t work’ (i.e. ‘it is no better than placebo’). To supporters of acupuncture, it suggests that while the studies show that it may not matter quite so much how the acupuncture is done, i.e. where the needles are placed or how deeply, acupuncture is much better than no treatment and equivalent to conventional treatment options, with considerably fewer side-effects. 3

Acupressure

Acupressure is a form of alternative medicine, and its principles are very similar to acupuncture. Like acupuncture, it is based on the concept that energy flows through the "meridians" through the body. Treatment typically involves applying pressure to acupuncture points to clear "blockages" in these areas. Pressure may be applied to the hand, or elbow to clear these blockages. 4

Wikipedia suggests that this treatment is useful in treating nausea, vomiting, lower back pain, and other conditions. Some studies support acupressure as a treatment for tension-type headaches, as well. 4

Aromatherapy

Aromatherapy involves the distillation of essential oils from plants. These oils are inhaled or absorbed through the skin in the form of ointments, compresses or aromatic baths. Some aromatherapy products may benefit some headache sufferers. On the other hand, some odours may increase or provoke nausea if used during migraine attacks. In particular, oil from lavender flower has been used to relieve muscle spasm and a small amount can be massaged over tense muscles of the forehead, neck or shoulders. In addition, a combination of peppermint and eucalyptus oils, when massaged into the forehead, has been found effective in relieving tension-type headache. 5

Chiropractic

Physicians maintain different viewpoints on the way that chiropractic mobilization treats your headaches, or migraines. It is probably because of these opposing viewpoints, that coverage for chiropractic care is often not offered by some health care plans.

Some patients really benefit from having their spine realigned. Some researchers have theorized that this manipulation causes the bodies natural preventing chemicals - the endorphins - to be released. This release of endorphins combats pain and makes us feel good. Some headache researchers suggest that Chiropractic mobilization is probably more effective in the treatment of tension-type headache (TTH) than it is in the treatment of migraine. 6

Dr. Joel Saper (Headache Neurologist) from the Michigan Headache & Neurological Institute in Ann Arbor, Michigan suggests "There is scientific evidence that neck manipulation can cause stroke. This risk is extremely low, but those with a previous history of strokes or other major health concerns should avoid neck and spine manipulation. 7

Further research on chiropractic can be found in Canada at the Canadian Chiropractic Association or in the US at the National Upper Cervical Chiropractic Association in Minneapolis, MN.

Dental Devices

A dental device is a mouth-guard fitted by your dentist to alleviate pain associated with night-time headaches. Another reason is to protect your teeth from night-time grinding, or bruxism. For serious OSA sufferers the most common treatment is a face mask called Continuous Positive Airway Pressure (CPAP). 8

Patients who wake-up frequently and do not feel refreshed, may be suffering from Obstructive Sleep Apnea (OSA).

OSA is a condition that many migraineurs suffer from; it includes symptoms like snoring, morning headaches, trouble concentrating, anxiety, depression, and increased blood sugar. For an article link and diagram on OSA by an international headache neurologist, refer the Lifestyle and Triggers tab - Lifestyle section, Cell #1.

Many sufferers find this mask bulky, have difficulty sleeping with it, and its effects on breathing are awkward. Dental mandibular advancement appliances are typically more easily tolerated and are less bulky. Consult your dentist about this dental appliance. 8

For those who sufferer from OSA or Temporomandibular Disorder (TMD) please read an article on Dental Appliances and Headache at here.

Many patients who have headaches and neck pain will experience night-time jaw clenching, known as nocturnal bruxism. A bite-plate prescribed, and fitted by your dentist can help to alleviate this problem. - American Migraine Foundation

Massage

Massage is a term that encompasses, a variety of methods using touch to press, rub or massage the skin, muscles, tendons and ligaments. Massage is used for several health conditions and provides many health benefits, including reducing stress (migraine's #1 trigger), pain and muscle tension. In addition to the health benefits, many people find massage produces feelings of caring, comfort and connection. There is some evidence that massage for migraine sufferers may help to reduce the number of attacks. 9

Massage is often used to relieve muscle tension (that many headache and migraine sufferers experience), reduce stress, ease pain, help with sleeping disorders, increase mental alertness, and in some cases, relieve depression.

It is thought to relieve pain by releasing the chemical serotonin. Serotonin and migraines are believed to be related. 9

Various types of massage exist including Swedish massage, sports massage, deep tissue massage, shiatsu, reflexology, and others. 10

Pregnant women should seek the advice of their physician before starting massage as a masseur specifically trained in massage for pregnant women, should be considered. 11

Dr. Rose Giammarco of Hamilton, Ontario claims that due to the relaxing, calming nature of massage - headaches like migraine and TTH would benefit. 11

Nerve Blocks

A nerve block is an injection of medication directly onto or very near a nerve that is suspected of causing headaches.

Each patient is different, but typically they often experience pain-free episodes from weeks-to-months, after an injection. Often a nerve block procedure must be repeated and many patients do not prefer this. 12

Most nerve blocks are done at the back of the head. The occipital nerve is irritated in many headaches, and nerve blocks can provide some relief. 12

Published articles have reported poor results in the treatment of tension headaches, paroxysmal hemicrania and hemicrania continua. They have been useful for treating cluster headache and cervicogenic headache. . 12

Patient education, and a follow-up with a specialist are highly recommended. 12

Physiotherapy (also called Physical Therapy)

Physiotherapy or Physical Therapy is a physical medicine that promotes mobility and function and focuses on rehabilitation. A physiotherapist is trained and licensed to examine, evaluate, diagnose and treat impairment, functional limitations and disabilities in patients. 13

Physiotherapists help patients understand what is causing their condition, and they make suggestions, treatments, to correct the problem. Home exercises are often a big part of their treatment plan. 13

Physicians will sometimes refer patients to a physiotherapist and many migraine patients can be significantly helped by a skilled physiotherapist.

A physiotherapy office can include: physiotherapists, occupational therapists, massage therapists, kinesiologists, chiropractors, medical specialists, family physicians, nurses, disability management professionals, psychologists, exercise physiologists, dieticians and much more. 13

The largest physiotherapy organization in Canada in called CBI Health Group. They have 5 offices in London. Visit www.cbi.ca to find a location in your city.

What physical therapy approaches are most helpful for chronic headache sufferers?
Many headache sufferers have already utilized various relief measures and treatments, such as heat and ice, and use them at home. The most effective treatment for the chronic headache patient is to find the underlying structural cause or contributor to their illness and focus treatment on this area. For example, the physical therapist may be able to identify a specific joint in the neck that is moving poorly, or a spasm in one of the small muscles in the face or neck that when mobilized and stretched can significantly reduce or eliminate the pain being experienced by the patient. 13

Does physical therapy produce permanent pain relief?

That depends. When a physical therapist can get at the root of a problem, such as poor mobility in a joint or muscle spasm or postural dysfunction, and address that problem, the results can be longer lasting. The patient may need to perform a few exercises in order to maintain the improvement. 13

Yoga

Yoga is a spiritual, physical and mental practice that originated in India, and is now practiced world-wide. Yoga involves certain postures, deep breathing and meditation. Yoga is a mind/body therapy and it is said to be for the purpose of uniting the mind, body, and spirit. 14

Many headaches or migraines can be triggered by certain foods, sleep disturbances or stressful events. Therefore, any approach that advocates stress-reduction is useful. There is a lot of research that shows that migraines improve with stress reduction techniques.

Yoga Graphic from Non-Drug Treatments for Headache, 2013 Page 35

Scientific studies suggest that yoga was very helpful in both treating migraines and the disability associated with migraines.

If incorporating yoga, other areas of your life will benefit including coordination, flexibility, calmness, self-awareness, mood, and studies report that often anxiety is lessened. For a complete article on yoga and migraines, also tips to get you started ckick here 14

REFERENCES

  1. Cleveland Clinic Canada, Acupuncture
  2. Healthline 2019, Acupuncture
  3. Migraine Trust, 2019, Acupuncture
  4. Wikipedia, Acupressure
  5. Cleveland Clinic Canada, Aromatherapy
  6. Canadian Chiropractic Association
  7. Please note:
    Naturopathy is a form of alternative medicine that focuses on natural treatments like herbalism, acupuncture,
    homeopathy and others. Naturopaths often believe that the body can perform "self-healing" which is in conflict
    with evidence-based medicine. For this reason the author has not included Naturopathy as an alternative headache
    treatment, however some migraine sufferers enjoy relief from this method.
    12

    Websites accessed

    • Canadian Headache Society
    • CBI Physiotherapy
    • Cleveland Clinic Canada
    • Michigan Headache and Neurological Institute
    • Migraine.com
    • Migraine Canada
    • Migraine Trust
    • National Centre for Biotechnology Information, Library of Medicine
    • National Center for Complimentary and Integrative Health (NCCIH)
    • Wikipedia

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