Saturday, June 7, 2014

Migraine Awareness – An exercise that might help when all else fails. Followed by some recent research. by Celeste Cooper

Because migraine occurs in many patients with fibromyalgia, chronic fatigue syndrome, and chronic myofascial pain and this is migraine awareness month, I felt you might find the following excerpt from our book Fibromyalgia, Chronic Fatigue Syndrome and Myofascial Pain helpful. Following the excerpt are some more recent research citations on migraine if you are so inclined to share with your healthcare provider.

Before the advent of medications to treat migraine, I had to find ways of working through them in other ways. Some not so pleasant, but I learned early in my life how to meditate through pain.

From Integrative Therapies for Fibromyalgia, Chronic FatigueSyndrome and Myofascial Pain: The Mind Body Connection, pgs. 285-286.

I combine body scanning with progressive muscle relaxation for dealing with migraine, chronic pain, and tension...I lie down on my back in a comfortable, quiet place, usually my bed.

  • I allow my eyelids to gently close while feeling the softness of their flowing movement across my eyes.
  • I practice diaphragmatic breathing, focusing on the sound of each breath as the air moves in and out of my nose or mouth.
  • I begin progressive relaxation by starting at the top of my head and proceeding down my body to the tips of my toes, paying close attention to each individual segment.
  • I contract the muscles around the area I am concentrating on, and allow the tension to release as I relax the muscles.
  • If I have a hard time releasing the tension, or find my mind keeps drifting back to this area after I have left it, I go back to it.
  • For resistant areas, I visualize something comforting as I release the tightened muscles. I might imagine my head full of gelatin that starts to melt as I release the tension in my head. I imagine multiple colors blending into one, full of the strength needed to push out the resistant toxins.
  • As I leave each area, I take a deep breath and blow off the cellular waste that had been allowed to accumulate there.
  • I allow myself to recognize different sensations, like pain, numbness, tightness, or coldness.
  • I move along my body parts, from eyebrows to nose, to mouth, to neck, to shoulders, to arms, to fingers, and so on.
  • If the soreness or sensation is deeper, perhaps lodged in my organs where I cannot intentionally contract and release, I visualize something internally soothing, like warm herbal tea or chicken broth flowing from my mouth down my throat, then coating my stomach and comforting me.
 If I’m still awake by the time I get to my toes, I take a deep breath and allow my body to cleanse itself as a whole.

Some recent research from the NIH, Pub Med

Bashir A, Lipton RB, Ashina S et al. 2013.  Migraine and structural changes in the brain: A systematic review and meta-analysis. Neurology. 81(14):1260-1268. “This review and meta-analysis was conducted: “To evaluate the association between migraine without aura (MO) and migraine with aura (MA) and 3 types of structural brain abnormalities detected by MRI: white matter abnormalities (WMAs), infarct-like lesions (ILLs), and volumetric changes in gray and white matter (GM, WM) regions….These data suggest that migraine may be a risk factor for structural changes in the brain. Additional longitudinal studies are needed to determine the differential influence of migraine without and with aura, to better characterize the effects of attack frequency, and to assess longitudinal changes in brain structure and function.”

Bodes-Pardo G, Pecos-Martin D, Gallego-Izquierdo T et al. 2013. Manual treatment for cervicogenic headache and active trigger point in the sternocleidomastoid muscle: A pilot randomized clinical trial. J Manipulative Physiol Ther. [July 8 Epub ahead of print].  Twenty patients. “The preliminary findings show that manual therapy targeted to active TrPs in the sternocleidomastoid muscle may be effective for reducing headache and neck pain intensity and increasing motor performance of the deep cervical flexors, PPT (pressure-pain threshold), and active CROM (cervical range of motion) in individuals with CeH (cervicogenic headache) showing active TrPs in this muscle. Studies including greater sample sizes and examining long-term effects are needed. “

Boldingh MI, Ljostad U, Mygland A et al. 2013. Comparison of interictal vestibular function in vestibular migraine vs. migraine without vertigo. Headache. [May 15 Epub ahead of print]. This study found vestibular abnormalities in all migraine patients tested. 

Boyer N, Dallel R, Artola A et al. General trigeminospinal central sensitization and impaired descending pain inhibitory controls contribute to migraine progression. Pain. 2014. [Mar 12 Epub ahead of print.] 

Castaldo M, Ge HY, Chiarotto A et al. Myofascial trigger points in patients with whiplash-associated disorders and mechanical neck pain. Pain Med. 2014. [Mar 18 Epub ahead of print.]  “Active MTPs are more prominent in WAD (whiplash associated disorders) than MNP and related to current pain intensity and size of the spontaneous pain distribution in whiplash patients..." 

Cvetković VV, Strineka M, Knezević-Pavlić M, Tumpić-Jaković J, Lovrencić-Huzjan A. Analysis of headache management in emergency room. Acta Clin Croat. 2013 Sep;52(3):281-8.

Evans RW, de Tommaso M. 2011. Migraine and fibromyalgia. Headache. 51(2):295-299

Gerwig M1, Rauschen L, Gaul C, Katsarava Z, Timmann D. Subclinical cerebellar dysfunction in patients with migraine: Evidence from eyeblink conditioning.Cephalalgia. 2014 Feb 24. [Epub ahead of print]
CONCLUSIONS: Reduced acquisition of CRs in the cohort of female patients studied here supports findings of a cerebellar dysfunction in migraine.

Kashikar-Zuck S, Zafar M, Barnett KA et al. 2013. Quality of life and emotional functioning in youth with chronic migraine and juvenile fibromyalgia. Clin J Pain. [Feb 26 Epub ahead of print]. “Chronic pain in children is associated with significant negative impact on social, emotional and school functioning.” …“Youth with JFM (juvenile fibromyalgia) had significantly higher anxiety and depressive symptoms, and lower quality of life in all domains. Among children with CM (chronic migraine), overall functioning was higher but school functioning was a specific area of concern….Results indicate important differences in subgroups of pediatric pain patients and point to the need for more intensive multidisciplinary intervention for JFM patients.”

Küçükşen SGenç EYılmaz HSallı AGezer IAKarahan AYSalbaş ECingöz HTNas OUğurlu H. The prevalence of fibromyalgia and its relation with headache characteristics in episodic migraine. Clin Rheumatol. 2013 Feb 27. [Epub ahead of print] “This study indicates that the assessment and management of coexisting FM should be taken into account in the assessment and management of migraine, particularly when headache is severe or patients suffer from widespread musculoskeletal pain.”

Laursen JC, Cairns BE, Kumar U et al. Nitric oxide release from trigeminal satellite glial cells is attenuated by glial modulators and glutamate. Int J Physiol Pathophysiol Pharmacol. 2013. 5(4):228-238. “…these findings suggest that targeting SGCs (satellite glial cells) may provide a novel therapeutic approach for management of craniofacial pain conditions such as migraine in the future.”

Lovati C, Mariotti C, Giani L et al. 2013. Central sensitization in photophobic and non-photophobic migraineurs: possible role of retino nuclear way in the central sensitization process. Neurol Sci. 34 Suppl 1:133-135. “Overall, these findings suggest that light stimulation may contribute to central sensitization of pain pathways in migraineurs, possibly contributing to progression into chronic forms. The possible connections underlying this type of sensitization are offered by the recently published data on a non-image-forming visual retino-thalamo-cortical pathway which may allow photic signals to converge on a thalamic region which is selectively activated during migraine headache.”

Pérez C, Villalibre I, Ramírez-Nicolás B, Porta-Etessam J. Prevalence of Migraine in Patients With Restless Legs Syndrome: A Case-Control Study. Headache. 2014 May 20. doi: 10.1111/head.12382. [Epub ahead of print]

Pinto Fiamengui LM, Freitas de Carvalho JJ, Cunha CO et al. 2013. The influence of myofascial temporomandibular disorder pain on the pressure pain threshold of women during a migraine attack.  J Orofac Pain. 27(4):343-349. Conclusion: Migraine attack is associated with a significant reduction in PPT [pressure pain threshold ] values of masticatory muscles, which appears to be influenced by the presence of myofascial TMD pain.”  [This was a very small sample size. While TMJ can have an MPS component, it is not synonymous, and I suspect the migraine with TMJ group would also have had MTrPs located in pain referral patterns. This very likely contributes to the reduction of PPT as well. Cc]

Silva-Néto RP, Peres MF, Valença MM. Accuracy of osmophobia in the differential diagnosis between migraine and tension-type headache.  J Neurol Sci. 2014 Feb 6. pii: S0022-510X(14)00064-1. doi: 10.1016/j.jns.2014.01.040. [Epub ahead of print]

Watson DH, Drummond PD. Cervical Referral of Head Pain in Migraineurs: Effects on the Nociceptive Blink Reflex. Headache, 2014... [Mar 25 Epub ahead of print.] “Our findings corroborate previous results related to anatomical and functional convergence of trigeminal and cervical afferent pathways in animals and humans, and suggest that manual cervical modulation of this pathway is of potential benefit in migraine.”

Yun DJ, Choi HN, Oh GS. 2013. A case of postural orthostatic tachycardia syndrome associated with migraine and fibromyalgia. Korean J Pain. 26(3):303-306. “Postural orthostatic tachycardia syndrome (POTS) refers to the presence of orthostatic intolerance with a heart rate (HR) increment of 30 beats per minute (bpm) or an absolute HR of 120 bpm or more. There are sporadic reports of the autonomic nervous system dysfunction in migraine and fibromyalgia. We report a case of POTS associated with migraine and fibromyalgia. The patient was managed with multidisciplinary therapies involving medication, education, and exercise which resulted in symptomatic improvement. We also review the literature on the association between POTS, migraine, and fibromyalgia.”

(Signature line appended, March 2018)

In healing,
Celeste Cooper, RN / Author, Freelancer, Advocate

Think adversity?-See opportunity!

No comments:

Celeste's Website

Celeste's Website
Click on the picture