Menstrual Migraines

Menstrual Migraine

A question we are continually asked is how physiotherapy can help a Menstrual migraine.

About 7-10% of women suffer from menstrual migraine, and it has commonly been associated with the decrease in Estrogen causing dilation of the blood vessels in the head. This is actually something that has been measured clinically using blood dopplers and MRI scans and we can say without a doubt that the blood vessels increase in diameter by about 6% as estrogen levels drop.  However there are 2 problems with linking this dilation and migraines. 

Firstly, ALL women's’ blood vessels dilate when estrogen levels drop, not just migraine sufferers. 90-93% of people have dropping estrogen levels and dilation of blood vessels without a migraine.

Secondly, there are no pain receptors in the blood vessels in your brain. There are no pain receptors anywhere in your brain so the pain you feel can’t be coming from the blood vessels because they literally cannot feel pain. 

The nerve that regulates blood vessel dilation is a small branch of the much larger trigeminal nerve which actually has its origins in the brainstem. The trigeminal nerve and all of the nerves that look after the muscles and joints and discs in the neck all share the same processing centre in the brain stem. What we have found with our menstrual migraineurs, is that the input from the blood vessels is being distorted by input from the neck and the end result is the brain can’t distinguish where the pain is coming from and attributes it to the area you are most likely going to do something about it, which is usually a headache!  This means we need to assess your neck to determine whether it is a contributing factor. 

Unlike other migraines, a menstrual migraine is quite predictable when it is going to arrive (usually 2 days before your period) so it is quite easy to determine the role of the cervical spine in your migraine. You can find more detail about actual migraine treatment here, but if we can treat your neck and change the intensity and/or the duration of your next menstrual migraine, we can determine exactly the actual cause of your migraine. There is no guess work.