Normally when I write a detailed article for my readers and subscribers to my newsletter I am trying to explain some simple exercise, nutrition, or lifestyle based solutions to a common health problem that they may be dealing with. However, with this article about migraines and headaches I feel like I pose more questions than I provide answers or solutions to, as it is such a complicated topic to discuss. Having said that, I hope by the time you have read all the information I am about to explore you may be clearer as to what factors may be causing your specific problem so you can implement the right corrective solution. This is part one of a two part series due to the amount of information I had to cover. In part two I will discuss the various things you can do to control your migraine attacks and hopefully prevent them in the future.
What Causes Migraines?
Migraines are on the most common and debilitating conditions in the world, yet they are often dismissed as “just a headache” and not treated as serious as it should be. Maybe it has something to do with the fact you cannot see the problem as you could with an obvious injury or physical ailment.
Statistics show that one in seven people will suffer from migraines with women three times as likely as men to have regular episodes. The damage ongoing migraines can have on a person’s physical and mental health cannot be overstated, so finding a way to get on top of it is critical.
One of the most frustrating things associated with this condition is finding out what triggers the migraine attack. We like to look at things with cause and effect and blame the last thing you did before the attack as the culprit but often the problem started well before the pain started. As I alluded to in the introduction there is one single cause of these problems, and there is usually a series of issues all working together to create the perfect storm that often triggers a severe reaction from the body.
A migraine attack can start anytime between 2 and 72 hours before you are fully aware of it! (Reference: “Managing your Migraine” by Dr Katy Munro on page 22)
This is why many leading migraine therapists will advise people to keep a migraine diary as there is no specific test to diagnose a migraine. More on this later.
It is extremely important that you get a correct diagnosis and assessment by your Doctor to be certain you know what you are dealing with. Self-diagnosis, Dr Google, or taking advice from someone else who has had migraines is the worst thing you could do as you could end up treating the wrong condition making matters much worse.
To appreciate just how many factors can contribute to causing a migraine, and why you must seek an expert diagnosis from a doctor, I will explain how symptoms can be created from many different sources.
Take a look at the chart below.
This chart shows how a doctor will investigate several potential causes and via process of elimination and results of various tests narrow down the root cause of the problem.
In the early stages you must rule out any neurological or brain pathology, along with any viral illness causing the problem. You will not be able to find this information out by yourself as it requires specific testing and examination by a qualified doctor. Many people think it is only a muscular problem such as a spasm in a neck muscle and seek help from a massage therapist or physiotherapist to make it go away, when in fact it could be a neurological or viral problem.
If the doctor rules out any neurological pathology then they will often try to rule out that it is a vascular problem from a viral illness or respiratory infection. Sometimes it may even be side effects of medications used to treat a different health problem that causes a reaction within the body. It is important to investigate this factor before lastly determining if it is a musculoskeletal, hormonal, or psychological cause. Even with all the blood tests, MRI, or CT scans, the test results may indicate everything is normal!
This might mean that there is a combination of several factors combined together which is not that surprising and also helps to explain why focusing on only one form of treatment will do little to change things.
Stress Can Easily Overload the System
If you look carefully at the chart above you will notice that STRESS is listed as a cause twice. This is not a typing mistake, this is to emphasize how powerful this can be across various systems. You cannot underestimate the damage that stress can create on the body and how it can completely derail the fittest and strongest person. Also it is not that easy to solve either. You cannot just tell someone to stop stressing out and you may not even be able to avoid the stressful situation. What you can control is HOW YOU REACT to the stress.
When we experience a stress response our body goes into “fight, flight or freeze” mode triggered by the sympathetic nervous system which is where I brain perceives a threat and our unconscious mind triggers one of these responses to get us away or protect ourselves from this threat. Our body will release cortisol from the adrenal glands which helps supply glucose to the bloodstream, there will be a release of adrenaline which increases the heart rate and breathing rate to provide your muscles and brain with energy from the glucose and oxygen to either run from or fight this animal.
This is a good response to have when faced with a real short term threat because it get us away from danger, however it is not good if this system is turned on all the time.
An unchecked stress response can cause repeated spikes in blood pressure increasing the chances of a stroke. You will begin to stockpile fat around the abdomen due to the high levels of the stress hormone cortisol being activated lowering IGF-1 and maintaining high levels of glucose in the bloodstream. This endless supply of cortisol greatly weakens the immune system and exposes the body to deadly diseases like diabetes and cancer.
And of course it increases your chance of suffering from migraines significantly.
The reasons for the stress response is very complicated and once again differs from person to person. More on what to do for this later, but for now recognize how critical this cog is in the wheel of the migraine attack.
Something that goes hand in hand with stress is gut health!
The Impact of Gut Health
This is a bit like what came first the chicken or the egg when we talk about stress and gut health. Was it the stress that caused the gut problems or, was it the gut problems that caused the stress? It can be difficult to tell but one thing is for sure when your gut is out of balance you will need to do several things to get it back under control. Failure to do so will always put you at risk of exceeding the migraine threshold.
The first thing most people think of when they hear the term ‘gut health’ is how our body digests food. While this is definitely its major role, gut health is so much more than that as it can have a direct impact on the health of your entire body. Our gut breaks down the meals we eat into a functional form that can enter the bloodstream and go where it is needed in the body.
When you understand how many of systems of the body are dependent on a healthy gut you will realize how something that is a bit off can cause serious problems. Did you know that the gastrointestinal system comprises 75% of the body’s immune system and that there are more neurons in the small intestine than in the entire spinal cord!
How does this relate to migraines though?
Our gut communicates with all cells in the body, which means that disturbances in the gut can show up as problems in the brain. Interestingly the same thing can work in reverse as mental problems can instigate gut problems! The brain actually kicks off digestion before the gut as we secrete acids and digestive enzymes before even swallowing the first bite of a meal!
In addition, our emotions influence gut health.
When you’re afraid, your brain and gut know, and your digestion slows down. Ever had the experience of not being able to eat when you’re feeling especially anxious? That’s because blood flow and enzyme production in the gut are limited during stress to direct the blood to your arms and legs in preparation for fight or flight.
Tring to restore gut balance can be quite tricky as you will need to avoid certain foods, and even pay attention to how you eat. Many of the things we are going to discuss in this article will dramatically improve your overall gut health.
You can read more about this in more detail in the article – Why gut health matters
Migraine Symptoms Vary Significantly From Person To Person
To appreciate how complex and difficult it can be to pinpoint the actual cause of your migraine you only to look at the multiple symptoms that people often feel. These symptoms can also be result of other illnesses, diseases, or injuries which is why you must investigate further to find out what is going on.
Even if the problem is just a severe headache or migraine the symptoms may differ widely from person to person making it difficult to establish the underlying cause.
Take a look at the chart below to give you an idea of the range of symptoms people may suffer with during an attack. Some of these symptoms may happen well before the onset of the headache.
Instead of trying to look for one single trigger try to look for patterns of things that work together to create the perfect storm. In the book “Managing your Migraine” by Dr Katy Munro she says on page 33, “It is more helpful to think of triggers adding together to irritate the brain, pushing its sensitivity towards a threshold. Once the threshold is breached, a migraine attack starts to roll”.
I think that is a great way to look for the various factors contributing to your problem, and you can already start to see how valuable a migraine diary can be for identifying these patterns.
Be patient in your endeavour to uncover the trigger for you may find that there is not one definitive pattern that always provokes the attack. It could be culmination of events that led up to the overload and it is your job to try and control these events as best as you can.
Different Types of Headaches
Some headache conditions are diagnose as migraines but they could be something much different which is why it is vital you get a diagnosis from a doctor.
The picture below provides you with a good visual as to the difference in headache types.
Cluster headaches are one of the most painful conditions and are characterized by severe burning and piercing pain usually around or behind one eye or on one side of the face at a time.
These headaches occur in a series. Each individual headache can last from 15 minutes to 3 hours. During a cluster, most people experience one to four headaches a day, usually around the same time each day which is why it is sometimes referred to as the “alarm clock headache”. After one headache resolves, another will soon follow.
A series of cluster headaches can last from weeks to even months at a time!
Tension headaches is the most commonly experienced headache and one that can also be misdiagnosed as a migraine. This is where you feel a dull, aching sensation all over your head. It is not necessarily a throbbing feeling or piercing pain like the cluster headache. Tenderness or sensitivity around your neck, forehead, scalp, or shoulder muscles also might occur.
These type of headaches can affect anyone and often the biggest factors here are stress and poor posture or repetitive movement that tighten the neck and shoulder.
This brings us to the next factor that you need to consider.
How Poor Posture Can Trigger Migraines
In almost every article I have written about injury or pain the importance of maintaining a good posture is always discussed.
Poor posture not only takes away from looking good, it compromises how we were designed to function, eventually leading to pain and/or injury. In almost every case where a person has developed poor postural habits, the neck and shoulder are highly vulnerable to trigger points and stiffness as they attempt to hold the head upright. When you look at a human skeleton you can clearly see how your bones are all stacked upon each other to create stability at your joints. Gravity basically compresses your bones to lock everything into place so you do not fall apart like a bag of bones. The one area that is different to all the others is clavicle (more commonly known as the collarbone) at the front of the shoulder.
The clavicle appears to be the only thing holding up your shoulder as it is not stacked upon other bones vertically like the spine and the lower limbs. The only way it can create stability to hold itself in good position is via use of multiple muscles, tendons, and ligaments.
The clavicle and the scapula appears to be floating in space as neither is connected or stacked upon other bones!
Two of the main muscles that hold these bones in place, LEVATOR SCAPULA and the TRAPEZIUS attach to the neck and the base of the skull. This explains why dysfunctional movement at the shoulder can easily lead to neck pain and headaches.
Neck pain is a common symptom of migraine and statistics show it is reported by up to 76% of people when they have an attack.
The levator scapula is often the muscle that people feel neck pain with as it is easily overloaded when weakness is present in other muscles. This is where people try to stretch or massage these muscles, but really they should be trying to strengthen the weakened muscles that are creating the overload in the first place. This is why I believe many people should not stretch their neck muscles.
The other muscle that attracts a lot of attention is the upper trapezius. Once again most people think this muscle is short and tight, when in reality it is the exact opposite, it is usually long and weak. And when that happens the scapula begins to sit too low and disrupt overhead movements forcing the levator scapula to work extra hard to lift your arm.
This constant pulling and straining of levator scapula it easily leads to headaches as it attaches to the upper four vertebrae of your neck. This poor scapula position is referred to as a "depressed shoulder" and is associated with many shoulder and neck dysfunctions. This cannot be resolved via stretching for it is a weakness that has led to this dysfunction being created.
I discuss the various ways you can combat this problem and rule it out as a factor in part two of this article.
Before you check that out I think it is important to discuss why migraines affect women more than men. For as you will see the stability and mechanics of the shoulder may have a big role to play in creating ongoing headaches and migraines.
Why Do Migraines Affect Women More Than Men?
I mentioned earlier that women are three times more likely to suffer from a migraine. The big question is why? Once again there is not a simple answer to this but the two biggest factors are hormones and lack of muscle mass.
Firstly, the biggest factor is the complex hormonal system of the female body. Falling oestrogen levels are often the trigger of the worse migraines at the end of the menstrual cycle. With some women these levels drop really fast which can sensitize the brain to pain triggering hormones. During the transition to menopause periods become irregular and the hormone production goes up and down creating the potential for these rapid drops in oestrogen.
About 8% of premenopausal women report having high frequency of headaches. When you consider the other life stresses a women around this age has to contend with you can see how easily her brain can reach that dreaded sensitivity threshold. Menopause is not necessarily a guarantee a woman will suffer from migraine attacks, it just adds another factor that may push a woman over the edge. You can begin to see how easily stress can turn nasty and cause catastrophic problems if it reaches the point of overload.
Trying to resolve hormonal problems is very difficult and not an easy thing to explain as once again there are so many factors that contribute to imbalances. Many of the things we will discuss towards the end of this article will help you out with getting any hormonal problems under control but I do suggest you seek out specialist help if you feel you have specific problems.
You can read more about the various hormonal problems that are specific to women in this article – 7 Health facts every woman should know
The other factor to consider here is the lack of muscle mass. This is not limited to the prevalence of migraines either as along with eating quality nutrition the value of adding muscle to a women’s body is far and away the most important ingredient for optimal health. Many of the chronic diseases like cancer and heart disease can be more easily controlled and prevented by adopting strength training 3 times per week.
Research shows that your muscles are more indicative of your overall health than your BMI is and that low strength with females dramatically increases health risks. Without regular exercise with resistance, the process of strength and muscle loss can start in women as early as their late 20’s and early 30’s. When this is combined with endless dieting and finding ways to lose weight the consequence to their health is immense.
How this relates to migraines in terms of a muscular component this loss of muscle mass can lead to instability of the neck and shoulder causing muscular trigger points that add to the onset of headaches and tension. Once again, if you add stress and the hormonal cycle to this problem you now have three things attacking the body and the overload is not far away.
This is something I have covered before numerous times relating to shoulder and neck problems that you can read in more detail in the two articles below.
Take a look at the chart below showing the prevalence of shoulder injuries in males versus females.
There are several reasons this happens.
- Females have much less muscle mass to begin with and are more prone to weakness and development of trigger points to maintain joint stability.
- Women are more prone to osteoporosis than males leading to softening of the bones and poor spinal alignment that contribute to hunched postures like the dowagers hump
- Poorly fitted bra straps can drag the scapula down into retraction leading to depressed shoulders and scapula dysfunction that we have discussed in great detail already.
- Women tend to carry heavy handbags or purses over one shoulder dragging the shoulder down into depression again.
- More females attend Yoga and Pilates classes that attempt to stretch more, and emphasize the pulling of the shoulders "down and back" that contribute to depressed shoulders.
Females generally present with greater mobility than males which can be a good thing if the joints are controlled, however it can pose huge problems when poor movement is combined with weak muscles. Click here to see results of a study about this. This is an interesting point to keep in mind for I very rarely find a male outscore a female on our flexibility assessment. Yet the onset of tight necks and muscles around the neck is more common in females!
Another factor that is often associated with headaches and migraines is TMJ disorder or jaw pain. In the book “The TMJ Healing Plan” by Cynthia Paterson she quotes a study by the New England Journal of Medicine that 40-75% of adults in the US report at least one sign of TMJ disorder! They also found it is 3-9 times more common in females than males.
Once again you can see how stress can greatly influence this problem as clenching is often linked to this disorder. Clenching and grinding can exert up to 300 pounds of force per square inch to your teeth, cranium, ligaments, cartilage, and disc within the TMJ. This is why clenching is often referred to as the leading cause of jaw problems. The same muscles that are involved in clenching can easily develop trigger points or spasms and lead to severe headaches that could progress to migraines.
Shortly, I will provide you with some ideas of how to incorporate the right exercises to improve your posture, shoulder, neck and jaw function to avoid these problems contributing to your migraine. Remember, it may not be only these things that are behind your problem but then can very easily be the thing that tips you over the threshold and into pain.
What Can You Do To Control Your Migraine Severity?
I hate using the word “fix” when it comes to this problem. Sometimes you cannot fix things, but you can control the severity of the response from the body. Also as we discussed earlier with the potential causes, there are a multitude of things you will need to consider. There is no single thing to do that will make things go away. You need to address ALL of the factors to give your body every chance of overcoming the stress.
The quote below I believe sums it up perfectly as what you will need to do to find your long term solution.
There are some factors that you may have very little control over such as hormonal fluctuations from menopause, or side effects of medications to treat a different medical problem, or even stressful event that happens in your life. All of these things can push you close to the threshold. On their own they are unlikely to throw you over the edge. It is the combination of these with the other factors exceeding their capability that is likely to irritate the brain and start the attack. While some things are out of your control, there are many factors that have a great influence over and this is where you need to place a huge focus.
By reducing the impact the other factors have on your body may be just enough to keep your brain below the threshold of a migraine attack. The more exposed you are to the other factors the more important it becomes to improving the factors under your control. While medications and anti-inflammatory pills can help to reduce the severity of the attack after it has started, I am sure many people would love to avoid the attack in the first place.
The degree of influence each of the controllable factors have on each person will differ significantly. For example, some people it may be their diet that is terrible so a positive change here will have a bigger impact than it will to the person who already eats healthy nutritious foods. A person who exercises regularly and maintains great posture may see little benefit from changing their exercise program, whereas the person who does no exercise and has bad posture may make significant changes. Your job is to identify where you are lacking and place your focus on the worst areas first.
To give you a good visual of what I mean here is a hypothetical example of two people who are vulnerable to migraines.
Both of these women have a history of migraines and both are going through menopause and dealing with a stressful work or home life. The woman on the right also has a medical condition that requires her to take medication that can initiate side effects that may trigger her migraine. These are factors that are to some degree out of your control and you have little influence over.
While both women have the same factors to contend with, one is much more likely to suffer constant and debilitating migraines than the other as her brain is more exposed to sensitivity triggers due to her poor lifestyle habits. Even though the woman on the right has the added burden of medication side effects, her willingness to work on the exercise, diet, and lifestyle habits that she can control allows her to stay below the sensitivity threshold. She may still at times suffer from an attack but it is fair to say her chances of overcoming this are much greater than the person who is ignorant to the factors under their control.
As I explained earlier the degree of influence of some of the factors may differ considerably and this hypothetical example gives you an idea of where you may need to spend the most time to making a difference.
So how do you control these various factors?
In part two we will discuss how you can manage your migraine by addressing these factors.
Great Resources To Help You Right Now
If you are struggling with many of the various things we have discussed in this article you will find the detailed PDF reports below a great resource. These contain detailed programs, exercise instructions, and information relating to many of the problems people with migraines face. Both of these reports you can download instantly by clicking the images below.
Summary
As you can see this is not an easy subject to explain. There are so many potential factors you need to consider and it can be extremely difficult to determine what is causing it. Many times it is the combination of several of the factors all merging together at once to create a perfect storm. I know that one thing is for certain is that anyone who suffers from chronic migraines and headaches would do anything to find a way to prevent it from happening. Painkillers and tablets are good at treating the problem once it has started, but many would rather avoid it altogether if they could. Hopefully this article gives you some ideas of how to do this.
For more ideas and information on specific topics I may not have covered in detail be sure to check out our INDEX PAGE on the website that has over 300 of our best articles. These are all sorted into categories for quick reference so you can find what you are after more easily. You can also subscribe to our FREE fortnightly newsletter by clicking here.
If you live in Melbourne and feel you need specific help with your exercise program please feel free to reach out to me for help and we can set you up with your individualised program.
About The Author
Nick Jack is owner of No Regrets Personal Training and has over 16 years’ experience as a qualified Personal Trainer, Level 2 Rehabilitation trainer, CHEK practitioner, and Level 2 Sports conditioning Coach. Based in Melbourne Australia he specialises in providing solutions to injury and health problems for people of all ages using the latest methods of assessing movement and corrective exercise.
References:
- Fixing Shoulder & Elbow Pain - By Rick Olderman
- Shoulder & Scapula Injuries in Athletes - By Chris Mallac
- TMJ Healing plan by Cynthia Peterson
- TMJ Therapy by Dr Kimberly Bensen
- Sitting On The Job - By Scott Dunkin
- Movement - By Gray Cook
- Osteoporosis Australia
- Corrective Exercise Solutions for the Hip & Shoulder - by Evan Osar
- Back Pain Mechanic - by Dr Stuart McGill
- Diagnosis & Treatment Of Movement Impairment Syndromes - By Shirley Sahrman
- Low Back Disorders - by Dr Stuart McGill
- Ultimate Back Fitness & Performance - by Dr Stuart McGill
- Core Stability - by Peak Performance
- Assessment & Treatment Of Muscle Imbalance - By Vladimir Janda
- How To Eat, Move & Be Healthy by Paul Chek
- Scientific Core Conditioning Correspondence Course - By Paul Chek
- Advanced Program Design - By Paul Chek