If you get migraines, you know they're not "just a headache". The throbbing pain, sensitivity to light and sound, nausea, and the hours or days lost to an attack can affect work, family and everything in between.
Many people with migraine also notice neck pain and stiffness before, during or after an attack, and wonder whether a chiropractor could help.
In this article we'll cover what migraine is, the most common triggers, how it differs from headaches that come from the neck, and an honest look at what the research says about where chiropractic care fits in.
What is a migraine?
Migraine is a neurological condition, not simply a bad headache. A migraine attack often involves:
Moderate to severe pain, often throbbing and on one side of the head
Pain that worsens with routine activity, such as walking or climbing stairs
Nausea or vomiting
Sensitivity to light, sound or smells
Some people also experience an aura before or during an attack. This might include visual changes such as flashing lights or zigzag lines, tingling, or difficulty speaking.
Migraine tends to run in families, and it's more common in women, partly because of the influence of hormones.
Common migraine triggers
A trigger doesn't cause migraine on its own, but it can tip a sensitive nervous system into an attack. Triggers vary a lot between people, and often it's a combination of factors rather than one thing. Common ones include:
Stress, and sometimes the let-down after a stressful period ends, such as the first days of a holiday
Changes in sleep: too little, too much, or irregular sleep
Hormonal changes, particularly around menstruation
Skipped or delayed meals
Dehydration
Alcohol, especially red wine for some people
Caffeine, either too much or withdrawal when you miss your usual intake
Bright or flickering lights, loud noise or strong smells
Weather changes and changes in air pressure
Certain foods for some people, though food triggers are less common than many believe
Overusing pain medication, which can lead to more frequent headaches over time
Keeping a simple migraine diary, noting sleep, meals, stress, your cycle and what you were doing before an attack, can help you spot patterns.
Migraine or neck-related headache?
Not every headache is a migraine. Two other types are especially relevant to chiropractic care.
Cervicogenic headache starts in the neck. It's usually on one side, often begins in the neck or base of the skull and spreads forward, and is typically brought on by neck movements or sustained postures. Neck movement is often restricted.
Tension-type headache is usually a dull, band-like pressure on both sides of the head. It's often linked to stress, poor sleep and muscle tension in the neck and shoulders, and usually doesn't cause nausea.
The two can overlap with migraine. Many people with migraine also have neck pain, and neck pain is a common feature during migraine attacks. Working out which type of headache you have, or whether you have more than one, is an important first step, because it affects which treatments are most likely to help.
What does the research say about chiropractic care for migraine?
We think it's important to be honest here, because migraine is a complex neurological condition.
A 2019 systematic review and meta-analysis published in Headache combined six randomised trials involving 677 people. It found that spinal manipulation reduced migraine days and migraine pain intensity, with a small overall effect. However, the authors described their findings as preliminary because of limitations in the included studies, and called for larger, more rigorous trials.
A well-designed Norwegian trial published in the European Journal of Neurology in 2017 compared chiropractic spinal manipulation with a sham (placebo) treatment and with usual medication alone in 104 people with migraine. Migraine days fell in all three groups during treatment. The improvement lasted in both the manipulation and sham groups over 12 months of follow-up, but the difference between them wasn't significant, and the researchers concluded the effect was probably a placebo response. Side effects were few, mild and short-lived.
So what does that mean? Chiropractic care is not a cure for migraine, and it shouldn't replace medical management. The current evidence that spinal manipulation directly reduces migraine is limited. Where a chiropractor can be most useful is in a supporting role, particularly when neck pain, muscle tension or a cervicogenic headache component is part of the picture.
Exercise: one of the best-supported non-drug options
One of the most useful things you can do for migraine is regular aerobic exercise.
A Swedish randomised trial published in Cephalalgia compared 40 minutes of exercise three times a week with relaxation training and with the preventive medication topiramate in 91 people with migraine. All three reduced migraine frequency, with no significant difference between them. Topiramate was better at reducing pain intensity but caused side effects in a third of participants, while no side effects were reported in the exercise group.
The researchers suggested exercise may be an option for people who don't benefit from, or don't want, daily preventive medication. It's worth discussing with your GP, and building up gradually, since intense exercise can be a trigger for some people.
How a chiropractor can help
At Epoch Health, our role in headache and migraine care is to support you alongside your GP or neurologist. That can include:
A thorough assessment of your headache history, triggers and neck, to help work out whether there's a neck-related component
Managing neck pain and muscle tension, which often accompany migraine and can add to your overall pain and discomfort
Hands-on care where appropriate, such as soft tissue therapy, mobilisation and, if suitable, spinal manipulation, particularly for cervicogenic and tension-type headache
A home exercise program to improve neck strength, posture endurance and mobility, plus guidance on building up regular aerobic exercise safely
Help identifying triggers, such as sleep, workstation setup, stress and sustained postures
Advice on a headache diary to track patterns and progress
Referral to your GP for medical assessment, diagnosis and medication options, or if anything in your history needs further investigation
The aim is to help you reduce the things that make headaches more likely, manage the neck and muscle side of your symptoms, and feel more in control.
When to see a doctor urgently
Most headaches aren't dangerous, but some need urgent medical attention. Call 000 or go to the emergency department if you have:
A sudden, severe headache that reaches its worst within seconds to minutes, sometimes described as a thunderclap or the worst headache of your life
Headache with fever, a stiff neck, a rash, confusion or drowsiness
Headache with weakness, numbness, trouble speaking, vision loss or loss of balance
Headache after a head injury
Headache with a seizure or fainting
See your GP promptly if:
Your headaches are new, especially if you're over 50
The pattern of your headaches has changed, or they're getting more frequent or severe
Headaches wake you from sleep or are worse lying down, coughing or straining
You're pregnant, or have a history of cancer or a weakened immune system
You're using pain relief on more than a few days a week
If you haven't had your migraines diagnosed by a GP, it's worth doing so. There are effective medical treatments for both stopping attacks and preventing them.
Work with a team
Migraine is best managed with a team approach. Your GP or neurologist can confirm the diagnosis and manage medication, and your chiropractor can help with the neck, muscle and lifestyle factors that often come along with it.
If headaches and neck pain are affecting your life, we're here to help you work out what's going on and build a plan that fits.
Book an appointment at our Dundas Valley or Telopea clinic: epochhealth.net.au/bookings
This article is general information only and isn't a substitute for personalised health advice. If you have any of the urgent symptoms listed above, call 000 or go to your nearest emergency department.
References
Rist PM, et al. The impact of spinal manipulation on migraine pain and disability: a systematic review and meta-analysis. Headache. 2019;59(4):532–542.
Chaibi A, Benth JS, Tuchin PJ, Russell MB. Chiropractic spinal manipulative therapy for migraine: a three-armed, single-blinded, placebo, randomized controlled trial. European Journal of Neurology. 2017;24(1):143–153.
Varkey E, Cider A, Carlsson J, Linde M. Exercise as migraine prophylaxis: a randomized study using relaxation and topiramate as controls. Cephalalgia. 2011;31(14):1428–1438.