What is the difference between a headache and a migraine? 

A headache can be characterised as having a slow onset, usually bilateral, mild to moderate dull pain. A migraine, however, can be described as more severe pain that is often unilateral, throbbing and can last between hours to a few days. Migraines can also include the following symptoms:

• Sensitivity to light, sound and touch.
• Altered sensation to the face/hands.
• Nausea.
• Vomiting.
• The presence of an aura (visual change such as blind spots or light flashes). 

What is the mechanism behind hormones influencing headaches/migraines?

Research over time has shown that headaches and migraines can be influenced by hormonal changes. A drop in estrogen in the premenstrual phase of the menstrual cycle has been associated with triggering headaches and migraines before and during menstruation. The physiological mechanism behind hormonal headaches/migraines is quite complicated. Below is a simplified description. 

It is thought that the drop in estrogen in the premenstrual phase triggers a response in different areas of the brain. These parts of the brain are linked with different symptoms.

Involvement of different parts of the brain:

Initial symptoms of migraines such as mood changes, light/sound sensitivity, fatigue and food cravings, are thought to be due to increased activity in cortical, brainstem and hypothalamic regions of the brain. Auras are thought to be influenced by increased cortical neuron (brain cell) firing. 

Headache pain (also experienced during migraines) involves the trigeminovascular system. The is a pathway that transmits detection of pain from the meninges (protective membrane encasing the brain and spinal cord) and cerebral arteries (arteries of the brain) to the brainstem trigeminocervical complex.

The trigeminocervical complex comprises the jaw (TMJ), neck (cervical) and trigeminal nerve (one of the cranial nerves detecting sensation in the face) and how they interact with each other. Activation of the trigeminovascular system causes vasodilation of the blood vessels in the brain. It also causes increased sensitivity of brain cell firing in response to dural (outer membrane of the brain) stimuli. This is what is believed to cause the throbbing sensation and increased pain during movement which is often experienced with migraines.  

Potential treatment options: 

• Speaking with your doctor to see what pain relief medications may be effective. This may also involve discussion around onward referral to a more specialised healthcare professional (i.e. a Neurologist).
• Avoiding known migraine triggers around the time of menstruation. Triggers may involve caffeine, certain foods, too much/little sleep, stress or exercise. 
• Seeing your Physiotherapist if you’re experiencing neck symptoms in conjunction with your migraine/headache.
• Speaking with our Dietitian, Bella, if you think there may be dietary triggers. https://www.chowbellanutrition.net

~ Leah Christoforou 
Physiotherapist

Migraine Australia: https://www.migraine.org.au

You may find these PMPP blogs interesting:

• https://portmelbournephysio.com.au/cervicogenic-headache-a-pain-in-the-neck/
• https://portmelbournephysio.com.au/strengthening-exercises-for-neck-pain/
• https://portmelbournephysio.com.au/is-your-smartphone-or-tablet-a-pain-in-the-neck/
• https://portmelbournephysio.com.au/physiotherapy-management-for-cervicogenic-headaches/
• https://portmelbournephysio.com.au/causes-and-treatment-of-headaches/