Alaska Institute of Oriental Medicine, Acupuncture & Massage Therapy

 Information on Headaches, Migraines and Vestibular Migraines:

What they are, what to do about them and Holistic Approaches to Healing them: Did you Know you Could Experience a Migraine without a Headache at all? Did you Know that your Migraine could cause temporary Numbness, Tingling, Vertigo and Visionary Problems?

Vestibular migraine is the most common neurological cause of vertigo in adults, affecting almost 10 million Americans. It is also under-diagnosed and under-recognized. Only about 20% of people suffering from vestibular migraine are diagnosed correctly.

Vestibular migraine is an invisible illness, on the surface everything looks fine, but underneath, vestibular migraine sits like a serpent ready to strike at any moment with the violence of a tornado. It does not care about your job, friends, family or life. The fear of it striking is paralyzing. What if it strikes while you are driving, or in public, or worst when no one is around to help you. It embarrasses you; it leaves you with guilt from missing out on opportunities, it condemns you for being a burden to others. While others around you can see a person with a visible disability or even a broken leg, they cannot see the invisible vertigo and debilitating dizziness that can come on at any time, like working on a computer, or being out at dinner, driving in traffic. There are no regular lab tests or imaging tests to diagnose it. You cannot just try to appear normal and get back to work; you cannot will it away. You need to take action!

Here are some of the common misdiagnoses for vestibular migraine; this is just some of them! Meniere’s disease, perilymph fistula, vestibular neuritis, benign paroxysmal positional vertigo, ear infections, allergies, sinus problems, deviated septum, multiple sclerosis, mini stroke, heart problems, epilepsy, anxiety, depression and even cancer.

Getting the right diagnosis is extremely important because it validates you, it will let your friends, family and coworkers know there is something validly wrong and it will also stop all the craziness of going to multiple practitioners for irrelevant surgeries, drugs, and treatments that will make the matter worst when attempting to cure an invalid illness.

Migraine can be diagnosed after experiencing at least 5 headaches lasting from 4-72 hours sever enough to impact routine daily activity, accompanied by nausea, or light/ sound sensitivity.

Migraines are categorized into 4 parts: premonitory, aura, attack, and postdrome.

The premonitory can start up to three days before the attack and may include fatigue, food cravings, excessive yawning, cognitive changes, and mood swings. 

The aura is characterized by transient neurological changes that last from 5 – 60 minutes, most commonly experienced as visual phenomena like flashes of light, colorful squiggly lines, zigzag patterns, or black spots. Some people may experience sensory symptoms like numbness, tingling, or unusual sensations as part of their aura. More unusual auras include word-finding difficulty or weakness or numbness on half of their body.

The attack will last from 4-72 hours and be painful enough to most likely need to lay down and can be accompanied by nausea, and light or sound sensitivity.

The Postdrome of migraine involves aftershocks, people usually experience lethargy, trouble concentrating, depressed mood, and in rare cases euphoria.

Migraine is not just another headache; and vestibular migraine is not just a migraine with dizziness!

What caused you to get a vestibular migraine? There is not a sure answer, but it was not something you did. Vestibular migraines are caused by some known things which include: Stress, Depression, Genetics, Hormonal Changes, and Sub-optimal Vitamin and Nutrient levels (which could have been from as long ago as birth, not necessarily recent)

This is a brief history of how a migraine starts and develops:

A migraine starts at the trigeminal system, the largest of the cranial nerves, which mediates sensation of the head, face, dura, and the surface of the blood vessels inside the skull. The cascade of migraine begins with neuronal dysfunction called cortical spreading depression, which triggers activation of the trigeminal system leading to changes in the dura and upper cervical cord. Migraine related changes also take place within the upper cervical cord. Then the dysfunction spreads to the thalamus, hypothalamus, the locus coeruleus located in the brain stem and the brain stem center.

It was in 1999 the term vestibular migraine was ever used in a study by Drs Dieterick & Brandt. The first set of diagnostic criteria was published by Dr. Neuhauser and colleges in 2001 and in 2012 The International Barnay Society and The International Headache Society collaborated to publish the criteria we use today. It is as follows:

A: At least 5 episodes lasting 5 minutes to 72 hours

B: Current or previous history of migraines with or without aura

C: 1 or more migraine feature with at least 50% vestibular episodes: headache with at least 2 of the following characteristics: unilateral, pulsated/ throbbing, moderate or severe intensity, aggravated by normal routine and activity, photophobia or phonophobia, visual aura

D: Not better accounted for by another vestibular or ICHD diagnosis

These are some of the vitamin, essential oils, herbs, and nutrients recommended by Dr. Beh to help combat vestibular migraine:

Vitamin B2, CoQ10, Magnesium, Vitamin D, Folate, Vitamin B6 and Vitamin B12, Vitamin C & E, Boswellia, Fever Few, Ginger, Ginko Biloba, Melatonin, Peppermint oil (for pressure points), Rose, Lavender and Eucalyptus oils to breathe, Omega fatty acids, probiotics, tryptophan, turmeric.

Dr. Beh recommends among other options Vestibular rehabilitation therapy, chiropractic therapy, physical therapy, massage therapy, acupuncture (make sure your acupuncturist is licensed in the state you are in), acupressure. 

For headaches, acupoint L14 (Hegu) is located at the base of the thumb and index finger. Use your right thumb to apply firm pressure at this point while moving it in a slow circular motion for 5 minutes. You do not have to press so hard as to cause pain. Repeat this on the right hand. Some vendors sell plastic clips that can be applied to this acupoint, but many people use clothespins with just as much benefit at a fraction of the price.

For stress: acupoint Extra 1 Yintang is right between the eyebrows. Apply gentle pressure between your eyebrows at this point with your thumb, moving with a slow circular motion for 5 – 10 minutes with your eyes closed.

For vertigo, dizziness, nausea, and vomiting: acupoint P6 Neiguan is located on the inner forearm, three finger-breadths from your wrist. You will feel the two prominent tendons that connect the forearm muscles to your fingers at this point. Use your index finger or thumb to press firmly while moving it in a slow circular motion for 3 minutes, repeat on the other forearm, Sea bands are bands that are worn at this point to apply pressure at P6. Some products apply electrical stimulation at this acupoint.

Dr. Beh describes vestibular migraine as Alice in Wonderland syndrome because the symptoms can be so unusual, devastating and there are a whole plethora of possibilities. Some of these unusual symptoms are: Feeling parts of your body do not belong to you, feeling really large where you can see above the treetops or really tiny, seeing double vision, sparkly lights, zigzags, an aura around people, seeing animals that are not there, having time lapses or time slows down, so you could be driving at 80 mph and think you are only doing 20 mph...or the other way around, there can be brain fog, word loss, or the complete loss of ability to move or speak for a  short amount of time (because the aura portion lasts for a shorter portion of time) Vestibular migraine can mimic TIA! The body can become numb and droopy on one side, combined with an inability to speak or the ability to move it is easy to see how a vestibular migraine with an aura could be mistaken as a stroke!

There is a whole tirade of medications used for migraines and taking them can make your migraine worst, that being said Dr. Beh does strongly suggest that you find a rescue medication that works for you. That is something you know will work and that can be sprayed in your mouth or dissolved under your tongue, this is something you would carry with you at all times.

In his book: “Zen Mind, Beginner's Mind” Zen Master Shuryn Suzuki Roshi said, “In the beginner's mind there are many possibilities, but in the expert’s there are few.”

This can be said of working for the relief of migraine because in the beginning there are a lot of options and hope, but as time and options go by, there becomes less hope for a cure and relief.

We have talked before about the placebo effect and how so many people can take a treatment and get better just because of their belief in the treatment alone. Visualization works on this level as well. In visualization you visualize yourself doing the event as if it was happening right now, or visualize yourself healthy and fully healed right now. For this reason, hypnotherapy or self-hypnosis works really well also.

2000 Olympic champion platform diver Laura Wilkinson suffered from a foot injury that kept her from practicing her dives for 2 months before the Olympics, usually enough to put a person out of contending due to loss of muscle and practice. China was already determined to be the winner as they had won the event 7 out of 8 of the last Olympic event years. Laura practiced visualization and won in spite of her injury and lack of physical practice. She was the first American in 36 years to have won!

Triggers for migraine are categorized as: Dietary, Environmental, Lifestyle, Physical, Medication, and hormonal.

It can be very tricky to figure out what might or might not be a trigger for your migraine, for this reason, it is important to always keep a migraine diary and include everything every day so you can go back and see where the cause might have been. Here are some of the things you might be looking for: 

Dietary: 

Cheese, alcohol, artificial sweeteners, beans, caffeine, chocolate, dairy, citrus, fatty foods, food sensitivity, lack of water, nitrates, nuts, pickled foods, sugar, additives, wheat/ gluten, msg.

Hormonal:

Birth control – pills, patch, IUD

Hormone replacement therapy

Menopause, pre-menopause, menstruation, ovulation, pregnancy

Environmental:

Air pollution, bright light, florescent light, chemical sensitivity, smoke, cold, damp weather, dim light, dry air, fumes, heat, noise, humidity, strong odors/ perfumes.

Lifestyle:

Smoking, disrupted sleep, excessive sleep, fatigue, insufficient sleep, let down headache, motion, drugs, routine change, stress, and travel. 

Medications:

Analgesic, antiasthma, antidepressants, antiseizure, blood pressure, blood vessel dilators, diuretics, drug cocktails, ergotamines, opioids, and triptans.

Physical:

Allergy, computer/ cell phone overuse, exercise, sex/ sports exertion, eyestrain, flu, cold, virus, head trauma, neck, shoulder, back tension, poor posture, sedentary lifestyle, sinusitis, rhinitis.

Record everything. It is tricky because a glass of wine that seems to have caused a migraine could be categorized as an alcohol trigger, or a sulfites trigger, tyramine, lack of water, or it could be lack of protein on the day it was consumed!

A 2 oz square of dark chocolate contains 40 mgs of caffeine just like a shot of espresso, so it might be a caffeine trigger or a chocolate trigger, or even a sugar trigger.

Dr.Rodolfo Low, a chemist, professor, Ford Foundation advisor, and migraine sufferer presented his findings of 22 years of clinical research on migraine and blood glucose in his book "Migraine: The Breakthrough Study That Explains What Causes It and How It Can Be Completely Prevented Through Diet." In his findings he determined that migraine sufferers could eliminate their migraines completely by better managing their blood sugar levels and he advised a hypoglycemic diet.

"You can't eat just one." - Lays Potato Chips

Hypoglycemic diet:

When your blood sugar is low, your body produces stress hormones to boost your energy level wreaking havoc on your neuroendocrine system. This stress causes you to store fat and crave simple sugars and carbohydrates. When you change your eating schedule to eat less, but more often and more protein your body no longer thinks it is starving and you store less fat.

The U.S. is the only place where sugar is what's for breakfast.

Eat early protein, your pancreas has been busy while you were asleep producing insulin and you need protein first thing in the morning; before you go off to work or start your daily routine and forget about it!

Eat every 2-3 hours first the meal and then 2-3 hours later a snack.

Eat protein at every meal and snack.

Eat first thing after you wake up, no matter what your schedule is.

Cut out caffeine a quarter every week and at the end of a month, you will have successfully and safely eliminated caffeine.

Do not skip any meals or snacks or go hungry. If you are hungry at least eat a protein.

Do not eat a dessert without a protein.

Take or eat essential fatty acids daily also take magnesium daily.

Drink at least 2 quarts of water per day, in addition to the decaff, herbal teas, juice, and milk you drink daily.

"I die by the help of too many physicians; it was the crowd of physicians that killed me." - Alexander The Great on his death bed

MOH Drugs ~ Medication overuse headaches:

So you have a bad migraine and you seek medical help and receive a prescription or even over the counter medication, now it might or might not work, but you are scared to stop taking it because what if it does help and you stop taking it, then the migraines might be even worst (if that could be possible!) On the other hand, the migraines are horrible, so you go and find another specialist and more medication...and on and on the merry go round goes. Here is a list of medications that can give you MOH migraines:

Tylenol, Acetaminophen, NSAIDS, Ibuprophren

Combination Analgesics: Excedrin, Fioricet, Esgic, Phrenilin

Ergotamine: Cafergot, DHE

Triptans: Imitrex, Zomig, Maxalt, Relipax, Treximet, Amerge

Opioids: Tylenol 3, Vicodin, Demerol, Percocet, Dilaudid, Morphine

Other off-label brands of medications as well.

Instead try Vitamin B2, CoQ10, Essential Fatty Acids, Butterbur, Feverfew, and Magnesium. Canibus helps some, but it can also be a trigger.

For Hormonal Migraine Try: Dong Quai, Black Cohosh, Ginseng, DHEA, and Qi tonics

Migraines are a wood element in traditional Chinese Medicine, but metal controls the wood element so breath is very important!

About Breathing: The Hawaiian term for outsiders is "haoles" meaning people without breath. Hawaiians are in tune with their breathing and perceive how other people's breath appear in their bodies.

Stress and the fight or flight syndrome bring a tightness to the chest and a shallow short breath. Babies were not born that way. They breathe deeply all the way in and out of what appears to be their bellies. They are still breathing with their lungs and diaphragm, but they are so relaxed their diaphragm relaxes and they can expand their lungs way down to their bellies!

Relax the lungs, abdomen and the diaphragm will drop allowing the lungs to open and breathe deeper.

Exercises for breathing:

Lay on the floor with your feet together and your arms out to form a T.

Find the "hinges" in your spine:

1) find the Yes / No hing by shaking your head no, and nodding your head yes

2) at the back of your waistband arch the small of your back off the floor at the waist keeping your hips on the floor and reflattening it.

3) find the front of each hip joint where the thigh bone meets the pelvis. Practice with the back hing.

Imagine you are breathing with your whole body and a gentle wave is moving through you.

Breath in; fill your abdomen as if blowing up a balloon, round out the space below your waist between your belly button and the top of your pubic bone.

As you inhale lift your waistline, but not your hips off the floor arching the small of your back.

Let the movement of your spine follow the breath, not the breath follow the movement of the spine.

Exhale: as you flatten the small of your back against the floor and feel the pelvis tilt up. Do not engage or squeeze your butt, legs, or thighs.

Continue inhaling and exhaling. The sensations are subtle like a wave. Let yourself flow into them, feeling your tailbone roll up and down the floor.

Many more exercises are available.

"Psyche and bodywork sympathetically, it seems to me. A change in the state of psyche produces a change in the structure of the body... conversely, a change in the structure of the body produces a change in the state of the psyche." - Artistotle, Physiognomonica

Practice meditation. Learn mindful meditation. While in pain get into meditation and find a pain point, feel, and name the pain; what kind of pain is it? Where exactly in the body is it? Keep describing it and meditating on it until it dissipates... then move on to the nest pain point until they are all dissipated.

Self-massage for migraines:

1) Sit in a straight-backed chair, feet hip-distance apart, legs perpendicular to the floor or extended out slightly

2) Place both elbows on the table or desk and place your hands one on the front and one on the back of your head.

3)Let your upper body bend at the waist and lean over the table at a 45-degree angle, so your head falls into your front hand and your neck is relaxed. Situate your chair at the distance from the table that allows your upper torso to be at 45 degrees.

Whenever possible, apply therapy sooner rather than later, just as you would with any acute medication or therapy. It's usually much easier to abort a migraine if you catch it before it escalates.

1. Position your body either sitting and leaning over a desk or a table, sitting on a couch or in bed with knees up in a fetal position.

2. Loosen any stuck, tight, painful areas in the lower skull, neck, forehead, or jaw with self-massage until the headache shifts to the front of the head. Skip this if the migraine is solely in the front of the head.

3. Place both elbows on the table, so your arms don't get tired from being held up.

4. Make puppy dog paws and drape your front hand gently across your forehead, thumb extended. Use the hand on the same side that your headache is on. Relaxing the back of your neck, let your head fall into front hand in the "Oy! I've got such a headache" position shown earlier in steps 1,2, and 3.

5. Find the headache in front: Use the pad of your thumb to find your pain by listening for pulsations and other sensations. Note, pressing too hard makes it difficult to locate the pulsing point.

6. Lightly position your cupped back hand on the back of your head, with your palm on or above the occipital ridge, not your neck. Place the center of your palm approximately 180 degrees from the headache point you are working on in front. The back hand should be relaxed and receptive, barely touching your hair, with your attention lightly aware of it.

7. With your front hand thumb, attend to and FLATTEN each pulsing point one at a time.

8. Flatten it with your touch, mindful meditation, and visualization.

9. As the headache begins to dissipate, let your back hand come into work and awareness.

10. As the headache points dissipate notice any sensations of heat, tingling, wave, a magnetic pull that come into your back hand and keep the hand in place.

11. Shift your attention to the back hand and notice how the sensations begin to increase in intensity.

12. Notice the sensations in your back hand begin to subside now.

13. Both the increase and the decrease in the back hand mean the headache is shifting and releasing.

14. Work on all the headache points using an inchworm technique.

15. Say seated and relaxed, do belly breathing, keep your eyes closed, and don't test the migraine too soon. This whole sequence can take 5 minutes or an hour depending on how severe the migraine is. Shake out your hands without jostling your head and neck. If the migraine returns start over and repeat.

There are many more treatments, techniques, and ideas in the wonderful books in my reference section.

Please also open this link to see 35 images I was unable to place into this document.

www.bing.com/saves/share?shareid=44690ed202154aceb34d5016f15e8af0

References:

Hell's Kitchen

J.D. Wallach BS, DVM, ND

Ma Lan, MD, MS, LAc

Victory over Vestibular Migraine

The Action Plan for Healing and Getting Your Life Back

Shin C. Beh, MD

Heal Your Headache

The 1.2.3. Program for Taking Charge of Your Pain

David Buchholz, MD

The Headache Healer's Handbook

A Holistic, Hands On Somatic Selfcare Program for Headache and Migraine Relief and Prevention

Jan Mundo CMSC, CMT