Menstrual Migraine

How Is The Neck Involved?

Oestrogen changes during your cycle

Day one of your cycle is the day menstruation (bleeding) starts. This is the lowest your oestrogen levels will be. From this point onward they slowly increase until they reach a peak at ovulation – only to rapidly fall again post ovulation.

Oestrogen levels will then increase again (although not to the high levels experienced at ovulation) and drop off again just before menstruation starts.

It is the fall in oestrogen levels just before a menstruation starts that explains why some women experience a headache or migraine around this time. It is also why some women have a mid-cycle headache or migraine as the level drops at this time as well.

Oestrogen and Serotonin

Oestrogen is necessary for the production of serotonin. As oestrogen levels rise and fall the levels of serotonin in the brain will rise and fall.

Serotonin is a neurotransmitter that is responsible for mood and feelings of calm. Low levels of serotonin are thought to contribute to depression while higher levels help us to feel positive and happy with our place in the world. Too high a level and it can contribute to feels of anxiety.

It also has an effect on blood vessels within the brain. When serotonin levels rise the blood vessels constrict, and when it drops the blood vessels enlarge.

One of the other roles of serotonin is to modulate activity in the brainstem. The serotonergic control system is located in the brainstem and works to influence how our body responds to stress, hormones and environmental factors such as food and smells.

Oestrogen, Serotonin and Headaches.

As I mentioned earlier the serotonin levels are monitored in the brainstem and changes in serotonin levels can affect activity in the brainstem. It is also in the serotonergic control centre that hormone levels are monitored and we know that changes in hormone levels, particularly oestrogen will change serotonin levels. Serotonin levels will also change the blood vessel flows within the brain.

The Sensitised Brainstem

Now research in the last 20 years has shown that headaches and migraines come from the brainstem. In particular an area of the brainstem called the Trigemino-Cervical Nucleus or TCN for short.

We currently know of 5 main inputs into the TCN. These are:

  • The upper 3 levels of the neck (including information from the occipital nerve)
  • The trigeminal nerve from the face, jaw, sinuses and teeth
  • Blood vessels within the brain
  • The serotonergic system that also monitors hormonal levels
  • Diffuse noxious pathway – helps to control perception of pain

What we suspect is happening with menstrual migraine is that the serotonin changes and hormonal changes feeding into the TCN area of the brainstem, along with information regarding changes in blood vessel flows push it over the edge so it produces a headache or migraine.

Why does this happen in some women and not others? Great question.

The answer is that some women have a brainstem that is already sensitised and overstimulated, which means it is primed to give you a headache or migraine before this extra information comes in and pushes it over the edge.

Recent research by Watson and Drummond has proven that this central sensitisation can be caused by information from the upper 3 levels of the neck feeding into the brainstem, and that the appropriate treatment can desensitise the TCN in the brainstem and make it less prone to producing headache and migraine.

At Bayside Headache Clinic, we look for a common, but very subtle, dysfunction in the upper 3 levels of the neck that is constantly feeding information into the brainstem, making it primed to give you a headache or migraine. We find this dysfunction is the major cause of migraine in approx. 80% of the people we assess.

We are then able to effectively treat this dysfunction, which allows the brainstem to calm down and return to its normal state, and eliminate or significantly reduce your headaches and migraines.

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