Efficacy of Cervical Spine Manipulation in Patient suffering from Migraine

Migraine is a common health problem with substantial health and socioeconomic costs. On the recent global burden of disease study, migraine was ranked as the third most common condition. About 15% of the general population have migraine.The socio economic costs of  migraine are enormous due to its high prevalence & disability during attacks.8 million adults in the united states are estimated to be migraine sufferers; of these 91% experience migraine associated disability.Migraine is usually unilateral with pulsating and moderate/severe headache which is aggravated by routine physical activity, and is accompanied by photophobia and phonophobia , nausea and sometimes vomiting.Migraine exists in two major forms, migraine without aura and migraine with aura. Aura is reversible neurological disturbance of the vision, sensory, and/or speech, occurring prior to the headache.The origin of the migraine is debated. The painful impulse may originate from the trigeminal nerve central/peripheral mechanisms. Extra cranial pain sensitive structures include the skin, muscle, arteries periosteum and joints. Skin is sensitive to all forms of usual form of pain stimuli, while the temporal and neck muscles may especially be sources for pain and tenderness in migraine. Acute pharmacological treatment such as analgesic or triptans is usually the first treatment option for migraine in adults. However, not all attacks respond to acute treatment. Some patient have contraindication to triptans such as vascular disease or pregnancy and triptans are not effective or approved during the aura phase of a migraine attack.Migraine might originate from a complexity of nociceptive afferent responses involving the upper cervical spine (C1, C2 and C3), leading to a hypersensitivity state of the trigeminal pathway conveying sensory information for the face and much of the head. It is suggested that spinal manipulative therapy may stimulate neural inhibitory systems at different spinal cord levels because it might activate various central descending inhibitory pathways.It also activate the diffuse descending pain inhibitory system, whose neurons are located in the peri aqueductal grey matter. The disruption of pain-spasm-pain cycle is another proposed mechanism through which SMT could improve headache.

Migraine is the most common disorder affecting population world wide and possess a major health problem. Thirty-eight million adults in the United States are estimated to be migraine sufferers; of these, 91% experience migraine-associated disability. Pharmacological management is the first treatment option for migraneurs. However some patients do not tolerate acute and/or prophylactic medicine due to side effects or contra-indication due to co morbidity of other disease or due to a wish to avoid medication for other reason.The risk of medicine overdose due to frequent migraine attacks represent a major health hazard with direct or indirect cost concerns. The prevalence of medicine overuse headache is 1-2% in the general population which is about half of the population suffering from headache. Therefore to reduce medication side effects and overdose headache a safe and effective intervention will be a milestone in the treatment of migraine. Manual therapy can be an effective approach in treatment of migraine. Cervical spine manipulative therapy can be very effective and physical method to treat migraine headache.