The third phase of a migraine attack, the pain phase, is also called the headache phase (Wikipedia, 2017b). Migraine pain begins unilaterally at the eye or forehead region and can expand to include the back of the head or travel to the opposite side. Sometimes the pain presents on both sides in people who do not experience an aura. Characterized as moderate to severe pulsating pain that increases in intensity with any form of physical activity, a migraine is accompanied by nausea or vomiting and possible sensitivity to lights or sounds. Other symptoms include swelling or tenderness of the scalp (Chawla, 2017; International Headache Society, 2016; Wikipedia, 2017b). Once the headache pain has peaked, the postdrome, or resolution phase, begins (Wikipedia, 2017b). As the pain subsides, it is replaced with soreness and in some cases a headache “fog.” During these final moments, the patient is likely to be overcome with fatigue, weakness, and mood changes. This concludes the migraine episode, but it can differ with each subsequent attack (Chawla, 2017; International Headache Society, 2016; Wikipedia, 2017b). It is most common for people to experience a migraine without aura, previously known as common migraine . A migraine with aura, which has several subtypes and is generally known as classic migraine , can be experienced at any time even if the patient usually suffers common migraine (International Headache Society, 2016). This may be because of triggers, or the cause for an attack. The validity of triggers as a singular cause for an attack is uncertain; however, enough sufferers have noted similar precipitants that health care providers must take note. Some of the most prominent triggers are hormonal changes, stress, weather, strong odors, or artificial sweeteners like aspartame (Chawla, 2017; Wikipedia, 2017b). Research is still being conducted to understand the role these play in sparking an attack, so patients are encouraged to maintain a headache diary to help pinpoint the relevancy of triggers in migraine episodes. Numerous theories are being explored to explain the phenomenon that is a migraine, especially one with aura. These range from genetics to magnesium deficiency and include dopamine and serotonin imbalances (Chawla, 2017). The currently held belief is cortical spreading depression (CSD). This is a domino effect that begins with a lack of difference in the charge inside the cell located in the brain compared to the charge outside of the cell, altering its permeability, which then triggers the aura phase of a migraine. From there, the trigeminal nerve is irritated, resulting in headache pain commencing the pain phase. The initial depolarization also results in a release of neurotransmitters from nearby tissues that continue the spreading cascade of effects (Chawla, 2017). Another theory labels trigger points as the culprit for migraine. Upon analyzing muscles of the head and neck for trigger points (as noted under the tension-type headaches section), an overwhelming majority of people showed positive results for referred pain patterns that replicated their migraine pain, as well as light-headedness and visual or auditory sensitivity (DeLaune, 2008). Because this theory does not explain the phenomenon of auras, it is only important to note as a reminder for the massage therapist to practice caution in trigger point therapy on a migraine sufferer. Knowing precipitants and premonitory signs will help refrain triggering an immediate attack. There are far too many theories regarding the cause for migraines that most scientists have agreed to simply classify it as a neurological disorder with various possible origins (Fritz, 2015). Regardless of the cause, a massage can be beneficial in preventing migraines or in reducing the frequency of episodes by carefully addressing trigger
3. Attacks that contain at least two of the following features: ○ Pain on one side. ○ Pulsating pain. ○ Moderate to severe pain. ○ Pain worsened by mild physical activity (walking, head movement, coughing). 4. One or both must occur during an attack: There are four phases to a migraine. Not all are required for it to be classified as migraine, but all are unique to a migraine attack. Likely two or three of the four phases will take place: 1. Prodrome phase. ○ Nausea with or without vomiting. ○ Sensitivity to lights and sounds. The prodrome phase begins a day or two before the headache episode. This is commonly referred to as the premonition phase because the symptoms alert the patient of an oncoming attack. The symptoms experienced are exclusive to each individual and vary from a change in mood, depression, fatigue, neck stiffness, food cravings, and euphoria to gastrointestinal complications. Approximately 60% of migraine sufferers begin an episode with the prodromal phase (Chawla, 2017; Johns Hopkins, 2017a; Wikipedia, 2017b). Aside from the presence of nausea and need to be in a dark, quiet place, the aura phase indicates a migraine episode. Not all sufferers experience an aura, and those who do may not have an aura with each attack. An aura can manifest as a visual, sensory, or even motor disturbance (International Headache Society, 2016; Wikipedia, 2017b). 2. Aura phase. 3. Pain phase. 4. Postdrome phase. (Johns Hopkins, 2017a; Wikipedia, 2017b) The most common aura is visual disturbance, with nearly 99% of migraine sufferers reporting having this symptom (Wikipedia, 2017b). There are several different forms of visual disturbance. Some experience a temporary complete loss of vision. Some simply have a blind spot in their field of vision that enlarges over the course of the migraine attack (Chawla, 2017; International Headache Society, 2016; Wikipedia, 2017b). Most often what is called fortification spectrum occurs before any partial or complete visual loss takes place. Fortification spectrum involves zigzagging lines resembling the walls of a castle that begin centrally and spread out laterally leaving blurriness or vision loss in its path. Another trait of visual disturbance is that it affects both eyes simultaneously beginning on either the right or the left side of the field of vision. And once the pain phase sets in, the pain begins on the opposite side of the visual disturbance (Chawla, 2017; Wikipedia, 2017b). Sensory disturbances are the next most frequently experienced aura afflicting 30% to 40% of migraine sufferers who present with an aura (Wikipedia, 2017b). Beginning in the hand or arm, a tingling sensation slowly travels up to the face and mouth, unilaterally, and then is replaced with numbness and loss of proprioception. It is not unusual, however, for numbness to be the only sensory symptom (Chawla, 2017; Wikipedia, 2017b). Finally, some people are afflicted with a motor disturbance that manifests as speech slurring or muscle weakness (Chawla, 2017; Wikipedia, 2017b). Although the aura phase lasts one hour, if a sufferer experiences muscle weakness, this symptom lasts beyond the normal time frame. Generally, these three types of disturbances take place in succession (Wikipedia, 2017b).
EliteLearning.com/Massage-Therapy
Book Code: MNJ0524
Page 40
Powered by FlippingBook