Headache and Migraine Specialists

Headache &
Migraine Specialists

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Drug Treatment for Headaches and Migraines

Abortive – serotonin modulators

These drugs are used at the first sign of a migraine in an attempt to abort the onset. They are designed to affect the levels of serotonin therefore changing activity in the TCN. For example Ergotamine stops a part of the TCN  from transmitting signals to the brain, therefore decreasing the chance of head pains and migraine symptoms.  Drugs of this kind include:

Triptans – including; Sumatriptan (imigran), rizatriptan (maxalt melt), zolmitriptan (zomig).

Ergotamines – including cafergot which is similar to serotonin and can bind to the serotonin receptors.

Simple Analgesics – including paracetamol, codeine, NSAIDs (ibuprofen) can also help relieve the symptoms of headache.

Prevention drugs

These drugs are taken regularly over the long term to prevent the onset of migraine.

Beta blockers

Pizotifen – serotonin antagonist – blocks serotonin (a chemical used in the production of messages as above)

Anti-epilepsy drugs – Epilem and Topamax have been shown to decrease migraine attacks


Botox and Steroid

The use of Botox to paralyse the neck and head muscles is becoming a popular tool for the management of headaches having been recently approved by the health organisation.

The use of steroid injections into the upper neck is another technique used by physicians to relieve headaches and migraines. Both Botox and steroid possibly help by reducing the warning messages from the head and neck into the TCN through muscle relaxation.

Physiotherapy Treatment headaches and Migraines – treatment of upper cervical dysfunction

Manual therapy

Following a thorough assessment of the neck, upper back and shoulder blades, hands on manual therapy should be used to decrease joint stiffness of the spinal joints, muscle tightness/shortening.


Acupuncture can be used to alleviate muscle spasm, increase levels of the natural chemicals in the body that inhibit/stop pain messages.


Following thorough assessment – exercises should be prescribed to address

Spinal alignment and posture, shoulder blade position and control.

Increased glide and slide movement between joints or “play”

Uncontrolled movement in one or more directions – the inability to pass movement control tests into certain directions

Muscle weakness

Headache and Migraine- self management tips

1. Medication – ensure you have seen a Neurologist. They will rule out other potential sources of headache and migraine and provide you with the most appropriate treatment.

2. Take your medications as prescribed and seek regular reviews with your Neurologist to modify your medication as required.

3. Maintain good spinal posture. Understand that sustained or awkward neck positions can affect the upper neck and send warning messages to the TCN and aid the sensitization process. This is no different from looking after a “bad back” through correct sitting postures and good work station ergonomics.

4. Avoidance of sustained neck flexion – Avoid looking down for long periods of time e.g. using a laptop, reading a book or while sewing. Note: Lying down in bed or in the bath looking towards your feet is the same position.

5. Home and work ergonomics – seek professional advice when setting up your home or work office. Don’t rely on a colleague to assess your desk even one trained in health and safety, they don’t have the level of understanding and experience required to assure you are sitting and working safely to avoid stressing your neck. Don’t forget about your home working environment too.

6. Make sure that you consider how you use your smart Phone, Tablet (I pad) or Kindle. Bring them up to your face don’t look down at them. Limit the amount of time you use them for.

7. Reading/writing positions – use a reading or writing slope to bring the work up to you, alternatively hold your arms higher so the object is at eye level.

8. Sleeping positions – Ideally your head should be in alignment with your body and not side flexed. You may choose to use shaped memory or foam pillows but ensure they are the right size for you. You may initially find it difficult to sleep with new pillows – persevere you will adjust.

9. Driving position – adjust the seat so you are upright (not leaning backwards) your head should sit over your body and not forwards of it. Ensure your chin is not poking forwards/out. When turning to shoulder check don’t just turn your head rotate your body and shoulders to decrease the amount of rotation your neck is performing.

10. Lounging positions – consider your head and neck alignment while lounging on the sofa, in an arm chair or even on the sun lounger. Sitting with your legs tucked up to one side can adversely affect your spinal positioning.

11. Exercise – Exercise is important; it promotes the release of natural pain relieving and mood enhancing chemicals which can help to suppress pain signals which sensitize the TCN. However consider your neck position during exercise – is you chin stuck out (cycling), are you straining your neck to hold a certain position (sit ups or weights) and don’t assume the exercise is ok for you because the instructor or a friend recommended it. Many of our patients are often worse following Pilates sessions!

12. Stress /Emotion – being stressed can increase muscle tension in the neck and raise your high blood pressure – both can indirectly sensitize the TCN. In stressful situations the release of certain hormones occurs these are linked with chronic pain states (long term pain). Learn to relax and use exercise to decrease stress and tension.

13. Other triggers – hormones (menstrual cycle), wine, cheese, coffee have all been linked to the production of headaches and migraine. However it is more likely that these factors simply add to the sensitization process of the TCN rather than cause the headache. Put another way these factors on their own do not cause the symptoms however they may predispose the individual to a headache/migraine attack when the other four factors described above are present.

If you experience sudden onset of a new headache or your current headache changes, please consult your Doctor immediately.

Should you have any questions relating to Headaches or Migraines please feel free to Contact Us

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