MIGRAINE!

The term "migraine" is often tossed around in a sense to convey a particularly severe headache. But not all severe headaches are migraines. One can also certainly have a "mild migraine". So what's the difference?

Usually the diagnosis is made from the associated symptoms and location of pain. The location of "head" pain is usually just above one eye. But the pain pattern can also reside around the temples or forehead, which would resemble a tension or sinus headache. Most migraine sufferers will also have pain in the neck. In fact, it's the single most commonly reported symptom for those who have been diagnosed with a "migraine". (Source: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1526-4610.2009.01608.x )

Nausea, dizziness, and light sensitivity are the next three on the "most common symptom" list. Sometimes the person gets a visual disturbance prior to the headache, called an "aura".  Or sometimes they just become very sensitive to light, and will tend to sit in a dark room by themselves.  Vomiting due to nausea is not uncommon.  This odd list of symptoms becomes less confusing when you start to look at one anatomical area...the BRAINSTEM.

The brainstem is divided into three major parts: the midbrain, the pons, and medulla oblongata. The last one, the "medulla", is the portion that sits lowest in the skull. Wikipedia states:
"The medulla oblongata (often just referred to as the medulla) is the lower half of the brainstem continuous with the spinal cord. Its upper part is continuous with the pons. [2] The medulla contains the cardiac, dorsal and ventral respiratory groups, and vasomotor centres, dealing with heart rate, breathing and blood pressure. Another important medullary structure is the area postrema whose functions include the control of vomiting." This is noteworthy since one of the most common symptoms of a migraine is nausea.

Why then would it then affect dizziness? Cranial Nerve VIII nucleus originates in the medulla as well the pons (source: Terminologia Anatomica). This nerve is partly responsible for balance and hearing.

How then could it affect vision? One theory as to why people will sometimes get visual disturbances (aura) is that it is from a lack of blood flow to the retina. Whereas the medulla is the control center for blood pressure, it could potentially lower the blood pressure enough to cause such symptoms. 

What about light sensitivity? This symptom may be related to the medulla's regulation of the sleep/wake cycle.   It is very common for migraine sufferers to go lay down in a dark room.  They typically do not fall asleep, yet they won't be watching TV or reading a book either.  To me, this sounds like the body is in an "in between state". It is as if it is not quite fully awake, and not quite fully asleep. Imagine if you are falling asleep, and someone shines a flashlight at you, you would certainly be "light sensitive".

From a chiropractor's viewpoint, it is also helpful to note how the medulla projects into the spinal canal of the top 2 vertebrae, C1 and C2. Therefore, any misalignments in these vertebrae can compromise or affect pressure on the medulla, and result in symptoms associated with a migraine! Things that can cause misalignments include poor posture, weak core muscles, and improper sitting and sleeping positions. Admittedly some of these mechanisms are not yet fully understood.  But considering that the medical system has yet to provide it's own explanation, I will stick with mine. 



Brainstem graphics provided by:
Version 8.25 from the Textbook
OpenStax Anatomy and Physiology
Published May 18, 2016
https://cnx.org/contents/FPtK1zmh@8.25:fEI3C8Ot@10/Preface
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