Proven approach to headache and migraine treatment
There are hundreds of types of headaches and numerous different migraine presentations with different combinations of causes. Individuals can suffer with different types of headaches, with headaches only, migraines only (or mainly) or a mixture of both. The underlying causes and triggers of headaches and migraines are many and varied, ranging from lifestyle factors to underlying health conditions, emotional and psychological challenges to musculoskeletal issues.
If you suffer from headaches and migraines (with or without a current diagnosis), we can help.
Headaches are a very common complaint with 57% of men and 76% of women reporting at least one significant headache per month.
Some people unfortunately suffer with headaches a lot more frequently, or with severe headaches, which can have a significant effect on day-to-day life. Most people use over the counter or prescription medication to manage headaches but these do not correct the possible underlying cause of the headache and can cause side-effects and even dependency issues.
By the time patients come to Core Clinics seeking a solution for their headaches or migraines they’ve often been suffering for a while and managing mainly with pain medication (prescription or over the counter). When treating chronic headaches and migraines that haven’t responded to initial treatment or medication it’s important to take a holistic approach including looking at physical causes (e.g. tension in the neck and shoulders), triggers (e.g. food and drink) and stressors (e.g. anxiety, poor sleep patterns) as well as any underlying health conditions and even the medications being used for them.
Sub-conditions and symptoms we can help with
If the headache is a condition in its own right, we call it a primary headache. If the headache is being caused by another condition, we call it a secondary headache.
There aren’t as many primary headache disorders, but the majority of headaches felt are primary.
The main types of headaches we help with are:
Depending on your symptoms, the duration of your complaint, and any current diagnosis, we can identify who is the best person for you to see in our team for your new patient appointment. To help you decide either click our handy guide or contact us to discuss.
In many cases, headaches originate from the upper three cervical vertebrae and the surrounding muscles. These types of headaches are often accompanied by neck, shoulder and/or arm pain. Lack of motion in these vertebrae causes the joints to be irritated, the muscles to spasm and blood supply to decrease. Restoring the motion and releasing tension in this area reduces the severity and frequency of headaches.
In most cases we tend to recommend an ‘integrated’ treatment protocol combined with lifestyle changes. This might involve you having appointments with several members of the team initially – for example, osteopathy, chiropractic, acupuncture and nutrition consultations. We’ll explain our full findings and recommendations for you after your first appointment as well as letting you know what results you can expect to achieve.
How we can help you
Comprehensive consultation, examination and health history
Treatment plans and therapies
A clear diagnosis with recommendations for self-management and treatment protocols
Tailored to your needs
We work in partnership with our patients to deliver consistent results, with regular reviews and follow ups
How we work
Multi-disciplinary patient-centred healthcare
Lots of clinics have different healthcare professionals under the same roof but they don’t tend to collaborate fully or share care with patients. They also don’t have clear and proven care protocols which have been tested and refined to provide the best possible results, and value for time and money for patients. At Core Clinics all our clinicians and therapists work in an integrated way, adapted to the needs of each patient. So, when you make a first appointment with anyone in our team, you’ll have access to everyone in our team – and we’ll clearly signpost to you who you should see and what you can do to help yourself too. We’ve developed and refined this approach for over 15 years and helped over 13,000 patients.
Don't just take our word for it
We have helped thousands of people to achieve a better state of health, or to reach their sports performance goals.
Headaches, migraines and neck pain
Frequently asked questions
There is no sure-fire way to get rid of migraines that works consistently and work for everyone.
The usual medication for migraines is Sumatriptan, though this doesn’t work for all sufferers. Some peoples migraines resolve with over-the-counter painkillers. There are lots of anecdotal reports of possible solutions to migraines, though none that universally work for all. The best bet is to try different things.
By definition an unmedicated migraine can last from 4-72 hours. If they last longer than this seek medical attention.
Migraines are a neurovascular disorder. They aren’t caused by any injury or other medical condition, they are a condition in their own right. When the nerves that supply the head become over stimulated they can trigger a migraine. There are several genes that have been linked with migraines, there is a strong hormonal element to them too.
Everyone’s trigger profile can be a bit different but there are some that are relevant to most people. These are stress, nutrition and hydration and sleep. Other common ones are exercise, weather, certain types of food. There are some apps that can be helpful for identifying your triggers, N1 Headache is an app developed by migraine researchers that can be very useful. Essentially, any shift from your body’s “comfort zone” for any of these triggers has the potential to trigger a migraine, ie too much or too little of something.
Medication is the most reliable way to stop a migraine, discuss this with your GP. There are other tips and tricks for non medical migraine treatment that might work for some people, but not for everyone. Examples are: caffeine, going for a gentle walk in nature, time spent in the fresh air, stretches or neck exercises, tiger balm on the temples, cold showers, sleep, acupuncture or acupressure, spinal manipulation, peppermint tea. Most of these possible solutions are in no way detrimental and are worth trying if you have a migraine.
Migraines are about 4x more common in females than males. The theory for this is that the female sex hormones lower the “threshold” for triggering migraine attacks. Many women are more susceptible to migraine around their time of menstruation for this reason. Women with migraines are also more triggered by missing meals, which may be due to the differences in male and female metabolism. Referece -Sex differences in prevalence of migraine trigger factors: A cross-sectional study.
A migraine Aura is when you get symptoms that can sometimes go alongside migraines. They happen in about 25% of migraine cases, this surprises some people as many mistakenly think that migraines must have an aura. There are different types of aura. The most common is a visual aura, this can be flashing lights in your vision, jagged lines, blurring of you peripheral vision or blind spots. Some auras affect your sensation and you may get numbness or tingling, some get speech and language difficulties. Less commonly you can get difficulty with movement coordination and balance.
Sadly, there isn’t an answer to this. Most people who overcome migraines learn to manage and minimise them so they aren’t taking over their life, but they will likely still get the occasional migraine from time to time. The best interventions can be different for different people and for different kinds of migraine. Many people get considerable improvement if they make changes to diet, sleep pattern, stress levels, exercise frequency. But if you let these factors slide, your vulnerability to migraine tends to increase again, so the improvement is only as permanent if you continue the factors that keep it at bay.
A migraine Aura is when you get symptoms that can sometimes go alongside migraines. They happen in about 25% of migraine cases, this surprises some people as many mistakenly think that migraines must have an aura. There are different types of auras. The most common is a visual aura, this can be flashing lights in your vision, jagged lines, blurring of your peripheral vision or blind spots. Some auras affect your sensation and you may get numbness or tingling, some get speech and language difficulties. Less commonly you can get difficulty with movement coordination and balance.
Alcohol can be a migraine trigger for some people. This can be for different reasons for different people. Sometimes it is related to chemicals in the alcohol and may be triggered by some types and not others. Sometimes they are triggered by dehydration from alcohol. Sometimes it is due to the activities that might accompany the consumption of alcohol, or if you have slept very heavily with your neck at an awkward angle due to the alcohol, the aggravation of the neck can trigger the head pain.
This doesn’t have a simple or reliable answer, here is a list of possible modes of relief. Cold showers/ cold packs on head and neck, heat packs on head or neck, massage/ manipulation, meditation/ relaxation, tiger balm/ Biofreeze/ 4head strips, mint or ginger tea, time in the fresh air, neck stretches/ muscle activation, caffeine, ensure you’re properly hydrated.
It is common to have a lower-level headache int the day or days following a migraine, it is called a postdrome, or “migraine hangover”. Different people can have different severities and symptoms. Most commonly it presents as a headache, difficulty concentrating, light and/or sound sensitivity, nausea, fatigue. Depending on your work you may or may not feel it is appropriate to work while you feel this way. The other barrier may be the attitude and level of understanding displayed by your employer and colleagues, it is important to feel like you aren’t being judged or penalised when you have a migraine and you may need to educate your work place about the reality of migraines and how they can support you with them.
To be classed as a migraine, the pain will last between 4-72 hours (3 days). A migraine lasting longer than this is called status migrainosus. Basically, an unrelenting migraine. If you have a migraine lasting for longer than 3 days you should call your doctor. If you are struggling with vomiting, you may become dehydrated, it is important to go to hospital for treatment if this is the case.
Identifying and minimising your triggers is very important in migraine prevention. Apps such at N1 Headache and migraine buddy can be great for helping you to identify your triggers, they are a form of headache diary. Managing your sleep, diet, stress levels, exercise levels and hydration levels can make a big difference in migraine frequency. Preventative medications may also be prescribed by your doctor if you suffer with migraines on more than 4 days in a month, there are different types of medications for this and they may need to trial a few. Manual therapy and acupuncture are often used and have supporting evidence for migraine management.
Migraines are a disabling condition and can be considered a disability in some cases. Disability is defined as “a physical or mental impairment which has a substantial and long-term adverse effect on your ability to carry out normal day-today activities” Under the Equality Act 2010. Chronic migraines may occasionally fall in this bracket. If you are asking this question from the point of view of claiming welfare benefits you will need to speak with your doctor or neurologist.
Stress is one of the most common and most well-established triggers for migraine. The physiology of why stress triggers migraines isn’t known, we can speculate at hormonal changes, muscle tension, sympathetic nervous system activation but the migraine researchers haven’t made any firm conclusions. What we do know, is that therapies targeted at stress reduction (psychotherapy, mindfulness, meditation, some medications) can have a very positive impact for migraine sufferers. If you think your stress levels might be triggering your migraines, then you should assess your lifestyle and look for modes of stress reduction. Seeking professional help is a smart move as these factors can be very hard to look at objectively in your own life and it can be hard to know where to start.
Daith piercings have become popular for migraines in recent years. If you trace your finger around the outside of your ear to the point where it comes into the middle of the ear, just above the canal, this is the point that gets pierced. The research for this is sparse, on the whole, most people (in the region of 50-75%) get improvement in migraine outcomes, there is not good long term follow up research to show if this improvement lasts beyond a year but the short-term studies show good results.
There is little risk associated with this kind of piercing, except for infection risk and can be a good option for many who are experiencing chronic, debilitating migraines, especially if you like the look of the piercing too. There is very little research on the subject but it makes most sense to get the piercing on the same side as the side you tend to get migraines on.
Usually, a headache is felt equally on both sides of the head and a migraine is felt predominantly on one side. Headaches are more of a tight, pressure feeling, migraines are more throbbing. Headaches aren’t usually made worse by activity, whereas migraines are. Headaches are mild to moderate in pain intensity, migraines are moderate to severe. Migraines are usually accompanied by some of the following: sensitivity to light and/or sound, nausea and/or vomiting. Migraines can be accompanied by an aura (visual or sensory changes) though this doesn’t happen to most migraine sufferers, auras don’t occur in tension type headaches. Sometimes it can be difficult to distinguish what type of headache you get, so should always get your diagnosis from a headache specialist.
Yes, in the majority of cases, a migraine sufferer will have a close relative who also suffers. There is a strong genetic component that determines if you will be a sufferer. This isn’t true of everyone, in some people, their migraines are due to a gene mutation, meaning they haven’t inherited the condition from their parents, but it has developed on its own.
Yes, up to 3 days is considered relatively normal for migraines. The diagnostic criteria cites a headache lasting 4-72 hours. If your migraine lasts for longe than this you should see a medical doctor, especially if you are suffering with nausea and vomiting, as dehydration can become a big problem. Migraines lasting longer than 72 hours are called status migrainosus, though you need to see a neurologist for appropriate investigations to see if anything else might be causing the prolonged migraine.
This answer is mixed. Keeping in a normal routine with caffeine is generally best. Having less or more than usual can be triggering for some. Caffeine can be helpful for aborting a migraine and is often included in migraine medication. However, if you have a lot of caffeine anyway, it can be less effective. Another issue with caffeine and migraines is having it into the afternoon will be detrimental to your sleep quality, which can make you more vulnerable. The optimum way of enjoying caffeine as a migraine sufferer is to only have a small amount of it in the mornings.
Migraines have a strong genetic component, making some people vulnerable to them while others aren’t. You may have times in your life when you get more migraines and this is usually due to some lifestyle factors. The most common reasons for increased bouts of migraine are: hormonal changes, periods of high stress, irregular sleep patterns, diet comprising of the wrong types of foods (often high sugar). Other factors may be at play, some are susceptible when there are big changes in the weather or to chemicals, allergens etc. If you are suffering regularly and are looking for answers to this question, you need to see a headache specialist.
Botox is an injectable toxin that paralyses your muscles. The theory of why this works for migraine is that it prevents neurotransmission (the nerve signals) from the trigeminal nerve (in the face) that can trigger migraines.
Co-codamol is not considered a good treatment option for migraine, the risk of medication overuse headaches is higher and opiate based medication can make nausea worse. If you are finding yourself reaching for co-codamol for your migraines, it would be better to get in touch with your doctor to get a prescription for migraine specific medication that is usually more effective with fewer side effects and lower risk of medication overuse/rebound/ withdrawal headaches which can all occur with opiate based pain relief if it is used regularly.
Headaches are a fairly common symptom of COVID-19, about 14% of COVID-19 cases present with headaches. However, the headaches don’t tend to have migraine features. Many migraine sufferers that get headaches with COVID-19 tend to report that they are different in nature to their usual migraines. If you are a migraine sufferer, getting COVID-19 may trigger attacks though this is not to be expected.
Many people wake in the morning with headaches or migraines, it is not uncommon. If you are woken up in the night by the pain of a migraine coming on this is considered a “red flag” meaning it needs urgent medical assessment and you should go to hospital, this is known as a “thunder clap headache onset”.
There is a type of headache subtype known as an “alarm clock migraine” which tends to wake you at around the same time in the early hours of the morning on a regular basis, though these headaches should be medically investigated and diagnosed by a headache specialist. The interesting solution to this type of headache is to have a coffee before bed, as counter intuitive as it may sound it usually prevents the migraines from occurring.
The supplements with the most evidence for helping with migraines are magnesium, Vitamin B2(riboflavin), Vitamin D3 and CoEnzyme Q10. Deficiencies of any of these may be the reason for your migraines.
Education is key, the more you can understand about your migraines, the better equipped you are to deal with them. Learning your trigger profile, making some lifestyle changes and seeking the help you need can go a long way to minimising the impact of headaches on your life.
Caffeine can be a trigger for some migraine sufferers, sometimes the trigger is too much caffeine and sometimes it is caused by not having any caffeine when you are used to having it. It can also be useful as an early intervention to head off a migraine and is often incorporated into headache and migraine medications.
No, migraines with aura aren’t dangerous, they are a primary headache disorder, meaning they aren’t being caused by another condition that could be dangerous. If you are over the age of 40 and are experiencing migraines (with or without aura) for the first time you should always get them checked on the off chance that they aren’t true migraines, but being caused by another medical condition. Historically migraines were thought to be caused by issues with the blood vessels, this is in part because there is a slightly increased risk of ischemic stroke in female migraine sufferers under the age of 45. The reason for this is unknown because current understanding attributes more blame on the nervous system than blood vessels. Despite this, the risk is still low, especially if you don’t have other risk factors for stroke (smoking, unhealthy diet, sedentary lifestyle)
Ocular migraines, or retinal migraines are a type of migraine aura. You can get loss or changes in your vision in one eye, usually on the side of the head as the migraine. These changes shouldn’t last longer than an hour and usually less than 15 mins. The theory for migraine aura is known as cortical spreading depression theory, put basically there is a change in brain activity that spreads across a region of the brain in response to the migraine trigger, the symptoms you get will vary depending on the region of the brain that is affected. There are other theories as to the cause and it is always important to see a doctor to rule out other causes of temporary blindness or visual changes.
Migraines are a condition in their own right, meaning they aren’t a symptom of another medical condition. However, you could argue that they are a symptom of stress, or not getting enough sleep, or of an unhealthy diet as these are all things that can make migraines worse. Headaches can sometimes be symptoms of other medical conditions, but this is quite uncommon. If you are worried your headaches are being caused by another medical condition, discuss these worries with your doctor.
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Core Clinics offer a unique, integrative approach to health and wellbeing and sports performance.
We leave no stone unturned to get to the bottom of your health issues and answer all your questions.
Treatment plans and therapies
We’ll give you a very clear diagnosis and prognosis so that you know exactly where you stand and what you can expect from working with us.
Tailored to your needs
We’ll explain in detail our recommended treatment approach and give you lots of advice for self-care. If we feel you’d be better served with another clinical professional, we’ll let you know and arrange a referral.
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