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If you suffer migraines or cluster headaches, it is very common for people to suffer from catastrophic thinking. That is, you think it’s because you have a brain tumour or a bleed or some other type of exotic condition. So you are prudent and follow up with your GP or specialist who refers you for an x-ray, a CT, or an MRI. And though you don’t want anything to actually show up, you hope that it does because it then gives you the ability to do something about it besides just taking pain medication. However, for the majority of people who suffer migraines or cluster headaches, their MRI comes back as completely normal. How can this possibly be so? How can you suffer migraines or cluster headaches but have a normal MRI? Fortunately, there is an answer. And frequently a solution.
What X-Rays, CTs, and MRIs normally show for Migraines and Cluster Headaches
First, let’s explain what x-rays and CT scans, and MRIs actually show. X-Rays show hard tissue (e.g., bone) as a 2-D picture of overlapping layers of anatomy.
- X-Rays are best for certain types of fractures, dislocations, or partial misalignments between joints known as subluxations, and arthritis.
- CT scans show blood and hard tissue as 3-D pictures (which is why they use a LOT more ionising radiation than x-rays). CTs are best for skull injuries or suspected pathology in the brain (e.g., bleeding) or abdomen.
- MRIs show soft tissue (e.g., brain, muscles, and ligaments) as a 3-D picture without ionising radiation. MRIs are the standard when it comes to identifying brain pathology that can sometimes cause migraines or cluster headaches.
So, when an MRI or CT scan comes back as being normal, the good news is that it is not a tumour or bleeding on your brain that is causing your migraines or cluster headaches. I repeat: this is a good thing!
However, this doesn’t necessarily help solve your problem. So, let’s consider what normal MRIs and CTs don’t show, and how this relates to migraines and cluster headaches.
What X-Rays, CTs, and MRIs normally DON’T show for Migraines and Cluster Headaches
One potential limitation of most standard CTs and MRIs is that they are taken in a lying-down position. While lying down doesn’t change anything if you actually have a brain tumour, it can actually have a substantial change on the functional relationship between your brain, your spinal cord, and your nerves as they relate to migraines or cluster headaches.
Especially if you have noticed that your migraines and cluster headaches are worst when you are standing/sitting upright, but then improve when you lie down, then it is likely that there is a functional relationship that doesn’t necessarily show up on CT or MRI. But what it also means is that things that might be considered normal on CT or MRI when you are lying down might actually be more abnormal if the scan was taken in an upright position (which is very rare and very expensive here in Australia).
Second, standard x-rays, CTs, and MRIs are typically taken from stock-standard angles in order to visualise 3D pathology. However, when it comes to the most subtle types of conditions that can also cause migraines or cluster headaches, the problem does not always show up. Why?
It is because your body architecture is three-dimensional and unique. Your body is different from everyone else. Not just on the outside, but also on the inside. And also different on the left and right sides even within your own body. What this means is that when you have large problems (>3-5mm), these are usually detected easily on CT or MRI. However, when you have small problems <3mm, these types of issues require additional study and attention to detail in order to see properly.
The Upper Cervical Region, Migraines and Cluster Headaches
Especially as it relates to migraines and cluster headaches, one of the most important potential areas are the nerves at the very base of your skull at the level of your C1-C2 vertebrae.
- A branch of your vagus nerve (which lies just in front of your C1 vertebra) is responsible for sensation around the base of your brainstem and is frequently associated with migraines.
- A branch of your C2 nerve is responsible for sensation along the sides of your skull
- A branch of your C2 nerve (just below the C2 vertebrae) is responsible for sensation along the base of your skull at the back of your neck.
So, basic neurology helps us understand that whatever type of migraine or cluster headache you may experience, there is something important about the upper neck. A recent study found that the junction between your skull and the C1 vertebra is actually the most commonly missed area in the neck when it comes to identifying pathology or abnormal conditions.
In other words, conditions in your upper neck region are very commonly missed, even among specialists and experts! Therefore, it is entirely possible that you have actually had x-rays, CTs, or MRIs that appeared to be normal at first glance.
However, if a qualified expert takes a deeper look, they may actually find underlying problems that were not noticed originally that may help to explain what is actually going on, and thus be able to offer a different approach to help you with your migraines or cluster headaches. Now, in no way am I pointing the finger or assigning blame. Headache specialists, radiologists, and the like: we are all human and look at things to the very best of our abilities from certain perspectives. And yet it is still possible despite our best efforts that we fall short. Of course, when it is in matters that relate directly to your health and well-being, this is no small mishap to you.
However, if you can appreciate that we all do the best that we can and that you may simply need a second opinion or different approach to help you with your migraines or cluster headaches, even if your MRI was “normal” the first time, you may still be able to improve your health.
Migraines, Cluster Headaches and Upper Cervical Chiropractic Treatment
The approach that we take in our practice, Atlas Health Australia, is a unique method in chiropractic that focuses on the structure and alignment of the top vertebrae in your neck: the C1 (atlas) and C2 (axis). The particular method we use is known as the Blair Technique, which belongs in a special division of chiropractic known as Upper Cervical Care (along with other techniques including NUCCA and Atlas Orthogonal).
There are a few major differences between the Blair Technique and general spinal manipulation. First, there is no twisting, stretching, popping, or cracking the neck. None.Second, the approach is personalised. Before ever working on your neck, we take a series of detailed, specialised x-ray images that unlike CT or MRIs are customised based on your unique body structure. As a result, we are able to properly visualise those small yet significant misalignments between vertebrae that can be the source of irritation that it producing your migraines or cluster headaches.
Third, we perform a series of physical and neurological tests to determine when you may need an adjustment to correct the motioned alignment of your spine … but we do NOT adjust on every visit. We believe in the Innate ability to go your body to heal with the least amount of intervention necessary. We just need to give it the change.
In this way, the Blair Technique is a gentle, precision-based approach that treats you as an individual so that your own body may have the best opportunity to heal so that you can enjoy the quality of life that you really want. Even if you have tried general chiropractic, physiotherapy or other methods to help with your migraines or cluster headaches, upper cervical chiropractic, and the Blair Technique are different.
We hope that this article has been both useful and valuable for you in your search for answers. However, knowledge without action can have no power.
If you would like to find out if the Blair Technique is right for you and may be able to help you with your migraines or cluster headaches, contact us through the link at the top of this page, or call our office at 07 3188 9329 to schedule an appointment.
References
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Aprill C, Axinn MJ, Bogduk N. Occipital headaches stemming from the lateral atlanto-axial (C1-C2) joint. Cephalgia. 2002;22(1):15-22.
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Bragatto MM, Bevilaqua-Grossi D, Benatto MT, et al. Is the presence of neck pain associated with more severe clinical presentation in patients with migraine? A cross-sectional study. Cephalalgia. 2019 May 27:333102419854061. doi: 10.1177/0333102419854061. [Epub ahead of print]. https://www.ncbi.nlm.nih.gov/pubmed/31132869
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