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Q&A with Australian Health Practitioners
Can migraine be triggered by neck movement?
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In 1984 I had a spinal injury. This left me with T12 paraplegia.
Following this my vision disturbance was diagnosed as a migraine like
disorder, but without headaches (some times called Alice in Wonderland
syndrome). The only abnormal test I had was some attenuation of visual
pathways in a VEP. This was decades ago.
Recently I have noticed vision disturbance triggered by neck movement.
So I started the GP -> Opthalmologist -> Neurologist thing all over
again. I am now waiting months for Neurologist after having
Non-contrast CT of neck and head: Extrathecal pressure in neck, brain
normal. Doppler of neck: Carotid and flow normal, both vertebral
arteries flowing.
Asked GP about MR Angiography (with Gadolinium chelate contrast). He
said it was expensive and I would have to pay all of it so wrote
referral for Neurologist I will need to see anyway.
Being blind and loosing verbal ability, even though currently still
transient affects my ability to work.
Why do they do more specific and -
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Dr Ryan Hislop
Chiropractor
Ryan Hislop is the Clinical Director at the Orange Chiropractic Health and Wellness Centre. As an experienced and evidence-based diagnostician, Ryan works largely by medical … View Profile
There is a neurological link between the neck and head pain, however there is also alot of other “red flags” that would cause similar symptoms.
There is an increasing body of evidence that put simplistically would suggest altered information to the brain from the neck changes the way pain is perceived at higher centres within the brain. With movements that further irritate and cause firing of these circuits in the neck to the brain may be linked with altered “downregulation”, which may cause an increase in pain levels in the head…
This is a very large topic and very difficult to explain in terms that are easily understood. It apperas that your condition is rather complex and there is probably not a singular entity causing the variety of symptoms and signs you have noted. Wait on your neurologists findings and keep us all at healthshare posted.Report this post
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There is very little if any pain, mostly vision and language disturbance. I have had chronic pain, but mostly from back (facet joints and below from spinal infarct). Vision disturbances were originally called a migraine like disorder and thats where I left it for decades.
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Dr Ryan Hislop
Chiropractor
Ryan Hislop is the Clinical Director at the Orange Chiropractic Health and Wellness Centre. As an experienced and evidence-based diagnostician, Ryan works largely by medical … View Profile
Although your neurologist has probably already applied this test, you can easily check if it is your neck or other senses that appear to trigger off the migraine symptoms. It is called a rotating stool test. (Im sure there would be a YouTube video).
It isn't unheard of (although it is less common) for people to have their migraine symptoms triggered via issues in the neck. As mentioned previously, the function of the neck greatly influences higher neurological centres, not only pain pathways but also autonomic centres that are often altered in migraine.
If your medical team is unable to find a cause of the symptoms, i would recommend a chiropractic neurologist. They are expertly tried in these types of complex cases.Report this post
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Mr Roger O'Toole
Physiotherapist
Roger O'Toole is the Director and senior clinician of The Melbourne Headache Centre. Since opening the Melbourne Headache Centre in 2012 Roger has amassed over … View Profile
Migraine aura wihtout pain is sometimes also referrred to as “Silent Migraine”.
It should be noted that for this to be considered an aura the symptoms should be “fully reversible”. If there are constant signs which don't improve and deteriorate over time I would suggest structures other than the neck are most likely at play and your line of investigation is appropriate.
As with other migraine types the research is pointing more and more towards the underlying problem being a sensitivity or “over activity” of nerve cells within the brainstem. On reaching a particular threshold they can trigger what is being called “Cortical Spreading Depression”. This is a wave of decreasing activity that can spread across the brain which often renders migraineurs unable to function, even as in your case, in the absence of pain.
The centre in the brainstem that is overactive receives direct input from the upper cervical nerve roots, and as such they are capable of providing this “over activity” and hence, yes, neck movement with a dysfunctional neck could trigger your attacks.
It is good that you have had this investigated by your doctors and specialists, but I would also reccomend having your neck assessed using highly specific techniques that allow us to rule in or out the contribution of your neck to the problem.
In short, if we can temporarily reproduce some or all of your symptoms, and have them ease whilst sustaining the technique it confirms the relevancy of your neck and also a strong lilkelihood of success with treatment.
Again though, if the “aura” symptoms are constant and deteriorating over time, having ruled out many other sources, I would be happy to assess and “exclude” your neck as the source, but the likelihood is more in favour of other causes.Report this post
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Mine may not be fully reversible as some attenuation of visual pathways in VEP (decades ago) or I could have had an episode during the test.
MR angiography should pick up infarct or vascular probs. I'll ask neurologist about this when I eventually get to see them. (MRI, non-contrast picked up infarct in thoracic spinal cord typical of ischaemic damage.)
My neck is dysfunctional. CT, non-contrast showed head was normal, but neck showed extrathecal pressure.
I let this lie for decades as was not too frequent, but now neck is triggering the probs. (As in your para. 3.) I have spinal specilist I can see after neurologist if necessary. Done the opthalmologist bit.
My back was broken by getting hit on head. The neck is between the head and back as pointed out to me by OT a long time ago.Report this post
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Mr Roger O'Toole
Physiotherapist
Roger O'Toole is the Director and senior clinician of The Melbourne Headache Centre. Since opening the Melbourne Headache Centre in 2012 Roger has amassed over … View Profile
I couldn't have said that any better myself. After headtrauma any headaches that persist are usually attributed to intra-cranial causes, and many may well be, but there is always the risk that the sudden acceleration or decelration of the head has also induced trauma to the upper cervical spine, and we now know they have direct input into the “headache/migraine centre” in the brainstem.
It makes sense to at least rule them out as contributors to your symptoms as part of your ongoing exploration for a cause.Report this post
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Dr Ryan Hislop
Chiropractor
Ryan Hislop is the Clinical Director at the Orange Chiropractic Health and Wellness Centre. As an experienced and evidence-based diagnostician, Ryan works largely by medical … View Profile
Very well said Roger
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