Interest Piece – Treating Migraines with Muscle Relaxants
By anti-aging Cosmetic Nurse Practitioner Michelle Fitzgerald
What is a migraine?
A migraine is a severe headache, commonly unilateral in nature, that may be preceded or accompanied by sensory warning signs (aura) including blind spots, tingling in arms/legs, nausea, vomiting, flashes of light, photosensitivity, unpleasant smells, difficulty speaking, confusing thoughts and sensitivity to sound (Medical News Today 2015).
Migraines, particularly those without aura, can be difficult to diagnose as there are no tests currently available which are specifically designed to confirm diagnosis. However, the International Headache Society recommends the 5, 4, 3, 2, 1 criteria to diagnose migraines without aura:
5 or more attacks
4 hours to 3 days duration
At least 2 unilateral location, pulsation with moderate/severe pain leading to avoidance of daily activities
A minimum of at least 1 additional symptom such as nausea, vomiting or photosensitivity (Medical News Today 2015).
What causes migraines to occur?
The exact cause of migraines is largely unknown, although a sudden increase in the blood flow (vasodilation) in the cranial blood vessels caused by a temporary alteration in nerve signals is thought to be involved. Often sufferers are able to identify triggers, although many cannot, including: allergies, bright lights/noises, stress, tiredness, smoking/exposure to smoking, dehydration, alcohol, skipping meals, hormonal triggers and certain food additives (Medical News Today 2015).
What current treatments available for migraine sufferers?
Before attempting to treat headaches/migraines it is essential for other causes to be eliminated including, but not limited to, stroke, haemorrhage, sinusitis and tumour. There is currently no cure for migraine therefore current treatment is aimed at prevention and alleviation of symptoms. Treatments include medication, oxygen therapy, exercise, chiropractic and or/acupuncture and dietary changes. Over more recent years the injection of muscle relaxants via several injection sights has been shown to significantly reduce/eliminate the occurrence of migraine episodes (Janis et al 2014).
How do muscle relaxants work regarding the treatment of migraines?
Muscle relaxants work as a preventative measure in the treatment of migraines. As there is no muscular component to migraines, the mechanism by which muscle relaxants work is not fully understood. However, recent evidence suggests that muscle relaxants may prevent the release of neuropeptides involved in pain perception and inflammation (Capehart 2014). Typically, muscle relaxants exert its effect via the uptake of cholinergic neurons resulting in temporary chemo denervation and a decrease in neuromuscular transmission, for the treatments of migraines, muscle relaxants also relieve pain where there is excessive muscular contraction (Blumernfeld et al 2004).
What happens during consultation/treatment?
When establishing a client’s suitability for preventative treatment of migraine with muscle relaxants, practitioners will ask a series of questions and undertake a thorough evaluation of the client. If triggers for attacks have been identified the importance of continuing to avoid these triggers (where possible) will be reinforced. If the migraine attacks are hormonal in causation or secondary to sinusitis, treatment with muscle relaxants will be ruled out due to lack of success in these circumstances. The use of the International Headache Society diagnostic criteria may be employed, furthermore if the client has not already sought medical attention regarding the migraine attacks they will be advised (referred) to do so to ensure that there is no potential for differential diagnosis.
There are several sites for treating migraine attacks with muscle relaxants, including muscles within the glabella (frown) complex, the frontalis (forehead), the temples and grinding/masseter muscles (Capehart 2014) and muscles located at the base of the neck. As part of the client evaluation practitioners will ask where the pain is most prominent during a migraine attack, as this will often provide insight regarding which areas require treatment. For example clients who have pain in the jaw and or temple region need to be assessed for bruxism (teeth grinding) and may require injections in the masseter, and possibly temporalis (temple) regions. Conversely, when the pain is most prominent in the frown region treatment of the glabella is likely to be most effective and so forth. This use of clinical features based on history/examination is known as the “follow the pain” approach and has been identified as a highly successfully technique in the preventative treatment of migraine attacks (Blumerfeld et al 2003).
The treatment of migraine attacks with muscle relaxants will typically last between 3-6 months depending on site treatment and amount of product used. It is both safe and effective, with excellent tolerability reported. Therefore, muscle relaxants are an exceptional preventive treatment for migraine sufferers, particularly those who have tried and not tolerated alternative pharmaceutical intervention.
Michelle, Australia’s first Cosmetic Nurse Practitioner, has been using her clinical expertise to provide cosmetic, non-surgical treatments for almost 10 years.
Michelle started her career as a registered nurse in the Royal Children’s Hospital, where she worked for 2 years. Michelle loves to travel and it was while living overseas she first became interested in cosmetic rejuvenation undergoing extensive training and beginning work as a cosmetic nurse with the Harley Medical Group (Dublin) in early 2005. Michelle returned home to Melbourne in 2007 and began working with Anti-Aging Cosmetic & Laser.
After completing her Masters in Nurse Practice/Practitioner and undergoing a thorough vetting process by AHPRA – involving the provision of evidence to demonstrate advanced practice, Michelle attained endorsement as Australia’s first Cosmetic Nurse Practitioner in February 2013.
Michelle loves the perfect mix of artistry and science her job provides and prides herself on delivering results that are both precise and remarkable. Crucial to achieving this is understanding how each client is individual with unique concerns and assets, and considering these when developing a treatment plan that will work for them.
Michelle feels the ultimate compliment a client can receive after having treatment is “You’re looking really well!” rather than “what have you had done?”