Migraines: Proper Breathing, pH and Oxygen Delivery
April 30, 2020
Migraines are a disorder of sensory processing of the brain and involve activation and sensitization of trigeminovascular pathways, as well as brain stem and diencephalic nuclei. It is referred to as a brain state of hyperexcitability and Migraineurs have difficulty modulating, or gating sensory input, including pain at the top of the list (1). Multiple systems are involved in this neuronal disorder, but the main regions involved are the trigeminal nerve complex, brain stem, thalamus, hypothalamus and sensory cortex.
What that means is that the brain is hyperexcitable, or too easily triggered, especially in the areas of our brain that process pain. We need to make it less excitable in these areas.
So how does Breathing, pH and Oxygen play into this?
The reasons that your brain isn't processing sensory information during Migraine can be due to genetics or environment, resulting in hyperexcitability. Both of which cause the part(s) of your brain that process pain to reset, becoming too close to threshold of action potential, or sending a pain signal at any given time. For instance, you can light a match in your living room without any worries, but if you lit that same match inside a propane tank, the result would be an explosion. Think of your brain like that if you experience Migraines. On some level, there is a gas leak in the brain and it doesn't take much to set it off. Except, in your case, your match is not breathing properly, causing an explosion of throbbing pain.
Why would not breathing properly cause a Migraine? Respiration is the greatest effector of pH in our body, not diet, although higher phosphorous levels from an unhealthy diet will lower calcium levels in an opposing effect. When you don't breath well, such as in hyperventilation, you will increase your pH and progress towards a state of Respiratory Alkalosis. An increase in pH, or basic environment causes Calcium (Ca2+) to bind to Albumin, one of the most common proteins in our blood. This is important because Calcium and Sodium (Na+) compete with eachother- both important in the activation of neurological signaling such as Excitatory Post Synaptic Potentials. Ca2+ raises the voltage-gated Na+ threshold, blocking Na+ from entering the cell. However, with Ca2+ out of the picture, Na+ can now enter the neurons free and clear, like a kid throwing a party with his parents out of town.
How does does Respiratory Alkalosis affect my Migraine? When Na+ rushes into the cells, our resting membrane potentials within our neurons will rise and make it easier to elicit a response from those Neurons. This is of extreme importance if you have Migraine, because that means the tolerance for pain, light, smell, movement, etc. is now at all on time low. But to get to that point we had to raise the intracellular membrane potential to a more positive state and now any little stimulation that woudln't normally cause pain, creates throbbing, Migraine type pain or responses.
How can I check to see if I'm breathing improperly or in Respiratory Alkalosis?
- If you have headaches or Migraines then you may not be performing proper breathing mechanics.
- We like to look at the expansion of the lower ribs at T10 level (slightly higher than your lower back), which should be a 1.5-2.5" expansion in a bucket handle type of movement. Have a person peform this for you by putting both of their hands around your waist and you should take a deep breath in and out so they can get a tight grip and see if your lower ribs are expanding properly. You can also check this with a cloth or tape measure at the level of T10. For reference, the lower tip of your shoulder blade is approximately T6 level. Lower rib activity is the most important action because the lower lobes of our lungs are where the most gas exchange occurs.
- It is also important to evaluate your lumbar lordosis (the curve that should be present in lower back) as that is essential for diaphragmatic movement.
- Also the tailbone (sacrum) movement (nutation) is important for lumbar lordosis and breathing mechanics.
- Tap, or have someone else tap your thenar eminence (thick pad at the base of your thumb) and see if it contracts more than one beat, or continues to contract, which is described as tetany
- Take a pH test
- Check the strength of your abs- weaker abs could cause a hyperlordosis and could allow the diaphragm to descend too far thus causing intercostal muscles (ribs) and scalene/accessory muscles of breathing to strain just to create stability in order to keep the chest from imploding. Can also be a source of chronic upper back pain
- Chronic upper back pain could be due to this
- Observe when you are breathinig, is it in an upward direction, or lower and expansive
- Lean forward while sitting and try to take a deep breath, you should find it very difficult, now sit up very straight and try breathing again and you should notice much more ease of breathing.
- Quadratus Lumborum tightness
- If you hyperventilate, do any of these findings worsen for you or do you notice other symptoms
And if you experience Migraines, of course, you will find yourself in a state of neurological hyperarousal that will make you susceptible to otherwise innocuous information that will be perceived as painful (nociceptive) information. The Migraine example of this is the normal activity of the blood vessels that supply your meningeal layers (inner cranium). The normal pumping activity of these blood vessels is now perceived as intense, throbbing pain by the brain if the areas that are supposed to relay that information are not able to detect the proper sensory signals coming into the brain due to an increase in the excitability of the pain neuron pathway (Trigeminovascular pathway).
- This can also be seen in individuals with anxiety. If you increase hyperexcitability within the limbic system, you will more easily aggravate/stimulate these areas adding to further anxiety and worry because the neurons (brain cells) in that are are already on high alert, or hypervigilance.
- You can also see this with dizziness that can be associated with Migraines. If the neurological structures that send information from your inner ear to your brain stem are sending excessive signals every time you move, then your brain may perceive this as dizziness (too much movement).
Our program at Portland Chiropractic Neurology evaluates oxygenation through pulse oximetry, autonomic testing, percussion myotonia, pH testing when applicable, breathing excursion, observation at T10, evaluation of thoracic, T1 ribs, T2-12 costovertebral (rib), costosternal, lumbar lordosis, sacral nutation, abdominal strength, postural evaluation, gait evaluation.
Treatments available that may be utilized include-
- Rib manipulation (RM)
- Postural restoration (PR)
- Specific Chiropractic Neurological Manipulations to lumbar/sacral/thoracic (SCNM)
- Physical Therapy (PT)
- Mild Hyperbaric Oxygen Therapy (mHBOT)
- Occupational Therapy (OT)
- Functional Neurological Rehabilitation (neuroplasticity exercises) (FNR)
- Vestibular Rehabilitation (VR)
- Cervicovestibular rehabilitation (CVR)
- Visuomotor retraining (VMR)
- Non invasive nerve stimulation (NINS)
- Vagus Nerve stimulation (VNS)
- Tilt Table Therapy (TTT)
This is not the only cause of Migraines, but can be very helpful in some or many Migraine cases when diagnosed and applied correctly. Genetics play a role, as do many other factors. Please reference our website for more information that will complete the Migraine story.
If you have any questions about this type of care or wondering if it might be right for you or someone else, please don't hesitate to reach out to us and we'll help you find someone close to you that may be able to help. Portland Chiropractic Neurology is located in Portland, Maine, but there are doctors worldwide that we may be able to connect you with. email@example.com , www.portchiro.com , 207-699-5600
Dr. Aaron MacArthur is a board certified Chiropractic Neurologist and teaches Nationally on the topics of Chiropractic, Neurology and Migraines. He has two fellowships, the first in Brain Injury and Rehabilitation (concussion) and also in Vestibular Rehabilitation. He has received hundreds of hours of education on the topic of Migraines and has been a passion of his to help those suffering needlessly. Please visit our website for more information on this topic.
(1) Goadsby PJ, et al. Pathophysiology of Migraine: A Disorder of Sensory Processing. Physiol rev 97: 553-622, 2017