Migraine-like headaches are due to a multifactorial process. At this point, the different forms of headache, the diverse causes, the underlying structural changes, and the corresponding treatment options can only be addressed in a very tentative and highly incomplete manner. From an osteopathic perspective, the following structures may be involved:
- Tension in the dura that affects the venous sinuses and arterial blood vessels, e.g., the middle meningeal artery. Consequences include cerebral edema, inflammation, reflex muscle tension in the neck, etc.
- SSB dysfunctions with restrictions of the suturae sphenosquamosa, occipitomastoidea, petrojugularis, petrosphenoidalis
- Occipital bone and temporal bone: At the jugular foramen, the vagus nerve may be exposed to tension in the dural membrane and venous return may be impeded, resulting in nausea, dizziness, and vomiting. On the anterior wall of the petrous apex of the temporal bone there is a shallow depression for the trigeminal ganglion. The trigeminal nerve provides sensory innervation to the face, the forehead, and the intracranial dura.
- Upper cervical spine and tension in the neck musculature: Sensory innervation of part of the skull and the dura runs via the first three cervical nerves.
- Restrictions at the sacrum and the upper ribs
- Tension in the masticatory muscles: The temporalis muscle in particular can cause pain by compressing the sphenosquamosal suture.
- the hyoid musculature and its influence on the internal jugular vein (Ch. 16.3.6.14)
- Among the vessels, the arteries are the most sensitive to pain, followed by the large sinuses; the small sinuses and the veins are the least pain-sensitive. The blood vessels of the head receive preganglionic supply from C8–Th3, from the stellate ganglion (via the vertebral artery), and from the superior cervical ganglion (via the internal and external carotid arteries). Parasympathetic innervations are also encountered irregularly, e.g., via the facial nerve. Not infrequently, the middle meningeal artery is exposed to tension at the sphenosquamosal suture, which can lead to headaches.
- visceral structures of the thorax or digestive system (via the fascial connections to the pharyngeal tubercle of the occipital bone)
- vascular dynamics: vertebral artery, branches of the internal carotid artery, external carotid artery, outflow disturbances of the internal jugular vein
- trigeminal nerve and its branches, and in particular the spinal nucleus region
- somatic nerves, e.g., greater occipital nerve, lesser occipital nerve, great auricular nerve, etc.
Treatment of these structures and all other underlying dysfunctions can have a very positive effect on migraine and headaches. Of course, all other possible causes should be clarified, psychological tension regulated, foci eliminated, and, if necessary, nutritional counseling provided. Possible techniques: CV-4, atlanto-occipital release, treatment of the SSB, release of the occipitomastoid suture, intracranial dural release techniques, release of tension in the neck musculature and the hyoid musculature (see also Liem T: Praxis der kraniosakralen Osteopathie. 3rd ed. Stuttgart: Haug; 2010). According to a systematic literature review from 2011, studies to date on the treatment of migraine, tension-type headaches, and cervicogenic headaches in children and adolescents have been conducted with insufficient validity [39]. In particular, stress, sleep, and nutritional factors can act as trigger factors for primary headache [40]. In a controlled clinical study with quasi-randomization involving 19 migraine patients, a clear improvement in disease symptomatology in migraine patients was demonstrated through findings-oriented osteopathic treatment. Overall, the patients showed multiple dysfunction patterns across all body systems [41]. According to a study from 2012, there is evidence that migraine, headaches, and associated symptoms can be improved by osteopathic manual therapy. In 28 patients (76%), a dysfunction in the area of the atlanto-occipital joints was diagnosed, in 21 (57%) in the area of C7–Th1, and in 14 (38%) in the region of the sacroiliac joints. At least one visceral dysfunction was found in every patient, most commonly of the liver. On average, 2 cranial dysfunctions per patient were localized (most commonly the cranial dura mater and SSB) [42].
