What if the headache isn’t coming from inside the skull?

It’s no secret that our work is second to none when it comes to the resolution of migraine headaches. In fact, our Upper Body class consistently outsells our Lower Body class for this exact reason.

It’s also no secret that many therapists shy away from treating migraines because, truth be told, they’ve often made them worse.

So, what are we doing differently?

Most migraine conversations focus almost entirely on what’s happening inside the skull. With RAPID, we’ve always paid very close attention to what may be happening outside of it.

A 2017 review paper gives us a whole lot more to go on.

It suggests that in some people with chronic migraine, particularly those with occipital pain and significant scalp and neck tenderness, some of the nociceptive input may be coming from extracranial tissues.

One of the studies discussed in the review biopsied the occipital periosteum of people with chronic migraine and compared it with controls. The migraine group had more inflammatory markers and fewer of the signals involved in resolving inflammation.

But it gets even more interesting.

Sensory nerve fibres associated with meningeal nociceptors can travel through the skull sutures and into that same extracranial periosteum.

In other words, what’s happening inside and outside the skull may not be two separate conversations.

For RAPID therapists, the importance of the periosteum is not news. What is interesting is the possibility that the occipital periosteum may have a greater influence of the internal nociceptive network involved in migraine than we have suspected.

And where does that periosteum sit? The tissue showing that altered inflammatory signature is literally sitting under our hands.

This certainly doesn’t prove that every migraine is being driven by tissues outside the skull. But it does suggest that ignoring extracranial nociceptive input may mean ignoring a very important part of the migraine picture.

We didn’t need this paper to tell us the periosteum matters.

But it gives us a pretty fascinating explanation for why paying attention to it may matter so much when treating migraines.

Burstein R, Blake P, Schain A, Perry C. Extracranial origin of headache. Curr Opin Neurol. 2017;30(3):263-271.