Impact of membranous treatment and C0 / C1 / C2 / C3 in fascia on chronic primary headaches.
Randomized clinical study carried out in 2020 with control population. By PARRAUD Aline.
Osteopathy is distinguished from any other form of therapy, in particular by its neurovegetative approach to the patient. The “Moods” formerly described and taken care of at the medical level, have given way to biological analyzes which reveal metabolic imbalances without, however, integrating a dosage relating to the “orthosympathetic” or “parasympathetic” activity of the organism. The osteopath therefore remains one of the rare practitioners to question and test this aspect. yet fundamental to the physiological balance of the individual.
Neuro-vegetative dystonia at the origin of seizures
The osteopathic concept of autonomic neurovegetative dystonia associates among other types of headaches with different cases of imbalance, thus we distinguish:
a) Case of hyperparasympathicotonia
White headache : the patient is better in a supine position to avoid gravity emptying and thus counter the state of cranial hypoperfusion[1].
b) Case of hypersympathicotonia
Red headache : The patient is better in a standing position, he is awake at night to promote gravity emptying in connection with cranial hyperemia[1].
c) An application of this principle to explain the Vascular Trigemino Reflex
Research by Professor Aubineau (1996)[2] suggest new insights to understand the triggering mechanism of primary neurogenic inflammation.
In migraine, the painful impulse is transmitted via the sensory nerves that follow the major arterial axes, such as the middle meningeal artery.
The migraine would come from the stimulation of the arteries of the dura mater and the venous sinuses via the trigeminal nerve, and this by nerves joining them (C2: large and small occipital ..) which would project the pain at the fronto-ocular or temporal level. It would also be linked to the vertebrobasilar plexus, for the posterior third, which would give occipital pain through the posterior meningeal artery.[4].
The cephalalgic brain would experience its seizures following a dysfunction of the autonomic nervous system and in particular a decrease in sympathetic activity. At the cerebral level, there is a very important interaction between autonomic and sensory systems in migraine.
Sympathetic activity has an inhibitory effect on the parasympathetic, therefore on sensory activity and on that of mast cells. There is a balance in the healthy subject, a balance which will protect the subject from neurogenic inflammation. In this context of headache called “white headache”[1], there is a decrease in the sympathetic impulse which therefore induces a parasympathetic increase, an increase in sensory and mast cell activity. This state is therefore naturally pro-inflammatory. Any environmental factor (day-night rhythm, hormonal cycles, stress, climate, etc.) would exacerbate this neurovegetative imbalance, trigger the trigemino-vascular reflex and therefore migraine.
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The digestive sphere victim of neurovegetative imbalance… not always!
“We are what we eat” said Hippocrates 2500 years ago[5].
We can now enrich this concept as follows: “We are like our microbiota …”
The importance of the intestinal microbiota is no longer to be demonstrated, it appears to be fundamental in immune mechanisms and is thought to be in direct connection with the central nervous system.
Thus, recent advances in the field of neuro-gastroenterology have allowed to establish a link in patients with Parkinson’s disease with structural abnormalities of central and enteric neurons, associated with an imbalance of the intestinal bacterial population. It has also recently been shown that dysbiosis and disturbances of the immune system are frequently present in depressive disorders.
It thus appears in several research works[6] that digestive problems are often present in migraine patients. The associated symptoms such as nausea and vomiting confirm the idea previously developed that the autonomic nervous system plays a key role in the headache mechanism. A recent study presented in 2016 even established a genetic link between migraine and Irritable Bowel Syndrome.[7].
Taking probiotics would also bring, by its balancing action on the intestinal flora, an improvement on migraines[8].
It therefore seems essential to take into account the digestive system in migraine patients. and to take into account that, potentially, the primary cause can be found at its level.
What is more, in an approach to overall patient care, if it is essential to establish the type of neurovegetative “profile” to which it relates, it also seems important to respect it. So the practitioner confronted with a reason for constipation or chronic headache in connection with a pattern of hypersympathicotonia or hyposympathicotonia, should he question the specific aspect of this state (momentary episode of anxiety …) or its “Normality”. In one case, it will undoubtedly be interesting to carry out an “ortho” vs “para” rebalancing in parallel with the somatic treatment, in the other, a “healthy lifestyle” approach may prove to be more effective.
Bibliography
1. B RIVET. Neuro-Vegetative System. COP-DCOE1. 10/2006. Page 37
2. C. GIRIAT. Osteopathy in the heart of headaches, migraine of abnormal excitability of endocranial mechanical origin, Sauramps Medical, 2016, p. 48.
3. PJ Goadsby, RB Lipton, MD Ferrari. Migraine- Current understanding and treatment. N Engl J Med, Vol. 346, No. 4 January 24, 2002
4. L. Florette. Anatomical structures to be investigated in a migraine patient. ISO Paris thesis. 2017.
5. Christian Defrance de Tersant. The venous sinuses of the skull A key to migraines. De Verlaque 1993.
6. A. Pradalier, JF Devars Du Maine. Migraine and digestive disorders, Clinical and Biological Gastroenterology, vol. 29, n ° 2, March 2005
7. V. Bargoin. Migraine-irritable bowel link confirmed, Medscape, May 3, 2016.
8. YJ Dai et al. Potential Beneficial Effects of Probiotics on Human Migraine Headache, A Literature Review, Pain Physician, February 2017.
References: Study carried out in 2020-21 by the author of the article, Aline PARRAUD, as part of her final thesis at the Collège Ostéopathique de Provence Aix-Marseille CC0 (No rights reserved).
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