Follow Sharron on Twitter

Sharron's book is now available at Amazon www.amazon.com, Barnes and Noble www.barnesandnoble.com, and wherever books are sold. The book can be purchased in print form or ebook format.

Conari Press, an imprint of Red Wheel/Weiser, LLC  is the publisher of Sharron's book, Migraine: Identify Your Triggers, Break your Dependence on Medication, Take Back Your Life -  An Integrative Self-Care Plan for Wellness," released June, 2013. Follow Sharron on Twitter @murraysharron, and her page Sharron Murray, MS, RN on Facebook, for tips to help you battle your migraines and achieve wellness.

 

Monday
Feb262018

Neck pain and migraine

"I've developed a stiff neck that's about to drive me insane..." - 'Little' Jimmy Dickens

For many of us with migraine disease, neck pain and stiffness may be a troublesome symptom. Along with neck pain associated with a migraine attack , neck pain and tension may occur with coexistent  disorders such as tension-type headache and cervicogenic headache. You can learn more about tension-type headache and cervicogenic headache in these links to articles from the American Migraine Foundation. In this article, we take a closer look at possible mechanisms and clinical implications of neck pain associated with migraine. Because neck pain often begins in the prodrome phase of a migraine attack, let's have a quick review of this phase.

Prodrome Phase: 

Prodromal symptoms (premonitory) may occur hours or days before the headache phase of a migraine attack, with or without aura. A number of symptoms have been reported, including fatigue (hypoactivity), euphoria (hyperactivity), depression, irritability, food cravings, constipation, neck pain and stiffness, yawning, difficulties with concentration, nausea, blurred vision, bloating, pallor, change in facial expression or body perception, piloerection, and sensitivity to light, sound, and smell (Charles, 2012; ICHD 3rd edition, 2018; Burstein, et al., 2015; Lampl et al., 2015; Maniyar, et al., 2015). In the Burstein article, the authors report premonitory symptoms most commonly described by patients point to the potential involvement of:

  • the hypothalamus, including symptoms fatigue, depression, irritability food cravings, and yawning;
  • the brainstem, including symptoms muscle tenderness and neck stiffness;
  • the cortex, including symptoms abnormal sensitivity to light, sound, and smell; and
  • the limbic system, including depression and anhedonia (p. 6620). 

In addition, both the Charles and Maniyar articles suggest premonitory symptoms may be associated with the hypothalamus and note the neurotransmitter dopamine may play an important role. In the Maniyar article, the authors also report emotional changes and a feeling of tiredness may result from involvement of limbic/frontal areas mediated by the hypothalamus; posterior hypothalamic dysfunction could explain neck discomfort and stiffness; and, involvement of the frontal cortex could explain difficulties in reading, writing, and concentration (p. 611). It is interesting to note that in the Charles article, the author mentions some premonitory symptoms may come and go before the headache phase, others may build up in intensity leading up to the headache, occur during the headache, and persist well beyond the resolution phase (p.413). 

Neck Pain 

It is important for us to know neck pain is commonly reported as a symptom with a migraine attack and may be experienced before (prodrome), during and after the headache phase (postdrome). While not conclusive and further studies are indicated, it is thought that neck pain may be an integral part of the migraine process ( Calhoun et al., 2010Ashina, et al., 2015Maniyar et al., 2015Lampl,et al., 2015). In a population study assessing neck pain in migraine and tension-type headache, (Ashina et al., 2015), the authors report neck pain may play a role in the pathophysiology of migraine and tension-type headache and may arise because of convergent input from the first division of the trigeminal nerve and the upper cervical roots to the trigeminal complex (p. 212). Clinical implications from this study that are beneficial for us to know are: 

  • "Neck pain is highly prevalent in the general population and is more prevalent in individuals with migraine and tension-type headache. 
  • Neck pain has the highest prevalence in coexistent migraine and tension-type headache.
  • Myofascial pericranial tenderness is significantly increased in individuals with neck pain compared to individuals without neck pain.
  • Neck pain may have a shared pathophysiological mechanism with primary headaches. 
  • Neck pain may result in increased disability in headache sufferers and treatment may also be directed to the neck," (p. 218).    

Additionally, we should be aware Maniyar et al., (2015), report "patients with neck stiffness do not respond as well to triptan treatment as patients without neck stiffness during acute migraine headache, suggesting a phenotype-mechanism dissociation" (p. 611). And, Lampl et al., (2015), indicate "prevention and treatment of neck pain could be important in the prevention of future chronic migraine" (p. 6/9). 

Treatment 

For those of us with migraine and neck pain, especially, since we may also experience coexistent tension-type headache and cervicogenic headache, treatment of neck pain is something we need to discuss as individuals with our doctors.  For me, since I went from episodic to chronic migraine with medication overuse headache and back to infrequent episodic migraine, when I do have a migraine, neck pain can be equally disabling as headache pain.  My treatment plan includes ice (some may prefer heat), posture correction, neck exercises I learned many years ago from a physical therapist, regular exercise, biofeedback, meditation, acupuncture, and a prescription compound keto/lido cream. There may be a number of other pharmacological and nonpharmacological therapies that can help you. Talk to your doctor about what is right for you. 

References:

Ashina, S., Bendtsen, L., Lyngberg, A., C., et al., (2015). "Prevalence of neck pain in migraine and tension-type headache: a population study." Cephalalgia. Mar;35(3):211-9.

Burstein, R., Noseda, R., & Borsook, (2015). "Migraine: Multiple Processes, Complex Pathopysiology." The Journal of Neuroscience. April;35(17):6619-6629.

Calhoun, A., H., Ford, S., Millen, C., et al., (2010). "The prevalence of neck pain in migraine." Headache. Sep;50(8):1273-7.

Charles, A. (2013). "The evolution of a migraine attack - a review of the evidence." Headache. Feb;53(2):413-9.

Headache Classification Subcommittee of the International Headache Society. The International Headache Society. "The International Classification of Headache Disorders: 3rd edition. Cephalalgia. 2018;38 (1):1-211 

Lampl, C., Rudolph, M., Deligianni, C., et al., (2015). "Neck pain in episodic migraine: premonitory symptom or part of the attack?" The Journal of Headache and Pain. Sep;16:80.

Maniyar, F.H., Sprenger, T., Monteith, T., et al., (2015). "The premonitory phase of migraine-what can we learn from it?" Headache. May;55(5):609-20.

Sharron Murray is an American Migraine Foundation Partner 

Sharron Murray MS, RN is a Health and Wellness Author. Her most recent book is, "Migraine: Identify Your Triggers, Break Your Dependence on Medication, Take Back Your Life- An integrative self-Care Plan for Wellness". San Francisco: Conari Press, 2013.

Follow Sharron on twitter @murraysharron, her FB page, Sharron Murray, MS, RN, and her website, www.sharronmurray.com 

This article is not a substitute for medical advce. If you have specific concerns about your health or nutrition, please contact a qualified professional.

Copyright February 26, 2018 Sharron E. Murray

Thursday
Feb152018

Migraine is a neurological disease - help change the conversation

"The only way to make sense out of change is to plunge into it, move with it, and join the dance."- Alan W. Watts

As more research continues to unfold about migraine, including increased knowledge about the pathogenesis, genetic and environmental influences, the economic burden to the individual and society, the toll on jobs and careers, and the affect of migraine on family relationships, the way we speak about migraine is beginning to change. For me, after living with migraine for so many years, I am beyond grateful to see the reference to migraine as a "bad headache" be replaced with migraine is a "neurological disease".

To change the conversation about migraine and "empower the more than 36 million individuals living with migraine to advocate for themselves to find the support and treatment they need", in March, 2017, the American Migraine Foundation launched the "Move Against Migraine" campaign. Three objectives of the campaign that stand out are:

  1. Raise awareness and brand migraine as a severe neurological disease.
  2. Empower and mobilize patients to advocate for themselves and live healthy and fulfilling lives.
  3. Inspire, motivate, and drive more funding for research into the causes and treatment of migraine so we can eventually and hopefully bring safer and more effective treatments to patients.

Let's take a closer look at these objectives. As I apply them to myself and my life with migraine, hopefully, as a person with migraine, if you haven't already, you can apply them to your life:

Raise awareness and brand migraine as a severe neurological disease 

In an interview with the American Migraine foundation, in a discussion of "It's simply not a headache",  Dr. Dodick mentions that the word "headache" is used flippantly and thus migraine isn't seen as a serious debilitating disease. He adds, "the stigma is that migraine patients can't withstand the stressors in life so they develop headaches". 

In my case, throughout my life, as I was told to pace myself and if I just learned to manage stress my headaches would disappear, I bought into this idea that somehow, because I couldn't cope with pressure, these "headaches" were my fault. Even, with the hours I spent at a migraine clinic and my visits with a psychologist and a biofeedback therapist, as well as lengthy discussions with my neurologist, I did not gain appreciation for migraine as a disease until my attacks became chronic and I was diagnosed with medication overuse headache. At that time, when my doctor told me I had to do something besides take medication for my headache and other symptoms, I began to educate myself. As I waded through the most recent evidence and research available about migraine, it was then I learned migraine was a severe neurological disease and headache was only one of many debilitating symptoms of a migraine attack...something, with the branding of migraine as a "severe neurological disease", I am much quicker to point out now to everyone, including my family, friends, doctors, and other members of my health care team.

Empower and mobilize patients to advocate for themselves and live healthy and fulfilling lives 

As I gain more knowledge about the pathogenesis (cause), genetics, and environmental influences (triggers) associated with migraine disease, I am increasingly empowered to take control of everything I can to help manage my attacks. For example, as I discover more about the hypothalamus and homeostasis and how a change in homeostasis like too much or too little sleep, dehydration, or skipped meals (hypoglycemia) may activate a migraine attack, I work harder to stick to routines like regular sleep, exercise and eating habits to manage these and other triggers for my attacks. In addition, where I had previously bought into stress as being the cause of my "headaches", I am firm on the realization that, although stress is a trigger for my attacks and makes me more susceptible to other triggers such as poor sleep, it is not the cause. However, that said, because stress is a factor in the frequency of my attacks, I am committed to managing my stress response through therapies like biofeedback and meditation. As I continue to approach migraine as a disease and focus on preventing attacks, not just treating symptoms like headache during attacks, I have been able to maintain the remittance to infrequent episodic migraine I achieved a number of years ago, and with many more migraine-free days, live a healthy and fulfilling life with migraine.

Excited about the Move Against Migraine campaign, I became a member of the American Migraine Foundaton Move Against Migraine Facebook Group, an effort to mobilize a community of migraine patients to become self-advocates and help us learn from one another. As well, along with resources available from the American Migraine Foundation, Facebook Live events provide access to experts who speak on a variety of topics. For me, being a part of this group, both as a member and a moderator, is a rich and rewarding experience.   

Inspire, motivate and drive more funding for research into the causes and treatments of migraine so we can eventually and hopefully bring safer and more effective treatments to patients. 

We all want safer and more effective treatments for migraine. By taking an active role in our care, educating the uniformed, raising our voices, and changing the conversation about migraine from "headache" to "migraine...a life-changing, debilitating disease that affects all aspects of our lives", we can inspire, motivate, and drive more funding into the causes and treatments of migraine and achieve our goal..."Plunge into it, move with it, and join the dance..." 

Sharron Murray is an American Migraine Foundation Partner 

Sharron Murray MS, RN is a Health and Wellness Author. Her most recent book is, "Migraine: Identify Your Triggers, Break Your Dependence on Medication, Take Back Your Life- An integrative self-Care Plan for Wellness". San Francisco: Conari Press, 2013.

Follow Sharron on twitter @murraysharron, her FB page, Sharron Murray, MS, RN, and her website, www.sharronmurray.com 

This article is not a substitute for medical advce. If you have specific concerns about your health or nutrition, please contact a qualified professional.

Copyright February 18, 2018 Sharron E. Murray

Saturday
Feb032018

American Migraine Foundation Partner

If everyone is moving forward together, then success takes care of itself. - Henry Ford

WE'RE NOW A PROUD PARTNER OF THE AMERICAN MIGRAINE FOUNDATION! 

We’ve joined the American Migraine Foundation to fight debilitating head pain together  

As part of our ongoing commitment to providing meaningful information, resources and support for those living with migraine, Sharron Murray is thrilled to announce our new partnership with the American Migraine Foundation.The American Migraine Foundation is the official resource for millions of Americans living with migraine seeking reliable information about diagnosis, treatment and advancements in research. Launched in 2010 as a patient support and advocacy effort of the American Headache Society, AMF’s mission is to mobilize a community for people living with migraine and their support networks, and to drive impactful research into the third most common and sixth most disabling disease around the globe.

Sharron Murray  is a cornerstone organization in the migraine world. It is truly an honor to work alongside them as we #MoveAgainstMigraine,” says American Migraine Foundation Executive Director Meghan Buzby. “We look forward to continuing to make an impact together.”

Sharron Murray

Like Sharron Murray, the American Migraine Foundation is dedicated to helping people with migraine live meaningful and pain-free lives. We’re so excited to join forces with AMF to provide support, advocacy and treatment innovations to people living with this disabling disease.

The American Migraine Foundation supports people living with migraine by providing free, comprehensive information sourced directly from headache specialists, by maintaining a searchable database and map to improve access to headache specialists, by investing in research efforts towards new, innovative treatments, and by creating support networks and communities where people with migraine can support and learn from each other.

We couldn’t be more excited about this collaboration. Be on the lookout for additional resources and enhanced communication from our team in the very near future.

Together, we are as relentless as migraine

 

Thursday
Jun012017

My Migraine Management: Science + Art = "DESSERT"

 

In this  MHAM 1: Blogging and Social Media Challenge, I share how, in my migraine management, a combination of science and art equals "DESSERT". For purposes of this discussion, I define science as the research and theoretical principles that give scientific efficacy to the ingredients in my "DESSERT". While art, through caring for myself as a whole person, physically, mentally, emotionally and spiritually, adds the flavor.

SCIENCE

"Somewhere, something incredible is waiting to be known" - Carl Saga

For many years I believed migraine was a severe headache caused by my inability to cope with stress. To find relief from the agonizing head pain, I consumed volumes of ineffective over the counter and prescription medications. My break through came when my journey with migraine progressed from episodic to chronic, along with medication overuse headache. Through research, I discovered migraine was a disease and today, believed to be a disabling neurological (neurobiological) disease, with genetic and environmental influences. Now, as I wait for a cure to be discovered, I keep up to date with studies that reveal the most effective pharmacological and nonpharmacological (including complementary or integrative) treatments and therapies for prevention and relief of my migraine attacks. As well, I enrich my body of knowledge by learning about other diseases and disorders that may be comorbid with migraine and complicate the course of my disease. 

ART

"Like a work of art, each encounter with a patient is unique." (M.G. Hackney, personal communication, April, 2015).

Like the colors in a watercolor are unique to a work of art, my personal characteristics; risk factors; comorbidities; triggers; symptoms; responses to treatment and therapies; socioeconomic status; and, family burdens that influence the course of my disease are unique to me. And, while I am fortunate to have doctors who know the person inside my migraine and are caring, compassionate, and nonjudgmental in their approaches, I have learned to be caring, compassionate, and nonjudgmental with myself as I make substantial changes in my lifestyle habits such as what I eat and drink, eating and drinking habits, exercise, sleep hygiene, and how I manage my stress levels.  

"DESSERT is like a feel-good song and the best ones make you dance" - chef Edward Lee 

You know that feeling you get when you wake up without a migraine? Yeah, you want to dance! That's what I call DESSERT! Thankfully, I have found with a combination of art and science thrown into a mix of the following ingredients and sweetened with a blend of persistence, patience, and consistency, I can enjoy DESSERT almost every day:   

D = Diagnosis and Diary 

After years of being misdiagnosed, I received my first official diagnosis of migraine from the neurologist at a migraine clinic. As I found out, effective treatment for migraine needs an accurate diagnosis. Shortly after, I learned that one of the most effective ways to help my doctor make an accurate diagnosis, assist with identification and management of my individual triggers, and improve my treatment outcomes was for me to keep a dairy.  To begin with I used a monthly calendar but now I use an electronic diary for a more scientific approach. 

*E = Eating and Drinking Habits 

Keeping in mind, skipped meals (hypoglycemia) and dehydration can trigger an attack, I eat a healthy meal 3 times a day (breakfast before 9 am, lunch before 1 pm and dinner before 7 pm) and drink 8-10 glasses of water (more if I need because of exercise or heat).  

*S = Stress Management 

Because emotional stress can keep me awake at night and/or interrupt my sleep and because I tend to run at full speed, which makes me vulnerable to "let-down" stress, I monitor my stress levels frequently throughout the day, practice mindfulness, and implement stress reduction strategies like meditation and biofeedback as part of my daily routine. As well, I have acupuncture on a regular basis.  

*S = Sleep 

Knowing good quality sleep is protective for migraine, I try to maintain a schedule of 8 hours a night, with a regular bedtime and awake time.  

*E = Exercise

Because exercise can help prevent my migraine attacks and reduce my risk for comorbidities, I attend a gym 3 times a week.

R = Routine 

Knowing my migraine brain does not like change, sticking to my daily routine is essential for living well with this disease.

T = Tender Loving Care 

Perhaps, the most important thing I've learned in this journey with migraine, is to love myself. When I have setbacks, rather than beat myself up, I concentrate on the good days  and what it is like to be migraine-free... You know, "DESSERT.... and move forward again...

 *My guide, "15 steps to create an environment conducive to wellness".   

Warm wishes for great success with your migraine management plan.

Sharron is the author of, ""Migraine: Identify Your Triggers, Break Your Dependence on Medication, Take Back Your Life- An integrative self-Care Plan for Wellness". San Francisco: Conari Press, 2013.

Follow Sharron on twitter @murraysharron, her FB page, Sharron Murray, MS, RN, and her website, www.sharronmurray.com 

This article is not a substitute for medical advce. If you have specific concerns about your health or nutrition, please contact a qualified professional.

Copyright June, 2017. Sharron E.Murray 

 

 

 

Thursday
Sep082016

Cold Therapy in Migraine: Mechanisms and Methods

"OF PAIN YOU COULD WISH ONLY ONE THING: THAT IT SHOULD STOP." - George Orwell, 1984

Although research about cold therapy (cryotherapy) in patients with migraine is limited, one thing is known, as the pain begins, many of us reach for the cold pack. In an article by Sprouse-Blum, et al., (2013), the authors report, "of all self-administered pain-relieving maneuvers, cold therapy is the most common maneuver applied in migraine without aura and the second most common maneuver applied in migraine with aura second only to compression" (p. 237). Before we take a look at the possible physiological effects of cold therapy, and some of our respective methods of application, let's have a quick review of helpful things to know about headache and neck pain in migraine. 

We need to be aware that migraine is a genetic neurological disease and headache is a phase of a migraine attack (a person may have an attack without headache). Headache is commonly unilateral, pulsating, moderate to severe intensity, and may be aggravated by movement. However, pain may be felt all over the head (on one or both sides and in the middle of the head), including the eyes, frontal, occipital and neck areas (Kelman, 2005; ICHD-3 beta, 2013; Burstein et al., 2015). The headache phase is thought to begin with activation of meningeal receptors at the origin of the trigeminovascular system. As the headache progresses, in activation and sensitization of the trigeminovascular pathway, a number of complicated electrical and chemical events take place, including the involvement of neurotransmitters, neuropeptides and inflammatory mediators. In the process, we may experience a wide variety of autonomic, affective, cognitive, and sensory symptoms, including allodynia. The clinical manifestations of cephalic allodynia may include scalp and muscle tenderness and sensitivity to touch (Burstein et al., (2015)

It is important for us to know neck pain is commonly reported as a symptom with a migraine attack and may be experienced before (premonitory symptom), during and after the headache phase. While not conclusive and further studies are indicated, it is thought that neck pain may be an integral part of the migraine process ( Calhoun et al., 2010; Ashina, et al., 2015; Maniyar et al., 2015; Lampl,et al., 2015). In a population study assessing neck pain in migraine and tension-type headache, (Ashina et al., 2015), the authors report neck pain may play a role in the pathophysiology of migraine and tension-type headache and may arise because of convergent input from the first division of the trigeminal nerve and the upper cervical roots to the trigeminal complex (p. 212). Clinical implications from this study that are beneficial for us to know are:   

  • "Neck pain is highly prevalent in the general population and is more prevalent in individuals with migraine and tension-type headache. 
  • Neck pain has the highest prevalence in coexistant migraine and tension-type headache.
  • Myofascial pericranial tenderness is significantly increased in individuals with neck pain compared to individuals without neck pain.
  • Neck pain may have a shared pathophysiological mechanism with primary headaches. 
  • Neck pain may result in increased disability in headache sufferers and treatment may also be directed to the neck," (p. 218).    

Additionally, we should be aware Maniyar et al., (2015), report "patients with neck stiffness do not respond as well to triptan treatment as patients without neck stiffness during acute migraine headache, suggesting a phenotype-mechanism dissociation" (p. 611). And, Lampl et al., (2015), indicate "prevention and treatment of neck pain could be important in the prevention of future chronic migraine" (p. 6/9). 

Now, keeping these things in mind, let's take a look at the possible physiological effects of cold therapy for symptomatic relief in migraine. In general, local cold therapy is thought to cool skin, decrease temperature, decrease blood flow (vasoconstriction), reduce inflammation in adjacent tissues, relieve pressure on affected nerves, decrease muscle spasm and muscle tension, and numb pain. That said, let's review some of the proposed pathophysiological mechanisms of action in migraine. 

In a study by Robbins, (1989), where a cold wrap was placed around the head with an elastic bandage and in a study by Ulcer et al., (2006), where cold was administered by gel cap, in a discussion of effectiveness, both study authors report, local anesthesia is important in the use of cold therapy in migraine. They go on to suggest cold sensations overwhelm and block transmission of the pain stimuli into the cerebral cortex and ice reduces the release of some substances including histamines, vasoactive substances and enzymes that stimulate nerve endings. Robbins adds a more thorough discussion, including the conduction velocity of peripheral nerves is decreased as the temperature is lowered. As well, Robbins mentions the major effect of ice is to decrease blood flow to the area (vasoconstriction) and a further effect is to reduce metabolism and oxygen demand. More recently, in a study by Sprouse-Blum, et al., (2013), where an adjustable wrap containing two freezable ice packs targeting the carotid arteries at the front of the neck was used to evaluate targeted cooling in the migraine patient by cooling the blood passing through the intracranial vessels, in a discussion of effectiveness, the authors report:

  • it is possible blood passing through the carotid arteries was cooled enough to decrease release of inflammatory mediators from the walls of the intracranial vessels, decrease vascular permeability, and decrease local pain stimulation;
  • there may have been a contribution of cold induced physiologic vasoconstriction similar to that observed with triptan type medications albeit through a different mechanism (the authors note the role of vasoconstriction in migraine remains unclear);
  • a minimal contribution of analgesia associated with the small diameter myelinated fibers located around the cranial vessels is proposed, and
  • there may be a minimal contribution of decreased metabolic activity in locally cooled areas (page 239).

Little is written about the contraindications of cold therapy in migraine. In the study by Ucler et al., (2006), the authors report one patient could not use cold therapy because of cold intolerance and another patient due to vertigo. Robbins, (1989), reports contraindications may include Raynaud's phenomenon and cold sensitivity. As well, Robbins, (1989), notes ice may cause some problems in rheumatoid conditions and in patients with paroxysmal cold hemoglobinuria. Taking these factors into consideration, in addition, if you have circulatory problems, are diabetic, are pregnant or are nursing, you should discuss individual concerns about cold therapy with your doctor.  

Today, there are a number of products on the market designed to meet our individual cold therapy needs and comfort levels, including gel packs, pillows, caps, hats, and collars. For example, a hat that covers the entire head may be appropriate for one person, while another person may like something that covers the eyes.

In my case, since my migraines escalated to chronic migraine and then remitted to infrequent episodic migraine, I have become increasingly sensitive to hats or anything tight around my head, or neck, because of allodynia. As well, when I do have an attack, neck pain has become a troublesome symptom for me in the premonitory phase, throughout the headache phase, and into the postdrome.

Recently, I was introduced to the Migraine Hat by Lisa Jacobson, founder of The Daily Migraine, who created the hat at a good price point, with the intent of using the proceeds to raise migraine awareness. My first impression was that along with being adjustable so I could regulate the pressure, it was light enough that I could use it for a head wrap and flexible enough that I could use it for my neck. That said, I have been using the hat for the last few months, mostly for neck pain. I find if I catch the neck pain early enough, along with breathing, slow and easy, in and out, some biofeedback exercises, and meditation, I can often prevent or lessen the severity of an impending headache. To get the maximum benefit from the Migraine Hat, when I apply it to my neck I: 

  • fold the Cryo-gel ice pack in half,
  • insert it into the cloth cover and close the Velcro  tabs,
  • with the the seam side of the cloth cover down and Velcro closure to the front of my neck, where I can easily access it for adjustments, I turn the two top corners down and fasten the lower portion just at, or slightly below, the level of my clavicle . 

This way the contact of the Cryo-gel ice pack is at the back of my neck and base of my skull, not the sides and front of my neck. If the pain moves to my head, I can remove the hat from my neck, readjust the Cryo-gel pack to its original size, and place it where it hurts, including around my head, top of my head, or over my eyes.

In addition to the flexibility of the Migraine Hat, I am impressed with the versatility of the well designed cooler, which comes as a gift. Because I don't eat fast food and avoid foods with MSG, preservatives and artificial ingredients, I often take a healthy snack or sandwich with me when I am away from home. Along with two Cryo-gel ice packs, I am able to tuck in my food choice and keep it cool for the day. 

References:

Ashina, S., Bendtsen, L., Lyngberg, A., C., et al., (2015). "Prevalence of neck pain in migraine and tension-type headache: a population study." Cephalalgia. Mar;35(3):211-9.

Burstein, R., Noseda, R., & Borsook, (2015). "Migraine: Multiple Processes, Complex Pathopysiology." The Journal of Neuroscience. April;35(17):6619-6629.

Calhoun, A., H., Ford, S., Millen, C., et al., (2010). "The prevalence of neck pain in migraine." Headache. Sep;50(8):1273-7.

Lampl, C., Rudolph, M., Deligianni, C., et al., (2015). "Neck pain in episodic migraine: premonitory symptom or part of the attack?" The Journal of Headache and Pain. Sep;16:80.

Maniyar, F.H., Sprenger, T., Monteith, T., et al., (2015). "The premonitory phase of migraine-what can we learn from it?" Headache. May;55(5):609-20.

Robbins, L., D., (1989). "Cryotherapy for Headache." Headache: The Journal of Head and Face Pain. Oct;29(9).

Sprouse-Blum, A., S., Gabriel, A., K., Brown, J. P., et al., (2013). "Randomized controlled trial: targeted neck cooling in the treatment of the migraine patient." Hawaii JMed Public Health. Jul;72(7):237-41.

Ulcer, S., Coskun, O., Inan, L., E., et al., (2006). "Cold Therapy in Migraine Patients: Open-label, Non-controlled, Pilot Study." Evid Based Compliment Alternat Med.  Dec;3(4):489-493.  

Sharron Murray, M.S., R.N. is a Health and Wellness Author. Her most reent book is  Migraine: Identify Your Triggers, Break Your Dependence On Medication,Take Back Your Life. San Francisco: Conari Press, 2013.

Follow Sharron on twitter @murraysharron, her FB page: Sharron Murray, MS, RN and her website www.sharronmurray.com

This article is not intended as a substitute for medical advice. If you have any specific concerns about your health or nutrition, please consult a qualified healthcare professional.

Copyright October 29th, 2016, Sharron E. Murray