A Comprehensive, Integrative Approach for Chronic Migraines

Chronic migraines are more than just frequent headaches. They represent a complex neurological disorder that often resists conventional pharmacologic treatments. Many patients are prescribed medications or receive Botox injections, yet continue to struggle with persistent pain, tension, fatigue, and reduced quality of life. At the Performance Medicine Institute, we take an integrative, multimodal approach that targets the root causes of migraine, not just the symptoms.

Understanding Chronic Migraines

A chronic migraine is defined as having 15 or more headache days per month, with at least 8 of those having migraine features. These headaches often involve nausea, photophobia, phonophobia, and functional impairment. Traditional treatment typically centers around:

• Preventive medications (e.g. beta blockers, anticonvulsants, CGRP inhibitors)
• Abortive medications (e.g. triptans, NSAIDs)
• Botulinum toxin injections every 12 weeks

While medications and Botox can reduce headache frequency, they often fall short in addressing underlying musculoskeletal and neurovascular dysfunction.

Our Integrative Treatment Model

We blend neurologic, orthopedic, and regenerative therapies into a unified treatment strategy. Our protocol includes:

Dry Needling

Targeted myofascial trigger point needling helps release muscular tension in the cervical spine, suboccipital region, temporalis, and masseter muscles. This reduces nociceptive input from hyperactive muscles and improves neural glide.

Strengthening and Manual Therapy

Migraine patients often show cervical instability, poor scapular control, and upper cervical joint restrictions. Our rehabilitation team addresses these biomechanical deficits through cervical deep flexor activation, postural correction, joint mobilizations, and thoracic spine mobility restoration.

Class IV Laser Therapy

High-intensity laser therapy enhances blood flow, reduces inflammation, and promotes tissue recovery in deep cervical and cranial tissues. It modulates pain signaling through photobiomodulation without any systemic effects.

Pulsed Electromagnetic Field (PEMF) Therapy

PEMF therapy improves mitochondrial function, oxygen delivery, and neurovascular regulation. It is particularly effective for patients with autonomic dysregulation and fatigue, often seen in chronic migraine syndromes.

Medication Management and Nutritional Optimization

While we aim to reduce reliance on medications, we carefully manage:

• Rescue medications for acute attacks
• Preventive agents when necessary
• Supplementation with magnesium, riboflavin, coenzyme Q10, and omega-3s
• Elimination of triggers through dietary tracking and metabolic testing

Why Our Approach Works

Migraine is a systems-level disorder involving vascular, neurological, musculoskeletal, and inflammatory mechanisms. By only targeting one aspect, like neuromuscular blockade with Botox, you may reduce symptom frequency, but not address the perpetuating drivers.

Our protocol:

• Improves musculoskeletal biomechanics that feed into migraine
• Enhances perfusion and autonomic balance through laser and PEMF
• Reduces peripheral and central sensitization
• Restores functional strength and posture
• Minimizes medication burden and side effects

We see the best results when these therapies are layered, not isolated.

Who Is This For?

This approach is ideal for:

- Patients who have failed or plateaued on medication alone

- Patients who want to reduce dependency on Botox or pharmaceuticals

- Individuals with overlapping neck pain, TMJ dysfunction, or postural headaches

- Athletes or professionals who require optimized neurologic performance without sedation or fogginess

Conclusion

Chronic migraines require more than just pills or periodic injections. A full-body, integrative approach that addresses the musculoskeletal system, nervous system, and cellular health can lead to better outcomes, fewer flare-ups, and a stronger sense of control. Let us help you build a treatment plan that goes beyond symptom suppression. Contact Us

References

Watson, D. H., & Drummond, P. D. (2014). Cervical referral of headache and its relationship to migraine: implications for diagnosis and treatment. Cephalalgia, 34(3), 233–243.

Calandre, E. P., et al. (2011). A pilot study of high-intensity laser therapy in the treatment of chronic migraine. Lasers in Medical Science, 26(5), 565–572.

Chow, R. T., et al. (2009). Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis. Lancet, 374(9705), 1897–1908.

Fisher, K., & Di Fabio, R. P. (1994). Cervical posture and isometric muscle endurance in asymptomatic subjects and patients with temporomandibular disorders. American Journal of Physical Medicine & Rehabilitation, 73(5), 283–289.