A New Technique Employing Direct Tactile Pressure on the common Carotid Artery to Relieve Acute Episode Attack of Migraine Headache: A Single-Arm Interventional Study

  • Farhad Tavakoli ORCID Brain and Spinal Cord Injury Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
  • Abbas Tafakhori ORCID Department of Neurology, Iranian Center of Neurological Research, Imam Khomeini Hospital Complex, Tehran, Iran
  • Jeyran Zebardast ORCID Institute for Cognitive Sciences Studies, Tehran, Iran
  • Zahid Hussain Khan ORCID Mail Department of Anesthesia and Critical Care, Imam Khomeini Medical Complex, Tehran University of Medical Sciences, Tehran, Iran
Carotid Artery, Common, Headache, Home Remedy, Migraine Disorders, Pain Management


Introduction: Migraine, is a common neurological disorder, and its pathology and acute treatment has not been determined so far. In the contemporary literature, there is no remedy that can abort an acute episode of migraine. Objective: We aimed to evaluate the effect of transient presser on the middle part of common carotid artery for terminating an acute attack of migraine headache. Methods: It is an interventional study without a control limb, performed on patients within age range of 18-45 years. Patients with established migraine headache based on International Classification of Headache Disorders (ICHD) guidelines, who had no atheromatous plaque in their common carotid arteries were included. Pain intensity was evaluated by Universal Pain Assessment Tools (UPAT). In safe position, applying vital signs monitoring and ipsilateral of headache, a gentle pressure was applied on the common carotid artery, lateral to the cricothyroid membrane and medial border of the Sterno-Cleido-Mastoid (SCM) muscle, by using both index and middle fingers, till the headache was relieved, following which the pressure was maintained for a period of 15 seconds. Then the middle finger was maintained at its position and the index finger slid caudally with the same pressure as far a distance of four centimeters and the pressure withdrawn slowly. After 2 minutes, patients were asked to report any change in headache which was recorded. Results: Totally, 215 patients entered this study. The mean of pain score before and after using the technique regarding to UPAT, was 6.28±1.34 and 0.4±0.64, respectively; Also, the pain decreases equal 5.88 score was significant, special by according sex (p<0.001). No side effect was seen. Conclusions: It seems that pressure on the common carotid artery and extending the pressure caudally, helped a rapid, safe and significant reduction in pain score for patients with acute attack of migraine headache.


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1. Levy D, Burstein R. The vascular theory of migraine: leave it or love it? Ann Neurol. 2011;69(4):600-1.
2. Tfelt-Hansen PC, Koehler PJ. History of the use of ergotamine and dihydroergotamine in migraine from 1906 and onward. Cephalalgia. 2008;28(8):877-86.
3. Silberstein SD, Hargreaves RJ. The History and Pharmacology of Ergotamine and Dihydroergotamine. InDrug Treatment of Migraine and Other Headaches 2000 (Vol. 17, pp. 52-65). Karger Publishers.
4. Tfelt-Hansen P, Saxena PR, Dahlöf C, Pascual J, Lainez M, Henry P, et al. Ergotamine in the acute treatment of migraine: a review and European consensus. Brain. 2000;123(1):9-18.
5. Diamond S, Bigal ME, Silberstein S, Loder E, Reed M, Lipton RB. Patterns of Diagnosis and Acute and Preventive Treatment for Migraine in the United States: Results from the American Migraine Prevalence and Prevention Study. Headache. 2007;47(3):355-63.
6. Binder WJ, Brin MF, Blitzer A, Schoenrock LD, Pogoda JM. Botulinum toxin type A (BOTOX) for treatment of migraine headaches: an open-label study. Otolaryngol Head Neck Surg. 2000;123(6):669-76.
7. Diener HC, Kronfeld K, Boewing G, Lungenhausen M, Maier C, Molsberger A, et al. Migraine Study Group. Efficacy of acupuncture for the prophylaxis of migraine: a multicentre randomised controlled clinical trial. Lancet Neurol. 2006;5(4):310-6.
8. Pfaffenrath V, Diener HC, Fischer M, Friede M, Henneicke‐von Zepelin HH. The efficacy and safety of Tanacetum parthenium (feverfew) in migraine prophylaxis—a double‐blind, multicentre, randomized placebo‐controlled dose–response study. Cephalalgia. 2002;22(7):523-32.
9. Kinfe TM, Pintea B, Muhammad S, Zaremba S, Roeske S, Simon BJ, et al. Cervical non-invasive vagus nerve stimulation (nVNS) for preventive and acute treatment of episodic and chronic migraine and migraine-associated sleep disturbance: preliminary findings from a prospective observational cohort study. J Headache Pain. 2015;16(1):101.
10. Grazzi L, Egeo G, Calhoun AH, McClure CK, Liebler E, Barbanti P. Non-invasive Vagus Nerve Stimulation (nVNS) as mini-prophylaxis for menstrual/menstrually related migraine: an open-label study. J Headache pain. 2016;17(1):91.
11. Shevel E. The extracranial vascular theory of migraine—a great story confirmed by the facts. Headache. 2011;51(3):409-17.
12. Olesen J. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, Asbtracts. Cephalalgia. 2018;38(1):1-211.
13. Pasquier M, Clair M, Pruvot E, Hugli O and Carron P-N. Carotid Sinus Massage. N Engl J Med. 2017;377(15):e21.
14. Stovner LJ, Hagen K, Jensen R, Katsarava Z, Lipton RB, Scher AI, et al. The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia. 2007;27(3):193-210.
15. Lipton RB, Stewart WF, Diamond S, Diamond ML, Reed M. Prevalence and burden of migraine in the United States: data from the American Migraine Study II. J Headache Pain. 2001;41(7):646-57.
16. Edmeads J, Mackell JA. The economic impact of migraine: an analysis of direct and indirect costs. Headache. 2002;42(6):501-9.
17. Kernick D. An introduction to the basic principles of health economics for those involved in the development and delivery of headache care. Cephalalgia. 2005;25(9):709-14.
18. Bigal ME, Kurth T, Santanello N, Buse D, Golden W, Robbins M, et al. Migraine and cardiovascular disease: a population-based study. Neurology. 2010;74(8):628-35.
19. De Hoon JN, Willigers JM, Troost J, Struijker-Boudier HA, Van Bortel LM. Cranial and peripheral interictal vascular changes in migraine patients. Cephalalgia. 2003;23(2):96-104.
20. Rocca MA, Ceccarelli A, Falini A, Colombo B, Tortorella P, Bernasconi L, et al. Brain gray matter changes in migraine patients with T2-visible lesions: a 3-T MRI study. Stroke. 2006;37(7):1765-70.
21. Spierings EL. Mechanism of migraine and action of antimigraine medications. Med Clin. 2001;85(4):943-58.
22. Bigal ME, Tepper SJ. Ergotamine and dihydroergotamine: a review. Curr Pain Headache Rep. 2003;7(1):55-62.
23. Amin FM, Asghar MS, Hougaard A, Hansen AE, Larsen VA, de Koning PJ, et al. Magnetic resonance angiography of intracranial and extracranial arteries in patients with spontaneous migraine without aura: a cross-sectional study. Lancet Neurol. 2013;12(5):454-61.
24. Burstein R, Blake P, Schain A, Perry C. Extracranial origin of headache. Curr Opin Neurol. 2017;30(3):263-71.
25. Marmura MJ, Silberstein SD and Schwedt TJ. The acute treatment of migraine in adults: The American Headache Society evidence assessment of migraine pharmacotherapies. J Headache Pain 2015;55(1):3-20.
26. Worthington I, Pringsheim T, Gawel MJ, Gladstone J, Cooper P, Dilli E, et al. Canadian Headache Society Guideline: acute drug therapy for migraine headache. Can J Neurol Sci. 2013;40(S3):S1-3.
27. Diener H-C, Charles A, Goadsby PJ, Holle D. New therapeutic approaches for the prevention and treatment of migraine. Lancet Neurol. 2015;14(10):1010-22.
28. Sabovchyk AY, Oros M. Migraine and tension cephalalgia. Int J Neurol Neurother. 2018;5(99):61-7.
29. Ferrari MD, Roon KI, Lipton RB, Goadsby PJ. Oral triptans (serotonin 5-HT1B/1D agonists) in acute migraine treatment: a meta-analysis of 53 trials. Lancet. 2001;358(9294):1668-75.
30. Gallagher R, Kunkel R. Migraine patient concerns affecting compliance: results from the NHF survey. Headache. 2003;43:36-43.
31. Jamieson DG. The safety of triptans in the treatment of patients with migraine. Am J Med Sci. 2002; 112(2):135-40.
32. Shevel E. The role of the external carotid vasculature in migraine. Migraine Disorders Research Trends New York: Nova Science Publishers. 2007:165-82.
33. Drummond PD. Motion sickness and migraine: optokinetic stimulation increases scalp tenderness, pain sensitivity in the fingers and photophobia. Cephalalgia. 2002;22(2):117-24.
34. Hmaidan Y, Cianchetti C. Effectiveness of a prolonged compression of scalp arteries on migraine attacks. J Neurol. 2006;253(6):811-2.
35. Iversen HK. Human migraine models. Cephalalgia. 2001;21(7):781-5.
36. Schröer FJ, inventor; Schroeer Frederikus Johannes, assignee. Pressure application device and method for ameliorating migraine headache. United States patent US 6,638,295. 2003 Oct 28.
37. Goadsby P, Grosberg B, Mauskop A, Cady R, Simmons K. Effect of noninvasive vagus nerve stimulation on acute migraine: an open-label pilot study. Cephalalgia. 2014;34(12):986-93.
38. Hord ED, Evans MS, Mueed S, Adamolekun B, Naritoku DK. The effect of vagus nerve stimulation on migraines. J Pain. 2003;4(9):530-4.
39. Hulsey DR, Riley JR, Loerwald KW, Rennaker RL, Kilgard MP, Hays SA. Parametric characterization of neural activity in the locus coeruleus in response to vagus nerve stimulation. Exp Neurol. 2017;289:21-30.
40. Pertovaara A, Almeida A. Descending inhibitory systems. InHandbook of clinical neurology 2006 Jan 1 (Vol. 81, pp. 179-192). Elsevier.
41. Moulton EA, Becerra L, Johnson A, Burstein R, Borsook D. Altered hypothalamic functional connectivity with autonomic circuits and the locus coeruleus in migraine. PloSone. 2014;9(4):e95508.
How to Cite
Tavakoli F, Tafakhori A, Zebardast J, Hussain Khan Z. A New Technique Employing Direct Tactile Pressure on the common Carotid Artery to Relieve Acute Episode Attack of Migraine Headache: A Single-Arm Interventional Study. Adv J Emerg Med.
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