Migraine Experts in York, PA

Treat All 4 Factors of Migraine, Rather Than Mask the Symptoms or Treat 1 Thing at a Time.


Dr. Adam Harcourt is one of the leading doctors worldwide on migraine. Author of ‘Mastering Migraine’, over the years Dr. Harcourt has developed his migraine program to treat each of the 4 main factors of migraine: Hormonal, Nutritional, Musculoskeletal and Neurological. Most patients tell us that their biggest challenge prior to finding our program was finding a team of doctors to properly and appropriately address each of these factors simultaneously. Patients find that most doctors are in their own lane and that it can be difficult to coordinate multiple different practitioners and get them all on the same page. Our program aims to move you down the spectrum of migraine from having them often, to as little as possible and get you long-lasting results by putting you in control of migraine, rather than having migraine control you.

Dr. Adam Harcourt, Author of Mastering Migraine

The 4 Main Factors of Migraine by Dr. Adam Harcourt

I’ve been treating and researching migraine for years. What I’ve found is that most of the research about migraine actually already exists. However, no one had put all the research together and come up with an overall explanation or treatment for migraine. This is what I’ve spent the last decade doing.

Based on my research and experience, I’ve simplified the explanation of migraine to these 4 main factors:
1. Hormonal
2. Nutritional
3. Musculoskeletal
4. Neurological

Migraine is a genetic condition, an altered brain state. When the stress of these 4 main factors becomes too much, a migraine occurs. If you’re familiar with my ‘Bucket Theory’ (see below), you know that most migraine patients have a small bucket, and some so extremely small that any amount of stress from these 4 factors causes a migraine. This shrinking of the the bucket over time is what causes progression to chronic migraine.

Addressing the 4th factor, the Neurological factor, is how we make the bucket bigger. We examine to identify the part of the brain that is causing migraine to occur in your case, and provide specific, customized brain therapies to strengthen this area. This allows you to be able to handle a higher amount of stress before a migraine occurs.

By also addressing the hormonal, musculoskeletal and nutritional factors, we are able to correct all 4 factors of migraine and push you as far down the migraine spectrum as possible. With most patients, we see the intensity and frequency of migraine diminish significantly.

1. The Hormonal Factor

The hormonal correlation with migraine has been pretty well known for awhile, but what to do about hormones in migraine is still an ongoing area of debate. Many of our patients had been prescribed birth control or hormone replacement therapies (HRT) by other doctors, which can be helpful in some cases. Unfortunately, there is also research about the long-term effects of some of these treatments which indicate they may lead to other health complications down the line. Many female patients report that they have a flare up in symptoms around the beginning of their cycle, which is why estrogen is often prescribed. I find that estrogen being low or needing to be supplemented is usually part of a bigger problem. Many migraine patients seem to have an increased response to stress and the estrogen changes are more as a consequence of sex hormonal resources being shunted over to stress hormones. This is why we prefer to take a ‘top down’ approach when looking at hormones and also run a comprehensive hormonal panel to see what might be causing the issues. While hormones don’t cause migraine, they play a big role and will make someone much more likely to have a migraine if they are dysfunctional.

2. The Nutritional Factor

A healthy diet and removal of common ‘triggers’ is essential for proper migraine treatment. However, many of my patients have tried just about every diet for migraine and will report that they didn’t help out. This is much more common than you would expect. This is why it’s important to understand that nutritional changes won’t cause or cure migraine, but they are a piece of the puzzle. Some patients have an extreme response to certain foods, histamine responses and/or cross-reactivities, so making these seemingly simple changes may drastically improve their migraine days and intensity. However, if dietary triggers aren’t a big contributor to another patient, they can try every diet and supplement under the sun without seeing much of a change. This is why we focus on not only looking at the current research on migraine and diet, but also blood sugar and other common factors that make people more likely to avoid migraine. The nutritional edits are never meant as a cure-all, but as a baseline so we don’t miss something simple that is slowing down or impeding progress. So if you’re one of those people that has tried every diet, just remember it’s only one piece of the puzzle and there is much more to migraine that needs to addressed. 

3. The Musculoskeletal Factor

Any increased physical stress on the body will make a person more likely to have migraine. This is why the research shows positive outcomes for migraine with almost any body work type of therapy. There is good research for massage, acupuncture, chiropractic, and exercise. These are all great modalities, but the one thing they have in common is that they reduce the amount of musculoskeletal stress on the system. However, because any of these techniques can cause short-term inflammation, the initial effect may actually be an increase in symptoms. This is why it’s important to understand that something that seemed to have made you a little worse may not have been a bad treatment, it just may have been too much treatment at that time. Another consideration is that each of these modalities impacts the nervous system a little differently. The pathways stimulated by acupuncture are different than the ones stimulated by massage. So if you have migraine and your main neurological dysfunction is located in an area that is not impacted by massage, it might look like massage isn’t that helpful. Your friend that has migraine may have dysfunction in an area heavily impacted by massage, so they may see more of an improvement. This is why a thorough functional examination is so important to understanding which modality will be most beneficial.

4. The Neurological Factor

The neurological component has 2 aspects to consider. The first is the genetic predisposition to migraine. Migraineurs have an altered brain state that is different from people that don’t have migraine, even when they are not having any symptoms. The way this seems to present is through certain pools of neurons being more likely to fatigue or fail, leading to symptoms associated with migraine. For example, if your genetic predisposition is in an area associated with pain inhibition of the face, and that area fails, you’ll experience a migraine. If your predisposition is in the area associated with sight, you’ll have visual symptoms. If it is in the area associated with balance, you can experience dizziness. The underlying pathology is basically the same, it just impacts different parts of the brain and brainstem. Therefore, the basic idea behind the neurological component is to identify the areas of the brain that are functionally not as healthy as the others, and stimulate that part of the brain at an appropriate level. Too much stimulation can actually lead to a migraine, and too little won’t make much of an impact. This is why we use a graduate approach in which some people will be given a great amount of stimulation right away, and some get very little. The key is to continually strengthen these parts of the brain, and essentially ‘make the bucket bigger’.

The other aspect of the brain has to do with injury and general neurological dysfunction. It is very common, for example, to see someone who gets in a car accident or has had a concussion to have a noticeable increase in migraines. It’s not that these injuries caused migraine, but the stress on the brain and nervous system makes them more likely to have migraine. This can also happen with vestibular imbalances, difficulty with eye or head movements, or difficulty with motion. Improving any of these aspects will help move you down the spectrum of migraine to have less and less.

Dr. Harcourt’s Bucket Theory

Picture the part of your brain that allows migraine to occur as a bucket. All migraine patients have different size buckets – some very small and some larger. The smaller the bucket, the faster it will fill up with stress and triggers and overflow into a migraine. One of the goals of our migraine program is to make your bucket as big as possible. This will allow you to be able to handle a lot more stressors without your bucket overflowing and causing a migraine. We do this with neurological rehabilitation, peripheral nerve stimulation, gaze stability exercises, vestibular rehabilitation, manual therapies, eye-head tracking exercises, and/or peripheral vision training. The bucket can also be in different parts of the brain, which is why different treatments are effective for different patients. 

Low-Level Laser Therapy (LLLT) and Migraine

There are over 9,000 papers published on LLLT and new research shows that patients who receive LLLT for migraine have similar outcomes to those undergoing treatment involving toxic injections 💉 Our lasers are FDA approved and we’ve been utilizing this therapy in our offices for both the prevention and abortion of migraine.

LLLT precisely targets areas of the brain, reduces inflammation while promoting bio-stimulation at a cellular level in the areas of the symptoms’ origination. LLLT does not produce heat and is completely painless. It works great with or without other treatments, but combined with our other treatments, it is a very powerful treatment for your brain.

Targeted Relief: Unlike invasive surgery, botox or prescription medications that can have harmful side effects on other organs in the body, LLLT’s ability to precisely target and treat brain centers means the only action that occurs during treatment is the painless bio-stimulation of the affected areas.

Obvious Choice: At most facilities that offer LLLT, you’d be paying just for that alone. At our offices, we don’t charge extra for LLLT! When combined with our migraine program, you get LLLT on-the-house. Our #1 goal is to get you feeling great again as quickly as possible using the most state-of-the-art treatments available.

What Type of Migraine Patient is a Good Candidate for our Program?

The reason that our ideal migraine patient has 4 or more migraines per month is because this is the point where we typically see the migraines progress. The patients who tend to progress to chronic migraine status started at 1-2 migraines per month, have progressed to 4-5 per month, and eventually end up continuing to gradually progress to the point that they have migraines every day.  Obviously, there is more room for improvement for a patient having migraines every day versus one having a migraine once per week. However, we will see a patient who has less than 4 migraines per month and can also provide them proper treatment and relief, as well as prevent their migraines from progressing toward chronic.

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