Pain & functional symptoms

Taking a functional look at migraine: distinguishing inflow and outflow specifically

Tino Both · 20 May 2026 · 7 min read

Briefly explained: In my work with Angewandte Neurofunktion, inflow and outflow at the head are separate autonomic assessment areas. I use them to explore functional response patterns, rather than ‘circulation’ in general. Migraine cannot be reduced to narrowed blood vessels or blocked outflow. What matters is which question proves helpful in the individual comparison.

Would you like an additional, closer look at your migraine situation?In the free initial telephone consultation, we clarify the diagnosis and care already in place and which difficulties occur between attacks. This establishes whether a functional approach in Vilshofen could be a useful addition.

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Migraine is recognised – and questions still remain

The attacks have a name. You may also know typical triggers and have treatment agreed with your doctor. You still want to understand why your neck also holds tension, visual demands quickly become tiring or your body feels less able to tolerate demands between attacks.

For me, this is where a different question from diagnosis begins: which specific function can we examine more closely? A notable head movement, a visual task or a recurring demanding situation can be a starting point. This does not mean that every such finding causes migraine. It initially enables an assessable comparison.

Why ‘migraine is a circulatory disorder’ is too simplistic

Migraine involves neuronal processes and interactions between the nervous system and blood vessels. The older idea that migraine simply results from blood vessels narrowing and then widening does not adequately explain the condition. A scientific review of the development of vascular theories of migraine describes this change in models.

In my work, this means I do not begin by assuming that something in the head must be ‘congested’. I keep different functional questions separate and compare their responses. Inflow and outflow relationships may be included, but they are not automatically the decisive pathway for every person.

Autonomic regulation and vascular mechanics are different questionsFor vascular mechanics in my testing system, the question concerns a mechanical-sensory relationship, for example during a particular movement. With autonomic inflow and outflow relationships I follow different combinations of contact and assigned regulation pathways. A finding in a mechanical assessment pathway therefore does not mean that blood flows less well – and an autonomic question is not replaced by the same test.

What I consider separately in inflow and outflow

Inflow: which assigned supply pathway is assessed?In my autonomic testing system, a head region can be combined with an arterial supply relationship. Depending on the question, different assignments are distinguished, such as anterior and posterior supply pathways. I do not reduce this to the single question ‘Is there a vessel-related finding?’.

Outflow: do not equate venous and lymphatic relationshipsWithin my method, I also distinguish different outflow assignments. A venous contact-based question differs from a lymphatic one. Describing both as ‘outflow’ does not make them interchangeable. What matters remains which combination shows a change in response in the same starting test.

Regulation: where does the test response change?Only afterwards do I look for a suitable addition. The methodological assessment pathway may, for example, compare assigned brainstem or ganglion levels. A ganglion is a collection of nerve cell bodies outside the central nervous system. The named level describes the direction of exploration in my contact-based assessment here, rather than a directly measured dysfunction of this nerve tissue.

A possible assessment example between two attacks

Suppose a person with medically assessed migraine notices between attacks that a particular head turn feels uncomfortably restricted. We select a tolerable version of this movement as the starting marker. Direction, posture and range remain the same in the later comparison. During an acute, highly distressing attack, such a test sequence would not be the priority.

1. Do not make the painful area the strength testI look for an indicator muscle that can be assessed without pain or a notable compensatory response. Its stable holding response forms the starting point. The head or relevant region is included as a reference, without repeatedly having to provoke the painful movement itself.

2. Make the autonomic question more preciseI combine the regional reference in turn with separate autonomic contact-based questions. Suppose the indicator muscle responds more weakly with the venous assignment, but not in the same way with the other assignments considered. I initially follow that assessment pathway. I do not jump to treating supposedly ‘narrow vessels’ or mix the result with vascular mechanics.

3. Look for a suitable integration stimulus through a counter-comparisonI then compare suitable additions. In this testing system, an integration stimulus assigned to the medulla – a section of the brainstem – might be considered, for example. The observation of interest would be: the original contact combination alone changes the holding response, while the same combination with the additional stimulus no longer does. I repeat the comparison under conditions that are as similar as possible, rather than treating one strong test as the final result.

4. Integrate and return to the starting pointI apply the suitable stimulus specifically for integration. I then assess whether the originally notable contact combination also receives a stable response without the additional help. Only afterwards do we repeat the head turn. Does the sensation of movement actually change? How does it remain on reassessment and in everyday life? These questions connect the methodological assessment pathway back to the person’s concern.

The example describes one possible test sequence, rather than a fixed process for every migraine. In another person, the same assessment may show no finding, while a visual task provides a much more useful starting point. This ability to distinguish between assessment pathways is particularly important to me.

What can be inferred from such a comparison

A more comfortable head turn would initially be a change in that movement. Whether the migraine burden also changes requires separate observation over time: headache days, intensity, accompanying symptoms, medication needs and restrictions in everyday life are much more informative than a single appointment.

I do not measure actual blood flow through contact-based assessments. If vascular disease or an outflow disorder is suspected, suitable medical diagnostics are required. The particular depth of my functional work lies in structured comparison of questions and responses, rather than replacing such a measurement.

What you can bring to an appointment

An existing headache diary, the medical assessment and your previous treatment plan help narrow down the concern. A specific everyday situation is equally useful: what remains difficult between attacks? Which demand causes problems early? What already helps reliably? You do not need to trigger symptoms deliberately.

Medicines or effective migraine prevention are not changed because of a functional test result. For a new, sudden, extremely severe headache attack, sudden paralysis or speech disturbance, call 112. New or markedly changed headaches and fever with neck stiffness require prompt medical assessment.

Frequently asked questions about migraine and inflow or outflow

Is migraine a sign of blocked outflow?No. Migraine is not a general diagnosis of a venous or lymphatic blockage. A corresponding contact relationship in my method is a functional question, rather than evidence of such a blockage.

Is this the same as assessing vascular mechanics in shoulder pain?No. In my work, a mechanical-sensory question during movement and an autonomic supply question are assessed differently. The shared term ‘vessel’ must not obscure this distinction.

Why are the eyes or neck also considered in migraine?Because specific tasks that burden everyday life may reveal difficulties there. A notable function is a reason to compare, rather than automatically the cause of attacks. Depending on the person, another approach may be more useful than the inflow and outflow question.

How would I notice whether the support benefits me?Through a course of change relevant to you: for example, better tolerance of an everyday task or fewer restrictions between attacks. Changes in migraine itself should be recorded over a longer period and considered in the context of your overall care.

A closer look begins with a specific questionIf you would like to complement your existing migraine care with an individual functional perspective, we can discuss a suitable starting point in an initial consultation. Without a blanket circulation explanation or a standard programme.

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