Exercise, Serotonin, Headache and Migraine
June 30, 2009 by dean · Leave a Comment
Reducing migraine and the need for medication with regular activity
Recent research from Sweden, published in Headache: The Journal of Head and Face Pain, states regular activity can reduce the number of migraines, the intensity of migraines and the need for pain medication.
This supports Norwegian research which found that people who don’t exercise are 14 percent more likely to experience headache.
Why is it that these findings are met with surprise in some circles? This is not rocket science! The Brainstems in migraine sufferers are sensitised and exercise increases the production of serotonin. Serotinin desensitises the brainstem.
However some headache and migraine sufferers avoid exercise because it may trigger an attack – the challenge is to find a form of exercise which does not …. stay tuned!
Cheers
Dean
(Katsavara Z, Giffin N, Diener HC, Kaube H. Abnormal habituation of ‘nociceptive’ blink reflex in migraine – evidence for increased excitability of trigeminal nociception. Cephalalgia 2003; 23:814-819
Katsavara Z, Lehnerdt G, Duda B, Ellrich J, Diener HC, Kaube H. Sensitization of trigeminal nociception specific for migraine but not pain of sinusitis. Neurology 2002; 59:1450-1453
Kaube H, Katasavara Z, Przywara S, Drepper J, Ellrich J, Diener HC. Acute migraine headache. Possible sensitization of neurons in the spinal trigeminal nucleus? Neurology 2002; 58:1234-1238
Koseoglu E, Akboyraz A, Soyuer A, Ersoy AO. Aerobic exercise and plasma beta endorphin levels in patients with migrainous headache without aura. Cephalalgia 2003; 23:972–6.
Kumar KK. Exercise for prophylaxis of migraine. Headache 1988; 28:228)
Lockett DM, Campbell JF. The effects of aerobic exercise on migraine. Headache 1992; 32:50–4.
Narin SO, Pinar L, Erbas D, Ozturk V, Idiman F. The effects of exercise and exercise-related changes in blood nitric oxide level on migraine headache. Clin Rehabil 2003; 17:624–30.
Sandrini G, Cecchini AB, Milanov I, Tassorelli C, Buzzi MG, Nappi G. Electrophysiological evidence for trigeminal neuron sensitisation in patients with migraine. Neurosci Lett 2002; 317:135-138
Varkey E, Cider A,Carlsson J, Linde M. Study to Evaluate the Feasibility of an Aerobic Exercise Program in Patients With Migraine. Headache 2009;49:563-570
Varkey E, Hagen K, Zwart J-A & Linde M. Physical activity and headache: results from the Nord-Trøndelag Health Study (HUNT). Cephalalgia 2008; 28:1292–1297.)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Migraine and Cervicogenic Headache
June 29, 2009 by dean · Leave a Comment
Whilst teaching in the UK recently I had the privilege of attending a Headache and Migraine Clinic at one of the major teaching hospitals in London.
The consultant neurologist and I examined nine migraine sufferers and I was able to temporarily reproduce their migraine pain, and furthermore this pain lessened as I maintained the technique.
This in my experience confirms significant cervicogenic (neck) involvement and according to The International Headache Society is a key diagnostic feature of cervicogenic headache. The conclusion of the consultant neurologist was that these patients had cervicogenic headache as well as migraine!
Why can’t cervicogenic (neck) disorders be the cause of the key feature of migraine – a sensitised brainstem? The answer I am constantly given …. “whilst we don’t know where migraine comes from it can’t come from the neck.” This is not a particularly useful answer ….
Cheers
Dean
(Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders, 2nd edn. Cephalalgia 2004; 24(suppl.1):1-151
Sjaastad O, Fredricksen TA, Pfaffenrath V. Cervicogenic headache: diagnostic criteria. Headache 1998; 38:442-5)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Headache and Migraine Treatment and the ‘Watson Headache Approach’
June 28, 2009 by dean · Leave a Comment
Further to the article in ‘Frontline’ and in reference to the approach I have developed it is important to clarify that whilst my approach does include a series of techniques which restore movement and maintain natural posture of the upper cervical spine, and whilst they are powerful, they are a small part of what I have developed.
My clinical experience of over 21000 hours with headache and migraine sufferers has demonstrated that neck disorders, as the cause of sensitisation, are significantly underestimated in migraine, tension and cluster headache, menstrual migraine…. sufferers.
There are many ways to treating headache and migraine. My approach is a powerful treatment tool if chosen by Practitioners. What I am primarily passionate about is that many of you are suffering unnecessarily because your necks have not been examined comprehensively and this is the main thrust of my approach.
It is about identifying whether your neck is the source of your headache or migraine before you commence treatment.
How much longer are we to accept the explanation that … “whilst we don’t know where migraine comes from it can’t come from neck disorders” … it is irresponsible, after other investigations have ruled out other causes, for the neck not to be examined. Information from the neck is one of four systems that has the potential to potential to sensitise the brainstem – the feature (sensitisation) that is evident in the common forms of headache and migraine.
Cheers
Dean
(Hunt L. When headache is a pain in the neck. Frontline 2009 17 June; 22-25)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Headache and Migraine Article in Frontline
June 27, 2009 by dean · Leave a Comment
In the recent ‘Frontline’ journal (which is the official journal of the Chartered Society of Physiotherapists in the UK) an article was published which discussed my approach and also the clinical trial being conducted by Dr Ian Davidson at the University of Manchester. The trial is investigating the effectiveness of my approach in migraine sufferers.
One of the participants of the trial, Sonja Lord, reported dramatic results describing “I feel like I’ve had a spring clean in my head. Colours are really vibrant.” Ms Lord had had years of medication and dietary advice without success. This is a story I hear all too often – if other approaches have failed and your neck has not been examined for relevant disorders (unlike Sonja’s), then your painful journey may continue when it need not.
Cheers
Dean
(Hunt L. When headache is a pain in the neck. Frontline 2009 17 June; 22-25)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Migraine and the University of Manchester (UK) Study
June 26, 2009 by dean · Leave a Comment
Dr Ian Davidson, University of Manchester (UK), is conducting a clinical trial involving over 100 migraine sufferers. This trial is investigating the outcomes of treatment using the approach I have developed.
Whilst the study began recruiting in April 2007, the results of the trial will not be known for at least 12 months – as you can imagine I am observing with keen interest!
Cheers
Dean
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Cluster Headache, Migraine and Tension Headache are related – more evidence ….
June 25, 2009 by dean · Leave a Comment
The brainstem sits at the bottom of the brain
Clinical correspondence in the latest Cephalalgia journal reports the presence of ‘cutaneous allodynia’ in two cluster headache patients.
What is cutaneous allodynia? Cutaneous (relating to or affecting the skin) allodynia (is a painful response to a normally non painful stimulus) so in this case there is a heightened, painful sensitivity to touch. This increased sensitivity to touch, along with other symptoms for e.g. photo-phobia (heightened sensitivity to light) and phono-phobia (heightened sensitivity to sound) is a sign of sensitisation of the brainstem.
Research shows quite clearly that the brainstems of migraineurs and tension headache sufferers are also sensitised …. and what do the ‘triptans’ do? they desensitise the brainstem and that is why they are effective in alleviating the pain in migraine, tension and cluster headache – all three headaches originate from the same condition i.e. a sensitised brainstem.
Cheers
Dean
(Katsavara Z, Giffin N, Diener HC, Kaube H. Abnormal habituation of ‘nociceptive’ blink reflex in migraine – evidence for increased excitability of trigeminal nociception. Cephalalgia 2003; 23:814-819
Katsavara Z, Lehnerdt G, Duda B, Ellrich J, Diener HC, Kaube H. Sensitization of trigeminal nociception specific for migraine but not pain of sinusitis. Neurology 2002; 59:1450-1453
Kaube H, Katasavara Z, Przywara S, Drepper J, Ellrich J, Diener HC. Acute migraine headache. Possible sensitization of neurons in the spinal trigeminal nucleus? Neurology 2002; 58:1234-1238
Nardone R, Tezzon F. The trigemino-cervical reflex in tension-type headache. European Journal of Neurology 2003; 10(3):307-312
Nardone R et al Trigemino-Cervical Reflex Abnormalities in Patients with Migraine and Cluster Headache. Headache 2008; 48(4):578-585
Milanov I, Bogdanova D. Trigemino-cervical reflex in patients with headache. Cephalalgia 2003; 23:35-38
Riederer F, Selekler HM, Sandor PS, Wober C. Cutaneous allodynia during cluster headache attacks. Cephalalgia 2009;29:796-798
Sandrini G, Cecchini AB, Milanov I, Tassorelli C, Buzzi MG, Nappi G. Electrophysiological evidence for trigeminal neuron sensitisation in patients with migraine. Neurosci Lett 2002; 317:135-138)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Headache and Migraine Courses in Sydney
June 24, 2009 by dean · Leave a Comment
Ludo and Kate Straetemans (Principals of Narrabeen Sports Injury and Physiotherapy Clinic) have been hosting my Level I and Level II courses in Sydney for the past 10 years – Thanks Ludo and Kate!
I have just completed another successful course. Course registrations are currently being taken for a subsequent course in November 2009.
Cheers
Dean
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Headache and Migraine Courses in Spain
June 23, 2009 by dean · Leave a Comment
An evening of theory expertly translated as part of the Level I Course In Barcelona
Eighteen months ago, Pepe Guillart, of Fisio Sport in Valencia invited me to present to colleagues in Valencia. Both Level I and Level II courses have grown significantly since then, having just completed courses in both Valencia and Barcelona.
Pepe has not only translated my 100 page course manual and power point presentation, but also translates during my courses – Many Thanks Pepe! Pepe’s enthusiasm (and sense of humour) contribute to the success of my courses in Spain.
In 2010 courses are planned for Valencia, Barcelona, Alicante and the Canary Islands!
Ciao
Dean
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Tension Headache, Migraine and Cluster Headache
June 22, 2009 by dean · Leave a Comment
The research clearly shows that the brainstems in tension headache sufferers and migraineurs are sensitised. One of the signs of sensitisation of the brainstem is ‘allodynia’ and therefore is present in tension headache and migraine patients.
What is ‘allodynia’? ‘Allodynia’ refers to excessive tenderness to physical pressure or touch.
Recent, interesting and exciting research has shown that cluster headache sufferers, also present with ‘allodynia’ – suggesting that those who endure cluster headache have sensitised brainstems. This, along with the fact that the ‘triptans’ are also effective in eliminating cluster headache, supports those authorities who suggest that the various types of headache and migraine originate from one condition or disorder – a sensitised brainstem.
Cheers
Dean
(Ashkenazi A, YoungWB. Dynamic mechanical (brush) allodynia in cluster headache. Headache 2004;44:1010-1012.
Katsavara Z, Giffin N, Diener HC, Kaube H. Abnormal habituation of ‘nociceptive’ blink reflex in migraine – evidence for increased excitability of trigeminal nociception. Cephalalgia 2003; 23:814-819
Katsavara Z, Lehnerdt G, Duda B, Ellrich J, Diener HC, Kaube H. Sensitization of trigeminal nociception specific for migraine but not pain of sinusitis. Neurology 2002; 59:1450-1453
Kaube H, Katasavara Z, Przywara S, Drepper J, Ellrich J, Diener HC. Acute migraine headache. Possible sensitization of neurons in the spinal trigeminal nucleus? Neurology 2002; 58:1234-1238
Milanov I, Bogdanova D. Trigemino-cervical reflex in patients with headache. Cephalalgia 2003; 23:35-38
Nardone R, Tezzon F. The trigemino-cervical reflex in tension-type headache. European Journal of Neurology 2003; 10(3):307-312
Nardone R et al Trigemino-Cervical Reflex Abnormalities in Patients with Migraine and Cluster Headache. Headache 2008; 48(4):578-585
Riederer F, Selekler HM, Sandor PS, Wober C. Cutaneous allodynia during cluster headache attacks. Cephalalgia 2009; 29:796–798
Rozen TD, Haynes GV, Saper JR, SheftellFD. Abrupt onset and termination of cutaneous allodynia (central sensitization) during attacks of SUNCT. Headache 2005;45:153-155
Sandrini G, Cecchini AB, Milanov I, Tassorelli C, Buzzi MG, Nappi G. Electrophysiological evidence for trigeminal neuron sensitisation in patients with migraine. Neurosci Lett 2002; 317:135-138)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
‘Triptans’, Hormones, and Menstrual Migraine.
June 21, 2009 by dean · Leave a Comment
The ‘triptans’ are effective in relieving menstrual migraine
The ‘triptans’ are effective in relieving menstrual migraine – how (?) – isn’t menstrual migraine caused by hormones – specifically a drop in oestrogen? Research showing that hormonal patterns and fluctuations are no different in women suffering menstrual migraine from those who don’t, suggests that this is not the case, and has prompted some authorities to suggest that there is an underlying disorder in the central nervous system. Managing menstrual migraine by artificially controlling normal hormonal fluctuations, therefore, whilst helping to ease symptoms in some women, is not addressing the underlying problem.
Could it be that the underlying problem is a sensitised brainstem (?) – after all the ‘triptans’ desensitise the brainstem.
Cheers
Dean
(Hoskin KL, Kaube H, Goadsby PJ. Sumatriptan can inhibit trigeminal afferents by an exclusively neural mechanism. Brain1996; 119:1419-28
Loder E. Menstrual migraine. Curr Treat Options Neurol 2001 Mar;3(2):189-200
Mannix LK, Files JA. The use of triptans in the management of menstrual migraine. CNS Drugs 2005;19(11): 951-72
Martin VT, Behbehani M. Ovarian hormones and migraine headache: understanding mechanisms and patohogenesis – part 2. Headache 2006;46:365-386
Varlibas A, Erdemoglu Ak. Altered trigeminal system excitability in menstrual migraine patients. The Journal of Headache and Pain 2009; 10(4):277-282)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.