Tension Headache and Tension
June 18, 2009 by dean · Leave a Comment
The medical model of headache and migraine recognises two conditions – migraine and tension-type headache. Recently the International Headache Society introduced a third ‘group’ of headaches; this group comprises Cluster Headache, Chronic Paroxysmal Hemicrania, SUNCT, and Hemicrania Continua.
In this model, the assumption has been the pain of tension headache arises from increased tension in the muscles of the scalp and forehead. However research has shown:
- that tension in muscles of the scalp and forehead in tension headache sufferers during a headache is no different to controls
- increased tension in the muscles of the neck in tension headache sufferers when compared to controls
- improved performance of the muscles of the upper neck reduced the severity and frequency of tension headache significantly
Perhaps then tension headache is an unrecognised cervicogenic (neck) headache?
Cheers
Dean
(Bakal DA, Kaganov JA. Muscle Contraction and Migraine Headache: Psychophysiologic Comparison. Headache 1977;17(5):208215
Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders, 2nd edn. Cephalalgia 2004; 24(suppl.1):1-151
van Ettekoven H, Lucas C. Efficacy of physiotherapy including a craniocervical training programme for tension-type headache; a randomized clinical trial. Cephalalgia 2006; 26(8):983-91)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Does Your Headache or Migraine Swap Sides?
June 17, 2009 by dean · Leave a Comment
If headache/migraine swaps sides it is a neck headache
The traditional medical model of headache and migraine, describes one of the key diagnostic criteria for cervicogenic headache as being a side-locked headache – which means that it is always on the same side – never on the other.
I have news for you. Based on over 13000 hours clinical experience with headache and migraine sufferers, I can confidently say that if your headache or migraine swaps sides between attacks, or within the same attack, it is a cervicogenic headache! … and the problem lies with the C2-3 spinal segment.
Cheers Dean
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Blood Vessels and Migraine
June 11, 2009 by dean · Leave a Comment
Blood Vessels of the Neck and Brain
The medical model of headache and migraine recognizes two conditions – migraine and tension-type headache. Recently the International Headache Society introduced a third ‘group’ of headaches; this group comprises Cluster Headache, Chronic Paroxysmal Hemicrania, SUNCT, and Hemicrania Continua.
In this model, the pain of migraine is considered to be from dilating or expanding arteries inside the head – an assumption based largely on the nature of pain – a throbbing, pulsating pain.
However research has shown:
Blood vessel dilatation persists after head pain has resolved – if dilatation were the cause of the pain one would expect pain to be there if dilatation was present, but this is not the case.
Blood vessel dilatation is not present in all migraineurs during an attack – if it was the cause one would expect it to be present in all sufferers.
Blood vessel dilatation is estimated to be about nine percent – too small to cause the significant pain of migraine?
Pain leads to or causes dilatation, not dilatation first, followed by pain.
Clearly this body of research demonstrates that dilatation of arteries is not the cause of migraine pain – why is it then that some authorities and information sources perpetuate this assumption?
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
Tegeler CH, Davidai G, Gengo FM, Knappertz VA,Troost BT, Gabriel H, Davis RL. Middle cerebral artery velocity correlates with nitroglcerin-induced headache onset. J Neuroimaging 1996; 6(2): 81-6
Thomsen LL, Iverson HK, Olesen J. Cerebral bloodflow velocities are reduced during attacks of unilateral migraine without aura. Cephalalgia 1995; 15(2): 109-116
Thomsen LL. Investigations into the role of nitric oxide and the large intracranial arteries in migraine headache. Cephalalgia 1997; 17:873-95)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Welcome Headache and Migraine Sufferers
June 9, 2009 by dean · Leave a Comment
In 1991 I embarked on a path that was to become the greatest challenge of my life, establishing The Headache Clinic, www.headacheclinic.com.au, in Adelaide, South Australia, in 1991. The fundamental purpose of The Headache Clinic was and is determining whether or not a neck (cervicogenic) disorder is the cause of or a significant contributing factor to headache or migraine.
We are the sum of our experiences — and my unparalleled clinical experience (having consulted over 7000 headache and migraine patients – in excess of 28000 treatments – with a range of diagnoses) suggests that neck (cervicogenic) dysfunction is significantly underestimated and can be the cause of various forms of headache and migraine. I believe therefore, that, in the presence of negative medical tests, the necks of all (primary) headache and migraine sufferers should be examined, irrespective of the diagnosis. Whilst this challenges traditionally held medical beliefs, it is incumbent to not only pass on this experience to my colleagues and headache and migraine sufferers, but to support this experience with rigorous scientific research (I am currently a PhD Candidate investigating the role of cervicogenic dysfunction in the mechanism of migraine at Murdoch University, Western Australia).
It is irresponsible to treat irrelevant cervicogenic (neck) dysfunction in migraine and headache conditions. However given that the causes of migraine and tension headache are not clear, the advances in our knowledge of pain mechanisms and the not insignificant body research supporting cervicogenic factors as key players in the headache and migraine processes, it is also irresponsible not to examine the necks of headache sufferers irrespective of the diagnosis. How much longer do we accept the notion that ‘whilst we do not know what causes migraine it can’t come from the neck’?
Over the past 15 years I have developed a series of techniques, which, by way of temporary reproduction of headache and easing of the headache as a technique is sustained, confirm that a neck disorder is the cause of or a significant factor in the mechanism of the headache or migraine – this a key diagnostic criterion for cervicogenic or neck involvement in headache according to the International Headache Society – importantly for the disorder to be related to the headache or migraine process the headache has to ease as the technique is maintained. If both reproduction and lessening are not possible then the neck may not be the source of the headache or migraine. Furthermore my experience has shown that if the techniques are performed in a specific manner it is possible to determine which spinal segment is the cause of or contributing significantly to headache and migraine. Having determined which spinal segment (or segments — there may be more than one) is involved then this significantly increases the chance of the treatment being successful because treatment can be directed at specific, relevant spinal segments.
The application of these techniques in Europe, United Kingdom and Australia has become known as the ‘Watson Headache Approach’ and forms the basis of courses I present for physiotherapists, chiropractors and osteopaths in Australia, New Zealand, Hong Kong, Singapore, United Kingdom, Northern Ireland, Belgium, The Netherlands, Switzerland, Germany, Norway and Spain — refer www.headacheeducation.com and www.headacheandmigraine.com for International Practioner Directory.
The Watson Headache Institute was established to increase the awareness of cervicogenic (neck) disorders in headache and migraine by:
imparting my (and that of others) clinical experience and knowledge
and,
undertaking and supporting rigorous clinical and scientific research in this specialty.
Dean Watson
Consultant Headache and Migraine Physiotherapist; Adjunct Lecturer, Masters Program, School of Physiotherapy, University of South Australia; PhD Candidate, Murdoch University, Western Australia
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Practitioners
June 5, 2009 by dean · Leave a Comment
Although Physiotherapy, Chiropractic and Osteopathy are different disciplines, we are supporters of the idea that headache and migraine sufferers, no matter what their diagnoses, can be helped to live their lives more effectively through appropriate neck treatment. Because treatment of the does not fit the medical model of headache and migraine, the model has demonstrated little interest in exploring this as an option.
It is essential that all factors, which have the potential to sensitise the brainstem, be investigated equally. Currently this is not the situation.
This directory aims to provide headache and migraine sufferers with practitioners who have a particular interest in and are skilled in examination of the neck as a source of your headache or migraine – to create a more comprehensive approach. Be assured that if, on examination, no relevant disorders can be found, treatment will not be recommended. Relevancy is determined by temporary reproduction and lessening of headache as the examination technique is sustained.
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 Education
June 3, 2009 by dean · Leave a Comment
Appropriate up to date knowledge is self empowering
Appropriate and up-to-date knowledge is self-empowering; I believe that every headache and migraine sufferer has the right to know their headache and migraine diagnosis as precisely as possible (and what it means), to know the nature of their headache disorder, its outcome and possible types of treatment. What has yet to gain acceptance is my belief, supported by my unparalleled clinical experience and a significant body of international research, that it is incorrect to consider headache and migraine types as totally different entities. ‘Headache and Migraine Education’ is one of the aims of Watson Headache Institute – it is here that relevant, past and present research will be summarised and discussed…
Cheers Dean
(Afridi SK, Shields KG, Bhola R, Goadsby PJ. Greater occipital nerve injection in primary headache syndromes – prolonged effects from a single injection. Pain 2006; 122:126-9)
Anderson CD, Franks RA. Migraine and tension headache: is there a physiological difference? Headache 1981; 21:63-71
Cady R, Schreiber C, Farmer K, Sheftell F. Primary headaches: a convergence hypothesis. Headache 2002; 42:204-16
Featherstone HJ. Migraine and muscle contraction headaches: a continuum. Headache 1985; 25:194-198
Featherstone HJ. Migraine and muscle contraction headaches: a continuum. Headache 1985; 25:194-8
Marcus D, Scharff L, Mercer S, Turk D. Musculoskeletal abnormalities in chronic headache: a controlled comparison of headache diagnostic groups. Headache 1999; 39:21-27
Mercer S, Marcus DA, Nash J. Cervical musculoskeletal disorders in migraine and tension-type headache. Paper presented at the 68th Annual Meeting of the American Physical Therapy Association; 1993; Cincinatti, Ohio
Marcus DA. Migraine and tension-type headaches: the questionable validity of current classification systems. Clin J Pain 1992; 8:28-36
Nelson CF. The tension headache, migraine headache continuum: A hypothesis J Manipulative Physiol Ther 1994; 17:156-167
Vernon H, Steiman I, Hagino C. Cervicogenic dysfunction in muscle contraction headache and migraine: A descriptive study. J Manipulative Physiol Ther 1992; 15:418-429)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Introducing the Watson Headache Institute
June 1, 2009 by dean · Leave a Comment
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.We are the sum of our experiences — and my unparalleled clinical experience (having consulted over 7000 headache and migraine patients – in excess of 28000 treatments – with a range of diagnoses) suggests that neck (cervicogenic) dysfunction is significantly underestimated and can be the cause of various forms of headache and migraine. I believe therefore, that, in the presence of negative medical tests, the necks of all (primary) headache and migraine sufferers should be examined, irrespective of the diagnosis. Whilst this challenges traditionally held medical beliefs, it is incumbent to not only pass on this experience to my colleagues and headache and migraine sufferers, but to support this experience with rigorous scientific research (I am currently a PhD Candidate investigating the role of cervicogenic dysfunction in the mechanism of migraine at Murdoch University, Western Australia).
The Watson Headache Institute was established to increase the awareness of cervicogenic (neck) disorders in headache and migraine by imparting my (and that of others) clinical experience and knowledge as well as undertaking and supporting rigorous clinical and scientific research in this speciality.
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.