Hemicrania Continua and Cervicogenic (neck-related) Headache – Are They The Same Condition?
August 31, 2009 by dean · Leave a Comment
Interesting to note a case study reporting that the head pain of a patient suffering hemicrania continua was temporarily reproduced and resolved by neck movements and later by blocking or injecting the greater occipital nerve. These two features are key diagnostic signs of cervicogenic or neck related headache and indeed this respected researcher concludes this.
Cheers
Dean
(Rothbart P. Unilateral Headache with Features of Hemicrania Continua and Cervicogenic Headache – A Case Report. Headache 1992;(32)9;459-60)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Migraine and Headache After Trauma – Post Traumatic Headache (PTH)
August 30, 2009 by dean · Leave a Comment
MRI results are used to reveal abnormalities after trauma
Headache is the most common symptom after a head injury. Post traumatic headaches, like non traumatic migraine and tension headache for some reason pose a significant challenge for clinicians and are surrounded by controversy. Because the neurological examination after mild head injury is normal and standard tests as well as imaging studies (such as MRI or CT of the head) fail to reveal abnormalities, it is often thought that the symptoms following mild head injury are psychological.
Why is it then that in the presence of any abnormal findings the focus on the head continues?
It is important that after a blow to the head an intracranial (within the head) cause of headache or migraine be ruled out. However once an intracranial cause has been eliminated, why then does the source of the headache or migraine become such a mystery?
If the head hits the windscreen for example, the body keeps moving; it is the neck which connects the head to a moving body and absorbs a significant amount of stress.
It is very important then that a skilled examination of the upper three spinal segments be performed and that prior to examination of the upper neck, assessment of crucial ligaments be undertaken – this is mandatory.
An examination of this nature may prevent years of frustration and unnecessary medication.
Cheers
Dean
(Packard RC. Chronic Post-traumatic headache: Associations with mild traumatic brain injury, concussion, and post-concussive disorder. Current Pain and Headache Reports 2008; (12)1:67-73
Treleaven J, Jull G, Atkinson L. Cervical musculoskeletal dysfunction in post-concussional headache. Cephalalgia 1994;14:273-9)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Hemicrania Continua – What Is It?
August 29, 2009 by dean · Leave a Comment
I have mentioned Hemicrania Continua a few times in my blogs assuming that you are familiar with this condition.
Hemicrania Continua is a headache characterised by constant pain on one side of the head (and always on the same side), of moderate severity, with episodes of aggravation. Hemicrania responds to the medication known as Indomethacin.
Hemicrania Continua is included (along with Cluster headache, Chronic Paroxysmal Hemicrania, and SUNCT) in the third primary group of headache classified by the International headache Society.
As with all of the headache and migraine types, Hemicrania Continua is based on a set of signs and symptoms with no indication as to the cause.
Cheers
Dean
(Peres MFP, Siow HC, Rozen TD. Hemicrania continua with aura. Cephalalgia 2002;22:246-248)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Neck X-Rays, Headache and Migraine
August 28, 2009 by dean · Leave a Comment
Neck X-Ray
Generally routine neck xrays are uninformative for headache or migraine sufferers. However, this does not exclude neck disorders as the source of headache or migraine.
Therefore xrays as a form of diagnosis are not highly regarded. Nevertheless it is very important that neck xrays be undertaken in the event of any significant head or neck trauma or injury.
It is information from structures supplied by the upper three cervical nerves which have access to the brainstem and therefore the potential to sensitise the brainstem. Consequently abnormalities seen on neck xrays, involving spinal segments below C3 (third cervical vertebra) are likely to be irrelevant. This is why it is crucial that when having a CT or MRI scan of your neck for headache that the upper 3 spinal segments are included.
Degenerative changes or spondylosis of C5-6 for example is irrelevant to the sensitisation process; information from this level does not have direct access to the brainstem.
Cheers
Dean
(Goldhammer L. Second cervical root neurofibroma and ipsilateral migraine headache. Cephalalgia 1993; 13:132
Jansen J, Markakis E, Rama B, Hildebrandt J. Hemicranial attacks or permanent hemicrania – a sequel of upper cervical root compression. Cephalalgia 1989; 9:123-30
Ward TN, Levine M. Headache caused by a spinal cord stimulator in the upper cervical spine. Headache 2000; 40:689-91)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Migraine, Headache And The Brainstem
August 27, 2009 by dean · Leave a Comment
There is clear clinical and experimental evidence that the BRAINSTEM plays a pivotal role in the migraine process.
Migraine and headache are conditions in which normal light is unpleasant, normal sound uncomfortable, and where there is an abnormal interpretation of activity – one in which normal pulsing of arteries is felt as pain.
Information from the visual and auditory systems along with activity of structures from inside the head are transmitted through the brainstem to the cortex where it is interpreted – it seems as though the cortex is misled by a sensitised or hyper excitable brainstem.
The key to successful treatment is determining the source of the sensitisation of the brainstem – information from neck disorders is neglected by traditional medicine as a potential source. Whilst it is important and responsible that other possibilities be investigated, given the clinical and experimental evidence, it is irresponsible that the neck not be considered.
Cheers
Dean
(Goadsby PJ. Migraine pathophysiology: The brainstem governs the cortex. Cephalalgia 2003;23:565-566
Knight Y. Brainstem modulation of caudal trigeminal nucleus: A model for understanding migraine biology and future drug targets. Headache Currents 2005 Vol. 2, No. 5:108-118)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Exertional Headache, Migraine and the Neck
August 26, 2009 by dean · Leave a Comment
"Exertional Headache"
‘Benign’ (or harmless) Exertional Headache is defined as headache caused by exertion such as coughing, sneezing, bending, heavy lifting, running (how is this different to headache triggered by exercise?) or when straining at stool.
It is important that if your headache history is less than 3 months and is triggered or aggravated by these activities that you consult you doctor.
These activities create similar effects on the body as do the Valsalva manoeuvers.
Recent research1 found a wide range of symptoms in Exertional Headache, some with migrainous symptoms, and the authors suggested that the ‘triptans’ might be useful. As usual there is a lot of discussion as to the actual mechanism of Exertional Headache and indeed Exercise Induced Headache, but the causes remain unknown – why?
The Valsalva manoeuver is used (and has been for years) to identify problems or injury in the nerves of the cervical spine. Upon the exertion of pressure, pain may be felt, and may indicate increased pressure on the C2-3 intervertebral disc or other part of a cervicogenic (neck) disorder.
Clearly increased headache or headache or migraine triggered by exertion or exercise is likely to be caused by a neck disorder.
Cheers
Dean
(Chen S-P, Fuh J-L, Lu S-R, Wang S-J. Exertional headache – a survey of 1963 adolescents. Cephalalgia 2008; 29:401-407
Johnson RH, Smith AC, Spalding JM (February 1969). “Blood pressure response to standing and to Valsalva’s manoeuvre: independence of the two mechanisms in neurological diseases including cervical cord lesions”. Clin Sci 36 (1): 77–86)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Headache and Migraine Causes
August 25, 2009 by dean · Leave a Comment
The recent research has shown convincingly that migraine and headache is underpinned by sensitisation of the brainstem or central sensitisation.
One of the potential sources of senstisation of the brainstem is abnormal information from a disorders of structures within the head, structures which are supplied by the trigeminal nerve. It is then interesting to find that headache persists after blocking information carried by the trigeminal nerve. This clearly demonstrates that headache or migraine can come from other sources, for example neck disorders, and that the triptans act on structures other than in the head to ease headache or migraine … a sensitised brainstem … sensitised from another source … perhaps a neck disorder?
This can be easily confirmed by a skilled examination of the upper neck structures.
Cheers
Dean
(Matharu MS, Goadsby PJ. Persistence of attacks of cluster headache after trigeminal nerve root resection. Brain 2002;125(pt5):976-984)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Triptans, Migraine and Menstrual Migraine – Further Evidence That Hormones Are Not The Cause!
August 24, 2009 by dean · Leave a Comment
Photophobia means sensitivity to light
Interesting to note that a recent study when reviewing migraine-associated characteristics including aura, allodynia-associated (excessive tenderness to touch) symptoms, photophobia (sensitivity to light), phonophobia (sensitivity to noise), and nausea were similar for both menstrual migraine and non menstrual migraine sufferers.
Furthermore the triptans were equally effective for both menstrual related migraine and non menstrual migraine patients.
I have also mentioned before, research which demonstrates that the triptans desensitise the brainstem – a case for sensitised brainstems in menstrual migraine sufferers.
Cheers
Dean
(Diamond ML, Cady RK, Mao L, Biondi DM, Finlayson G, Greenberg SJ, Wright P. Characteristics of migraine attacks and responses to almotriptan treatment: a comparison of menstrually related and nonmenstrually related migraines. Headache 2008 Feb;48(2):248-58)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Headache, Migraine and Auras
August 23, 2009 by dean · Leave a Comment
As I have mentioned previously, recent and substantial research demonstrates that the different types of headache and migraine develop from a common, shared disorder, and that this disorder is sensitisation of the brainstem.
Auras, which initially were thought to only accompany migraine and menstrual migraine, have now been reported in Cluster Headache and Hemicrania Continua, and provides further evidence that the various forms of headache and migraine are likely to originate from common disorder.
Cheers
Dean
(Bahra A, May A, Goadsby PJ. Cluster headache: a prospective clinical study with diagnostic implications. Neurology 2002;58:354-361
Peres MFP, Siow HC, Rozen TD. Hemicrania continua with aura. Cephalalgia 2002;22:246-248
Silberstein SD, Niknam R, Rozen TD, Young WB. Cluster headache with aura. Neurology 2000;54:219-221)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Migraine, Tension Headache, the Neck and Sensitisation of the Brainstem
August 22, 2009 by dean · Leave a Comment
Information from the neck - is a neck disorder relevant?
It is generally agreed and it has been demonstrated that the brainstems in migraineurs and tension headache sufferers are sensitised.
The brainstem is influenced by 4 systems:
information from structures inside the head – head scans which fortunately in over 95% of headache and migraine sufferers the scans are clear, will eliminate this factor
the diffuse noxious inhibitory control system – this is poorly understood, but it is the mechanism which acts when you hit your thumb with a hammer and your headache seems less painful – hardly an attractive treatment option!
the serotonin system – serotonin desensitises the brainstem – if there is not enough then the brainstem becomes sensitised – so it makes sense to optimise your production of serotonin – diet, exercise, sunlight and perhaps a L-tryptophan supplement (after checking with your doctor)
information from the neck – get your neck checked. Many of us have a neck disorder, but is it relevant? This can be determined by, when examining the neck, temporarily reproducing familiar head pain which lessens as the technique is sustained. In my 21000 hours of experience this occurs in over 90% of headache and migraine conditions. My approach as a diagnostic tool is unparalleled in the manual therapy area and is in accordance with the views of traditional medicine.
Why does it have to be complicated?
The last two systems are within your control – you can take steps to address these.
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
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
Jull G, Bogduk N, Marsland A. The accuracy of manual diagnosis for cervical zygapophyseal joint pain syndromes. Med J Aust. 1988 Mar 7;148(5):233-6
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
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
Sjaastad O, Fredricksen TA, Pfaffenrath V. Cervicogenic headache: diagnostic criteria. Headache 1998; 38:442-5)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.