Headache and Migraine on the Danube!
Level I Course Vienna
Now Vienna is somewhere I have not been so you can imagine how excited was when invited to present my Level I course there.
Despite my course being presented in (Aussie) English, the course was fully subscribed. I must say I admire and appreciate the extra effort delegates make in attending a course which is not in their native language – having said this the art and skill of manual palpation is universal – we communicate through our thumbs!
Now, all I got to see of Vienna was the Danube from the windows of the course venue! …. what matters however is that the course was well received and courses are planned for 2010.
Cheers
Dean
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Waking With Headache or Migraine is as a Result of Neck Position
Check your pillow if you wake with headache
In a recent survey of over 1000 adults it was found that 5% (48) reported waking with headache, problems staying asleep and regular use of sleep medication, and wait for it … difficulties staying awake and falling asleep unwillingly during the day! Wouldn’t we all if we had not had a good nights sleep or still under the influence of sleep medication!
If you are waking with headache then you may need to check your pillow of the number of your pillows. As a clinician it is not easy to advise on pillows as we are all different sizes and shapes; many of my patients have a number of pillows gathering dust in the wardrobe as they go about the eternal search for the ideal pillow!
I find the best approach is to use a soft pillow – something like a feather and down pillow which fits you, rather than forcing you to fit it – unlike many of those foam shaped pillows – too bad if your neck is not the same shape as the pillow! I tried one once and it gave me headache!
Cheers
Dean
(Seidel S, Kloch G, Moser DC, Zeitlhofer J, Wober C Morning headaches are related to sleep problems and poor daytime functioning – a population-based controlled study Cephalalgia 2009;29(Suppl. 1): 1–166)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Chronic Migraine and Episodic Migraine
In the 1980s it was suggested that the migraine state was a progressive condition.1
Over recent years there has been significant research which shows that this in fact is the case – that migraine is a continuum or spectrum disorder, i.e. a process in which episodic migraine may or may not evolve into chronic migraine.2,3 Indeed, the findings of various physiological and imaging (of the brain) investigative techniques suggest that the features of the ‘mis-behaving’ brain during episodic migraine are present persistently in chronic migraine sufferers.4 Three per cent of individuals with episodic migraine progress to chronic migraine over the course of a year.3
This brain dysfunction (or mis-behaviour) has been shown to be sensitisation of the brainstem and one of the sensitising factors could be abnormal information from a neck disorder or injury. Confirmation of this is not difficult or costly – a skilled examination of the upper neck is all that is required.
Cheers
Dean
(Aurora SK. Is chronic migraine one end of a spectrum of migraine or a separate entity? Cephalalgia 2009;29:597-605
Bigal ME, Lipton RB. Concepts and mechanisms of migraine chronification. Headache 2008; 48:7–15.
Cady RK, Schreiber CP, Farmer KU. Understanding the patient with migraine: the evolution from episodic headache to chronic neurologic disease. A proposed classification of patients with headache. Headache 2004; 44:426–35.
Mathew NT, Stubits E, Nigam MP. Transformation of episodic migraine into daily headache: analysis of factors. Headache 1982; 22:66–8)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Headache and Migraine Courses in Norway
Level 1 Course Lillehammer, Norway
After The Netherlands it was time to head (excuse the pun!) to Lillehammer in Norway to present a Level I course.
The last time I was in Norway was in 1997 when I met Professor Sjaastad in Trondheim.
Professor Sjaastad is a (retired) neurologist who introduced the concept of cervicogenic (neck-related) headache to the medical community in 1983. It was an interesting time and a highlight of my professional headache and migraine journey.
I am pleased that the Level I course was over subscribed and therefore (& because of the feedback) I have been invited to present both Level I and Level II courses in 2010.
Cheers
Dean
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
A Key Diagnostic Feature of Cervicogenic (Neck) Headache
A key diagnostic feature of cervicogenic (neck) involvement in headache is the temporary reproduction of headache and migraine pain when examining structures of the upper neck. This diagnostic feature is recognised by The International Headache Society, The International Association for the Study of Pain and The International Cervicogenic Research Group.
However, in my experience and neuro anatomical principles indicate that, reproduction of headache alone is not enough to confirm that the disorder is the cause of headache. There also needs to be lessening of the reproduced headache as the 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.
Are Whiplash Associated Headache, Cervicogenic Headache and Tension-Type Headache the same? Yes!
A motor vehicle injury can result in allodynia
Five patients who had developed headaches following a head and neck injury after a motor vehicle injury – the headaches had the same characteristics of tension-type headache.
Furthermore on examination it was found that they were all experiencing ‘allodynia’ (excessive tenderness to normal pressure). Allodynia is considered to be a sign of sensitisation of the brainstem. The area of allodynia suggested that it was as result of abnormal information from injuries sustained by structures in the neck.
This study further confirms that disorders of the neck are responsible for so-called ‘tension-type’ headache and that abnormal information from injured neck structures can sensitise the brainstem – a phenomenon which is evident not only in tension headache but also migraine, menstrual migraine and cluster headache ….. and that whiplash associated headache exists!
Cheers
Dean
(Baruah JK and Baruah GR. Post traumatic headache and allodynia. Cephalalgia, 2009; 29(Suppl. 1):1–166
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 et al Trigemino-Cervical Reflex Abnormalities in Patients with Migraine and Cluster Headache. Headache 2008; 48(4):578-585
Nardone R, Tezzon F. The trigemino-cervical reflex in tension-type headache. European Journal of Neurology 2003; 10(3):307-312
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
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.
Advanced Headache and Migraine Courses
Level 11 Course in Roermond, The Netherlands
Following on from the Level I course in Roermond, I presented an Advanced (Level II) course.
Level II is a two day course where delegates (primarily physiotherapists) are introduced to the recent research in relation to headache and migraine (which suggests that headache and migraine are not different conditions but are just different different expressions of the same condition) and also to the approach I have developed which not only confirms if a neck disorder is the source of headache or migraine but also which spinal segment is the cause.
After at least 6 months of using my approach, the course delegates are invited to attend a one day (Level II) course where the approach is revised, and importantly questions and issues are answered/discussed. I am pleased that these courses are always fully subscribed and often go on beyond 5.00 p.m.!
Whilst I examine and treat patients on both Level I & II courses, I have now been asked to present longer courses in which patients are examined and treated over a 2 week period ….. now that will be a ‘Master Class’!
Cheers
Dean
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Sensitisation in Headache and Migraine
I have mentioned in my previous blogs that sensitisation of the brainstem has been demonstrated in migraine, tension headache, menstrual migraine and cluster headache.
What I may not have made clear is that this sensitised state is present even when you are free of your headache or migraine, that is, your brainstem is sensitised constantly.
Then what happens is that you eat or drink something, your hormonal levels change, you smell a perfume – and this triggers your headache or migraine. These events lead to increased (but normal) activity of structures (including blood vessels) inside your head.
This increased activity is wrongly interpreted as being much more than what it actually is and pain results. If it wasn’t for your sensitised brainstem, what you eat, drink, smell or hormonal fluctuations would not result in the disabling headache or migraine.
If you are going to be free of your headache or migraine, the source of sensitisation has to be determined. Whilst the triptans desensitise the brainstem and are effective for many of you, they do not eliminate the cause of the sensitisation.
Information from neck disorders can sensitise the brainstem and of all the various investigations you may have for your headache of migraine, a skilled examination of your upper neck is relatively inexpensive and non invasive, and may change your life significantly.
Cheers
Dean
(Goldhammer L. Second cervical root neurofibroma and ipsilateral migraine headache. Cephalalgia 1993; 13:132
Hoskin KL, Kaube H, Goadsby PJ. Sumatriptan can inhibit trigeminal afferents by an exclusively neural mechanism. Brain1996; 119:1419-28
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
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
Milanov I, Bogdanova D. Trigemino-cervical reflex in patients with headache. Cephalalgia 2003; 23:35-38
Nardone R et al Trigemino-Cervical Reflex Abnormalities in Patients with Migraine and Cluster Headache. Headache 2008; 48(4):578-585
Nardone R, Tezzon F. The trigemino-cervical reflex in tension-type headache. European Journal of Neurology 2003; 10(3):307-312
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
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 and Headache in The Netherlands
Level 1 Course in Roermond, The Netherlands
In September another successful Level I course in Roermond was attended by 18 physiotherapists – it almost seems like a second home as I have been presenting courses for the past 10 years.
It is pleasing to see that the feedback from the course delegates suggests that there is increasing awareness of the role of the neck in different (from ‘cervicogenic’ headache) forms of headache including migraine, tension and cluster headache – hopefully my teaching has contributed in some way to this!
In this time, I have witnessed the transition from physiotherapists in The Netherlands relying on medical referrals to being first contact practitioners i.e. patients not requiring a referral. This is great for headache sufferers because with respect, physiotherapists have more training in relation to examination of the upper neck as a potential source of headache or migraine.
Cheers
Dean
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
How You Can Escape The Pain of Headache
The article “How You Can Escape The Pain of Headache And Get Your Life Back … Now!” outlines the first step – to identify the source of your headache.
Go to ‘Articles’ on the ‘Home Page’ and scroll down before clicking on the article title to be taken straight to it or click on …
Cheers
Dean
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.