Waking With Headache or Migraine is as a Result of Neck Position
September 28, 2009 by dean · Leave a Comment
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
September 27, 2009 by dean · Leave a Comment
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.
A Key Diagnostic Feature of Cervicogenic (Neck) Headache
September 25, 2009 by dean · Leave a Comment
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!
September 24, 2009 by dean · Leave a Comment
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
September 23, 2009 by dean · Leave a Comment
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
September 22, 2009 by dean · Leave a Comment
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.
How You Can Escape The Pain of Headache
September 20, 2009 by dean · Leave a Comment
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.
Migraine And Cluster Headache Are ‘First Cousins’!
September 19, 2009 by dean · Leave a Comment
Migraine sufferers experience many symptoms
As I have mentioned in many of my previous reports, my clinical experience agrees with the research which shows that the many different forms of headache and migraine share the same ‘heritage’ or disorder i.e. a sensitised brainstem.
This recent study which surveyed 76 Cluster Headache sufferers showed that nausea, vomiting, photophobia and phonophobia were reported by 41%, 24%, 49% and 46% respectively of the patients. Aura occurred in 28% of the patients and visual symptoms were reported most frequently.
Those of you who are migraine sufferers will be familiar with the symptoms mentioned above (!)
This is further evidence supporting a common, shared mechanism for headache and migraine.
Cheers
Dean
(Wober C and Knopf A. Migrainous features in cluster headache. Cephalalgia 2009;29 (Suppl. 1):1–166)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Cluster Headache Eased By Treating Cervicogenic (Neck) Disorders
September 17, 2009 by dean · Leave a Comment
Cluster Headache is a severe, nasty, form of headache
Cluster Headache is a very severe, nasty, form of headache which is often unresponsive to traditional (typically medication) treatments.
My clinical experience (examining the upper neck) comprising temporary reproduction of headache and also of the associated features i.e. watery eye, blocked, congested or runny nostril, and subsequent successful treatment, suggests that cervicogenic disorders can be responsible for this debilitating type of headache.
Cluster headache sufferers who either could not tolerate the side effects of the medication or their headaches were not responsive to medication, responded to blocking information from structures (joints, ligaments, muscles etc) of the upper neck. These studies support my clinical experience and my claim that the upper necks of cluster headache sufferers should be examined for relevant disorders.
Cheers
Dean
(Gaul C, Muller O, Gasser T, Diener H-C, Katsarava Z. Bilateral occipital nerve stimulation for chronic cluster headache. Cephalalgia 2009;29 (Suppl. 1):1–166
Lara Lara M, Paz Solis J, Ortega-Casarubios MA, Palao , Tarrero A, Heredero J, Diez-Tejedor E. Occipital nerve stimulacion: is peripheral approach effective in cluster headache? Cephalalgia 2009;29 (Suppl. 1):1–166)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Migraine – An Unrecognised Cervicogenic Headache?
September 15, 2009 by dean · Leave a Comment
Migraine Sufferers have a significantly reduced range of neck movement
It is interesting to note that ongoing investigation into the role of cervicogenic (neck) disorders in migraine sufferers has revealed significantly reduced range of neck movement when compared to non headache sufferers. Just more information to add to the growing body of evidence which supports the possibility that the sensitisation of the brainstem in migraine sufferers may be caused by a neck disorder.
Cheers
Dean
(Bevilaqua-Grossi D, Pegoretti KS, Goncalves MC, Speciali JG, Bordini CA, Bigal ME. Cervical Mobility in Women With Migraine. Headache 2009;49:726-73)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.