Level II Headache and Migraine Course in Cambridge
October 30, 2009 by dean · Leave a Comment
Level II Course Cambridge, England
Whilst in Cambridge for Level I course I also presented a Level II course which like the Level I course had an international flavour – it is encouraging to have delegates from Level I returning to complete the Advanced Level II despite the distances (Italy) involved and that the the course is in English!
Those delegates who have completed the Level II course now qualify to be listed on the international register list of practitioners at www.headacheandmigraine.com
Cheers
Dean
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Depression, Migraine and Tension Headache
October 28, 2009 by dean · Leave a Comment
Depression may be the result of headache and migraine's isolating experience
Every time I hear that depression is causing migraine or headache I get really frustrated – I would be depressed if I went through what my patients were experiencing!
Migraine and other forms of headache are significant stressors in themselves. However, it is more than coping with the pain, nausea, and vomiting etc. It is also about one’s inability to participate in life – to be able to plan a social life.
Depression is not the cause of headache or migraine … it results from it! It is amazing the change in a person’s demeanor once their headache or migraine has not necessarily resolved, but just improved!
Have you considered that your (upper) neck may be the cause of your depression?
Cheers
Dean
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Tension As A Factor In Worsening Tension Headache And Migraine
October 26, 2009 by dean · Leave a Comment
The stress and tension of "everyday life"
Research has shown that as many as 1 out of 10 migraine sufferers will develop daily migraine and whilst factors such as stressful life events, ongoing lesser every-day stressors and depression have been identified,1-6 neck disorders are not discussed.
Clearly significant life events such as divorce, death of a loved one, redundancy etc can cause significant tension for months/years and shortening of muscles in the upper neck can result. Then the stress of everyday life ‘stuff’ leads to more temporary further shortening of already shortened muscles, ligaments and capsules, exerting pressure on stiff joints leading to increased frequency of headache or migraine.
Once the daily stress lessens, headache and migraine eases, but the shortening which resulted from the stress of the major life event/s remains (this ongoing stiffness in the spinal segments is likely to result in sensitisation of the brainstem,7 which is now widely recognised as a key disorder in headache and migraine) waiting for the hassles of the next day, causing pressure on the stiff joints once again and migraine or headache results.
Headache or migraine which is increasing in frequency suggests that a neck disorder is worsening – if this is happening for you, I recommend that a skilled examination of your upper neck structures be performed as my experience suggests very strongly that your neck is the problem.
Cheers
Dean
(6. De Benedittis G, Lorenzetti A. Minor stressful life events (daily hassles) in chronic primary headache: Relationship with MMPI personality patterns. Headache. 1992;32:330-334.
1. Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders: 2nd edn. Cephalalgia. 2004;24(Suppl. 1):9-160.
3. Henry P, Auray JP, Gaudin AF, et al. Prevalence and clinical characteristics of migraine in France. Neurology. 2002;59:232-237.
4. Lanteri-Minet M, Auray JP, El HA, et al. Prevalence and description of chronic daily headache in the general population in France. Pain. 2003;102:143-149.
2. Scher AI, Stewart WF, Liberman J, Lipton RB. Prevalence of frequent headache in a population sample. Headache. 1998;38:497-506.
5. Scher AI, Stewart WF, Buse D, Krantz DS, Lipton RB. Major life changes before and after the onset of chronic daily headache: A population-based study. Cephalalgia. 2008;28:868-87)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Migraine, Tension Headache and Stress
October 24, 2009 by dean · Leave a Comment
Managing stress helps headache and migraine
Why is it that when stress and migraine and tension headache are discussed studies all sorts of unproven mechanisms are discussed at length – despite all of the research and billions of dollars there is no proven causal mechanism – ‘it may be this …. or ‘it may be that‘ etc.
Muscle tension is evident in the necks of ‘tension headache‘ sufferers and migraineurs – it is tensed, shortened musculature acting on joint stiffness which leads to head pain.1
Research has shown that stress management approaches, including Relaxation Therapy and cognitive behavioural therapy consistently improve migraine 2 – if you are less stressed then stiff spinal segments sit quietly without any significant movement expected of them. Biofeedback is also helpful in managing migraine 2 for the same reason.
It can be very difficult to manage stress in our lives (for a whole lot of reasons including heart disease, depression, and other mental health disorders) and whilst is is important to take measures to do this, from a headache and migraine point of view, identifying and eliminating relevant neck disorders is crucial.
Cheers
Dean
(1. Bakal DA, Kaganov JA. Muscle Contraction and Migraine Headache: Psychophysiologic Comparison. Headache 1977;17(5):208215
2. Rains JC, Penzien DB, McCrory DC, Gray RN. Behavioral headache treatment: History, review of the empirical literature, and methodological critique. Headache. 2005;45(Suppl. 2): S92-S109.)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Migraine and Stress
October 22, 2009 by dean · Leave a Comment
When stressed, muscles shorten, joints move abnormally, pain is referred to the head
One of the most common triggers reported by individuals with migraine is stress.1-5 Approximately 76% of migraine suffers report identifiable triggers and of those 80% report stress as a common trigger.6
When we get stressed our muscles shorten ‘asking’ the vertebra to which they are attached, to move. If however the joint is stiff, messages from shortened structures for example capsules, ligaments and muscles, which are there to prevent the joint from moving too much, are not allowing the joints to move normally and pain is referred to your head – stress without a neck disorder does not result in headache.
A skilled examination of the movements of the upper neck can confirm this for you.
Cheers
Dean
(2. Chabriat H, Danchot J, Michel P, Joire JE, Henry P. Precipitating factors of headache. A prospective study in a national control-matched survey in migraineurs and nonmigraineurs. Headache. 1999;39:335-338.
1. Hung CI, Liu CY, Wang SJ. Precipitating or aggravating factors for headache in patients with major depressive disorder. J Psychosom Res. 2008;64:231-235.
4. Karli N, Zarifoglu M, Calisir N, Akgoz S. Comparison of pre-headache phases and trigger factors of migraine and episodic tension-type headache: Do they share similar clinical pathophysiology? Cephalalgia. 2005;25:444-451.
6. Kelman L. The triggers or precipitants of the acute migraine attack. Cephalalgia. 2007;27:394-402.
5. Martin PR, Milech D, Nathan PR. Towards a functional model of chronic headaches: Investigation of antecedents and consequences. Headache. 1993;33:461-470
3. Rasmussen BK. Migraine and tension-type headache in a general population: Psychosocial factors. Int J Epidemiol. 1992;21:1138-1143)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Exercise and Migraine
October 20, 2009 by dean · Leave a Comment
Exercise encourages serotonin production
In a recent study 30 female migraineurs undertook an aerobic exercise program.
Measures of pain and psychological assessment (including body image, depression and quality if life) were assessed before and after completion of the 6 week exercise and exercise program.
The program led to a significant reduction migraine pain intensity. This is not surprising as exercise encourages serotonin production which desensitises the brainstem. Interestingly there was also an improvement in the depression related symptoms (I would be happier to if my migraine was less severe!), but the psychological factors were no different (good to see my experience confirmed i.e. migraine sufferers are psychologically normal!)
Sensitisation of the brainstem in my experience occurs because of a neck disorder and whilst increased serotonin is likely to improve symptoms the cause of the senstisation is still there. It is important that this (the neck) be confirmed and addressed – but start (and keep) exercising as well!
Cheers
Dean
(Dittrich SM, Guünther V, Franz G, Burtscher M, Holzner B, Kopp M. Clin J Sport Med. 2008;18:363-365 Aerobic exercise with relaxation: Influence on pain and psychological well-being in female patients. Clin J Sport Med. 2008;18:363-365)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Cluster Headache After Mild Head Trauma
October 18, 2009 by dean · Leave a Comment
Cluster Headache after mild head trauma
In this case study a 48 year old woman developed signs and symptoms of cluster headache after hitting her head on an iron ladder.
The authors consider various possibilities as to the cause, but all related to intra cranial, i.e. inside the head, factors … this pre occupation with intra cranial causes is frustrating on two counts.
Firstly, this woman is still suffering 19 years (Yes – 19!) later, and secondly, that a neck injury has not been considered. Research has shown that symptoms of cluster headache are treated successfully by blocking information from the upper neck indicating that neck disorders can be the source of symptoms.
In instances such as this when there is a blow to the head by a stationary object, clearly the head stops (suddenly and momentarily), and the body continues to move, leaving the neck to absorb the strain, effectively to put the brakes on! This patient has experienced a neck injury and even a minor incident can be much than what it seems especially when the blow is unexpected.
Cheers
Dean
(Lambru G, Castellini P, Manzoni GC, Torelli P. Traumatic Cluster Headache: From the Periphery to the Central Nervous System? Headache 2009;49:1059-1072
Peres MF. et al Greater occipital nerve blockade for cluster headache. Cephalalgia 2002;22:520-522
Solomon S, Lipton RB, Newman LC. Nuchal features of cluster headache. Headache 1990;30:347-9
Tobin J,Stephen Flitman S. Nerve Blocks: When and What to Inject? Headache 2009
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.
Headache and Migraine in Cornwall
October 16, 2009 by dean · Leave a Comment
Level I Course Lyskeard, Cornwall
Physiotherapists travelled from London and the south of England generally for this fully subscribed Level I course – so coffee on arrival was popular! The feedback from this course (in Lyskeard) was excellent making this venue a likely permanent fixture on the teaching calendar – can’t wait!
Cheers
Dean
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Migraine Headache and Cervicogenic Headache
October 15, 2009 by dean · Leave a Comment
The authors of this study have previously shown :
that neck pain is very common in migraine and is more often present during migraine than nausea
the presence of neck pain at the time of migraine treatment significantly decreases the chances of becoming pain-free within 2 hours
the presence of neck pain is likely to increase migraine-related disability irrespective of headache frequency and severity.
In the this study 127 migraine sufferers recorded 762 migraines and it was found that those with neck pain were less likely to achieve a pain free state and tended to have poorer outcomes than those with headache only i.e. without neck pain.
The authors considered that the presence of neck pain on the day before the migraine is associated with poorer treatment response; that neck pain before migraine is a better predictor of a poor treatment outcome than is headache only …. of course it is if the neck is not treated!
Clearly the reason for sensitisation can be abnormal information from neck disorders and if this is not addressed then treatment outcomes will be less than satisfactory.
Cheers
Dean
(Calhoun AH, Ford S. Headache or neck pain the day before: impact on migraine treatment outcome Cephalalgia 2009;29(Suppl. 1):1–166)
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Neck Pain is the Cause of Worsening Migraine
October 14, 2009 by dean · Leave a Comment
Neck Disorders can be part of the migraine process
How refreshing to find other researchers who also believe that cervicogenic (neck) disorders can be part of the migraine process – we are few and far between!
Calhoun and Ford (whose research I have quoted recently), investigated the incidence of neck pain on wakening in 113 migraineurs. They found that the more chronic the migraine the more likely that neck pain would be present on wakening; and that the presence of neck pain on wakening increases the likelihood of waking with a migraine as well!
They concluded that either neck pain is a ‘migraine’ in the neck and/or that the presence of neck pain without a migraine is likely to lead to migraine becoming more chronic.
My clinical experience includes treating patients just with pain in the neck but whose neck pain responded to the ‘triptans’ i.e. their ‘migraine’ was in their neck!
Cheers
Dean
(Calhoun AH, Ford S. The prevalence of neck pain on awakening in a cohort of migraineurs Cephalalgia 2009;29(Suppl. 1):1–166)
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