Tension Headache and Cervicogenic Headache
November 14, 2009 by dean · Leave a Comment
I have just been asked to review a book:
“Tension-Type and Cervicogenic Headache. Pathophysiology, Diagnosis and Management.”
for the Physiotherapy Journal, published in the United Kingdom.
Whilst I am just getting started, I can’t help but be a little excited, because combining Tension Headache and Cervicogenic headache in the same title suggests that the authors may be implying that there is significant overlap between the two headache types. My clinical experience suggests that tension headache is an unrecognised cervicogenic headache.
Cheers
Dean
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Visual Aura and Migraine
November 13, 2009 by dean · Leave a Comment
Have a skilled examination of your neck.
Cervicogenic (neck related) Headache, according to the International Headache Society1 is side-locked i.e. it is one-sided headache which does not change sides. In my experience however, a one-sided headache that changes sides is a Cervicogenic Headache.
I remember a patient of mine whose visual aura changed sides i.e. for the first 10’ it was on the left, and then for the last 10’ changed to the right. After treating her very stiff C2-3 spinal segment, the patient was and has remained free of her visual aura.
If your one-sided headache changes sides or it is both sides simultaneously but worse on one side and the worst side changes, it is your neck, and furthermore, it is the C2-3 spinal segment which is at fault – this is based on over 21000 hours of clinical experience with headache and migraine sufferers.
My message – have a skilled examination of your neck…
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)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Cluster Headache – Another Headache or Migraine
November 12, 2009 by dean · Leave a Comment
Tension Headache and Migraine are recognised as the most common forms of headache.
Cluster headache is one of the third ‘group’ of headaches – the other headache types in this group are Hemicrania Continua, Chronic Paroxysmal Hemicrania, and SUNCT.
All of the headache types in this third group share similar symptoms with Cluster Headache and either blocking or modifying information from the neck has a beneficial effect on Cluster Headache suggesting that neck disorders not only play a significant role in Cluster headache but perhaps the others(?)
To review the posts on Cluster Headache return to the ‘Home Page’ and key in the search term ‘Cluster Headache’.
Cheers
Dean
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Treating Migraine with Greater Occipital Nerve Blocks
November 11, 2009 by dean · Leave a Comment
A skilled examination of the neck need not be an after thought
Whilst the primary of this study was to assess the effectiveness of greater occipital nerve blocks on ‘medication overuse headache’, it also demonstrated that of 108 nerve blocks, 78% of headache sufferers responded with an average 83% decrease in severity which lasted almost 7 weeks.
The greatest effect was in those patients whose headaches developed after being concussed (100%), then 89% for episodic migraine and less effect on those with chronic migraine (61%).
Once again more evidence that examination of the upper neck in headache and migraine sufferers should not be an ‘after-thought’ – it should be routine – it borders on irresponsibility if an examination of the neck is not performed once all other investigations have been carried out ….
Cheers
Dean
(Tobin JA, Flitman SS. Nerve Blocks: Effect of Symptomatic Medication Overuse and Headache Type on Failure Rate. Headache 2009;49(10);1479-1485)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Treating Headache and Migraine with Greater Occipital Nerve Blocks
November 10, 2009 by dean · Leave a Comment
Blocking the greater occipital nerve (which prevents information from the neck influencing the brainstem) continues to attract attention.
The authors after reviewing 21 pieces of research, whilst recommending that further research needs to be done, concluded that blocking or anaesthetising the greater occipital nerve is a worthwhile treatment approach for cervicogenic (neck-related) headache, cluster headache and migraine.
The positive results obtained through this procedure suggest that neck disorders are involved in the mechanisms of these headache conditions …. but blocks are not necessary … a skilled examination and treatment of relevant neck disorders can achieve the same result, without injections!
Cheers
Dean
(Tobin J, Flitman S.Occipital Nerve Blocks: When and What to Inject? Headache 2009;49:1521 - 1533)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Diagnosing Cluster Headache
November 9, 2009 by dean · Leave a Comment
Diagnosing Cluster Headache
I have mentioned before that diagnosing headache can be difficult and that many headache sufferers on their journey have been given more than one diagnosis. I recently came across some statistics, which although were in relation to diagnosing Cluster Headache, illustrate the complexities and frustrations of headache and migraine diagnosis.
Klapper et al1 using an internet survey investigated the process of diagnosing Cluster Headache. It was revealed that there was an average of 6.6 years’ delay in correct diagnosis. Eighty-seven per cent of Cluster Headache sufferers met the International Headache Society’s criteria for Cluster Headache (and should have been diagnosed by the first physician); an average of 4.3 physicians were seen and an average 3.9 incorrect diagnoses made before diagnosis of Cluster Headache and because of incorrect initial diagnosis, 4% of patients underwent unnecessary surgery.
I find this hard to comprehend. Cluster Headache, because of the redness of the eye and nasal symptoms, is easily recognised.
Cheers
Dean
(Klapper JA, Klapper A, Voss T. The misdiagnosis of cluster headache: a nonclinic, population-based, internet survey. Headache 2000; 40:730–5.)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Examining The Neck of a Cluster Headache Sufferer
November 8, 2009 by dean · Leave a Comment
I was talking to a neurologist when in the UK recently and he mentioned that he was writing a case study of a cluster headache sufferer who has been free of cluster headache since his neck was treated. This is not a surprise to me as cluster headache frequently responds to treatment of relevant neck disorders.
This discussion reminded me of patient I saw when in The Netherlands about 5 years ago. This gentleman was 55 years of age and had suffered cluster headache since he was 25 years of age. His episodes lasted 6 months and occurred every 5 years.
I have mentioned that a key diagnostic finding when examining the upper neck structures is the temporary reproduction of headache and for headache to lessen as the technique is sustained. I examined this man when he was not experiencing an attack. Not only was I able to reproduce his head pain, but his eye started to water and his nose started to run, just as if he was in the middle of an attack – those of you who are cluster headache sufferers will identify with this!
Unfortunately I lost touch with this gentleman so I am not sure of the outcome or if in fact he sought treatment ….. but I would be confident of a successful outcome in experienced hands.
Cheers
Dean
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
A Migraine Sufferer’s World
November 6, 2009 by dean · Leave a Comment
A Receptionist at The Headache Clinic recounted this description of headache and migraine told by one of our patients.
This migraine sufferer suggested that if someone has a pain in their toe it remains fairly localised. Unlike the pain of migraine which seemed to expand outwardly, beyond the head, as the pain of migraine increased. By this she meant the pain moved from the person suffering the headache, into their family, workplace, community until the pain became so intense it was the sufferer’s whole world. In fact (and often) at this stage the sufferer has isolated themselves from their daily life, often retreating to bed or seeking help via Accident and Emergency …… unfortunately an all too common story.
However our goal is for this to be a less common story, achieved without ongoing medication and with a skilled examination of the neck.
Cheers
Dean
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Neck Muscles and Migraine
November 5, 2009 by dean · Leave a Comment
Research suggests neck muscle tenderness is connected to migraine
It is interesting to note that injecting tender neck muscles with trihexyphenidyl (used for muscle disorders and in managing the muscle tremors in Parkinson’s disease) prevented migraine attacks from occurring.
The authors suggested that neck muscle tenderness was closely connected to the migraine process!
Cheers
Dean
(Teramoto J. New therapy to prevent migraine attacks just before onset. Cephalalgia, 29 (Suppl. 1) (2009) 1–166)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Menstrual Migraine – It’s Not Your Hormones!
November 4, 2009 by dean · Leave a Comment
As a clinician I am often asked why I recommend the necks of menstrual migraine sufferers be examined when menstrual migraine supposedly results from hormonal imbalances or abnormal fluctuations etc.
As I have mentioned in previous posts research shows that menstrual migraine sufferers do not have irregular hormonal profiles or fluctuations and that the brainstems of menstrual migraine sufferers are sensitised just as they are in tension headache and migraine sufferers – and one source of sensitisation is abnormal information from neck disorders.
Review other posts about Menstrual Migraine by keying in Menstrual Migraine on the ‘Home Page’.
Cheers
Dean
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.