Successful Headache and Migraine Treatment

December 10, 2009 by dean · Leave a Comment 

Several authorities recently summarised the reasons why headache and migraine treatment often fails.

Amongst other factors, they suggested that the diagnosis is incomplete or incorrect and that this could occur for various reasons.

One of the reasons is ‘misdiagnosis’. I have mentioned this research before but diagnosing headache and migraine is like ‘a dog’s breakfast’; it is all over the place with many patients receiving 2 or 3 diagnoses or patients being misdiagnosed – diagnosed as migraine when in fact it was a cervicogenic (neck-related) headache …..!

The medical profession refuses to acknowledge cervicogenic factors – why? Because relating to it does not fit the medical model and anything that does not fit into the medical model is discarded as unworthy of serious consideration.

The entire diagnostic process needs to be reviewed as well as approaches to treatment. Until cervicogenic factors are considered, headache and migraine treatment will remain unsatisfactory with the only option for you, the headache sufferer, being pharmacological management.

Cheers

Dean

(Lipton RB, Silberstein SD, Saper JR, Bigal ME, Goadsby PJ. Why headache treatment fails. Neurology 2003;60:1064-1070

Yi X et al Cervicogenic headache in patients with presumed migraine: missed diagnosis or misdiagnosis? J Pain. 2005 Oct;6(10):700-3)

© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.

Worsening Migraine Attacks

December 9, 2009 by dean · Leave a Comment 

Worsening Migraine Attacks are decreased significantly by cervicogenic (neck) treatment. Recent evidence suggests that migraine is an increasing condition in which over time, the attacks become more frequent, more severe, less responsive to medication, and perhaps lasting longer.

Research has shown that by decreasing information (surgically) from cervical (neck) nerves deceases the long term worsening of the migraine process. The natural progression of cervicogenic (neck) headache is exactly the same – if it is left untreated, cervicogenic headache becomes more frequent, more severe and eventually becomes continuous. This indicates that with the passage of time the neck disorder is gradually worsening (and it is likely to be loss of function or stiffness). This research supports the idea that cervicogenic (neck) disorders are the reason for not only worsening of the migraine process but also for the migraine process in the first place i.e. sensitisation of the brainstem.

Now I am not suggesting that migraine sufferers rush off and have the relatively minor surgery performed in this study (in fact I respectfully suggest that skilled treatment of the neck would have achieved the same result), but this research clearly demonstrates disorders of the upper neck are significantly involved in the migraine process.

Cheers

Dean

(Perry CJ, Blake P and Goadsby PJ Intervention altering the natural history of chronic migraine. Is chroni?cation of migraine headache a harbinger of peripheral afferent nerve involvement? Cephalalgia 2009; 29 (Suppl. 1):1–166)

© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.

How Common Is Migraine?

December 8, 2009 by dean · Leave a Comment 

There are plenty of statistics in relation to the incidence of migraine, but a recent survey revealed more than just gender incidence.

This survey of over 120,000 households found that four out of ten females and two out of ten males respectively will experience migraine at some stage in their lifetime – most likely before aged 35 years……

….. and that the greatest frequency of attacks are likely to occur between the ages of 20 and 24 years in females and 15 to 19 in males. The authors reported that these findings were in accordance with previous studies.

Clearly this is a significant problem for many!

Cheers

Dean

(Stewart WF, Wood C, Reed ML, Roy J, Lipton RB. Cumulative lifetime migraine incidence in women and men. Cephalalgia 2008;28:1170-1178)

© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.

Is Migraine Inherited?

December 7, 2009 by dean · Leave a Comment 

Is migraine inherited?

Is migraine inherited?

In a previous post I mentioned a recent survey which reported that 40 per cent of females will experience migraine in their lifetime.

Why is it then, that if three females in a family of ten for example, the assumption is often made that migraine is inherited? This incidence is no more than what occurs in the general population.

This assumption immediately leads to “ …. well you just have to live with it; there’s nothing we can do but manage the attacks.” This is a life sentence and not necessarily the case.

A skilled examination of the neck will confirm or eliminate cervicogenic disorders as the cause of your migraine condition.

Cheers

Dean

(Stewart WF, Wood C, Reed ML, Roy J, Lipton RB. Cumulative lifetime migraine incidence i women and men. Cephalalgia 2008;28:1170-1178)

© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.

Optimising Headache and Migraine Treatment

December 6, 2009 by dean · Leave a Comment 

Whilst I was in the UK recently I had the opportunity to meet with several of my accredited practitioners.

I am pleased to say that the results of treatment/feedback from headache and migraine sufferers was amazing. This has increased their (the practitioners’) enthusiasm for a more substantial course (I am already doing two and one day courses).

There was unanimous agreement that it should be a ten day course for small groups of already accredited practitioners. In this course or ‘Master -Class’, the aim would be to examine and treat headache and migraine sufferers on 3-4 occasions, and how to progress from one treatment session to the next.

It was always my aim to develop the best possible teaching model – here it comes! (and it is being driven by practitioners wanting the best possible outcomes for you the headache or migraine sufferer).

Cheers

Dean

© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.

The Headache and Migraine Sufferers Bill of Rights (cont)

December 5, 2009 by dean · Leave a Comment 

iStock_000005821544XSmall

A balanced approach to research is required

The last 2 ‘bills’ read:

“The headache sufferer has the right of access to an authorised healthcare provider and to relevant treatment, regardless of age, sex, race, state of health and economic standing and regardless of the geographical, cultural and economic circumstances of his/her community.”

and

“The headache sufferer has the right to expect society and the medical profession to conduct research in the field of headache to improve the understanding and treatment of headache in the future.”

The only issue I have is with conducting research – if research resources investigating the role of the neck equalled that which is put into drug solution then perhaps a more balanced and effective approach finding a would result.

Cheers

Dean

(Members’ Handbook. International Headache Society 2000 Scandinavian University Press)

© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.

The Headache and Migraine Sufferers Bill of Rights (cont)

December 4, 2009 by dean · Leave a Comment 

The second ‘bill’:

“The headache sufferer has the right to be taken seriously by the healthcare providers, whose duty it is to take down a relevant history (I have no issues with these!), conduct a relevant physical examination, provide advice and reassurance and prescribe the treatment most advantageous and acceptable to the patient according to current knowledge.”

The issue I have here is with:

conduct a relevant physical examination

It is appropriate that a neurologist conduct the aspects of the physical examination which rule out serious causes of headache – however and with respect the neurologist, physician, or general practitioner are not skilled in examination of the structures of the upper neck – this is where the ‘system’ fails you, the headache or migraine sufferer …. the prognosis, treatment, advice are dependent on the examination, which at this point in time is incomplete; incomplete because your neck has not been examined comprehensively.

So let’s summarise from the first 2 of the 4 ‘bills’ of rights’:

a precise diagnosis is not possible (and besides, does it mean anything)

the nature of the disorder is a sensitised brainstem

the prognosis and best treatment options are dependent on identifying the reason for the sensitisation

the examination you will get will most likely be incomplete because your neck will not be comprehensively examined and therefore one of the most likely reasons for sensitisation (a neck disorder) will not identified ….

…. which means you are likely to be destined to a lifetime of medication which at best manages the symptoms and not the cause.

It is appropriate that as headache or migraine sufferer that you consult your medical practitioner to exclude serious causes of headache (which are extremely rare) but once the various tests have been carried out and there is nothing to find, then a skilled examination of your neck is indicated. Research has shown that information from neck disorders can sensitise the brainstem.

Cheers

Dean

(Members’ Handbook. International Headache Society 2000 Scandinavian University Press)

© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.

The Headache and Migraine Sufferers Bill of Rights (cont)

December 3, 2009 by dean · Leave a Comment 

iStock_000007159824XSmall

The likely course or outcome of the condition is dependent on identifying the cause

The first ‘bill’ is that the headache sufferer has the right to know his/her headache diagnosis as precisely as possible, and to know the nature of the headache disorder, its prognosis and the possible types of treatment.

OK so we now need to look at:

its prognosis

The prognosis or the likely course or outcome of the condition clearly is dependent on identifying the cause of the condition, and despite the enormous amount of resources, financially and otherwise, the reason for the sensitisation of the brainstems in headache and migraine sufferers has not been identified ….. so prognosis cannot be predicted.

What next – the possible types of treatment ….. this depends on the examination and this is included in the second ‘bill’.

Until next time.

Cheers

Dean

(Members’ Handbook. International Headache Society 2000 Scandinavian University Press)

© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.

The Headache and Migraine Sufferers Bill of Rights (cont)

December 2, 2009 by dean · Leave a Comment 

The first ‘bill’ is that the headache sufferer has the right to know his/her headache diagnosis as precisely as possible, and to know the nature of the headache disorder, its prognosis and the possible types of treatment.

I have discussed the first point regarding diagnosis; now

to know the nature of the headache disorder

Clearly there is a substantial body of research which shows that the brainstems of Migraine, Tension Headache and Menstrual Migraine sufferers are sensitised.

We know that the ‘triptans’ desensitise the brainstem and are effective in preventing Migraine, Tension Headache, Cluster Headache, Hemicrania Continua, Menstrual Migraine, Cervicogenic (neck-related) Headache (which shows that cervicogenic disorders can sensitise the brainstem) ……

The underlying disorder is sensitisation of the brainstem; optimal management therefore is identifying the reason for the sensitisation ….

Stay tuned,

Cheers

Dean

(Members’ Handbook. International Headache Society 2000 Scandinavian University Press)

© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.

Headache and Migraine Sufferers ‘Bill of Rights’

December 1, 2009 by dean · Leave a Comment 

is likely to respond to treatment of relevant neck disorders.

Is a diagnosis important?

Some time ago (2000), the International Headache Society, published a Headache Sufferers ‘Bill of Rights’.

The first ‘bill’ is that the headache sufferer has the right to know his/her headache diagnosis as precisely as possible, and to know the nature of the headache disorder, its prognosis and the possible types of treatment.

I would like to spend the next few posts looking more closely at these points:-

“the headache sufferer has the right to know his/her headache diagnosis as precisely as possible”

diagnosis is difficult because it is based on a set of signs and symptoms, and the signs and symptoms of many different headache and migraine forms overlap – perhaps that is why many headache sufferers have been given 2, 3 or even 4 different diagnoses

not only do we have ‘Pure’ Menstrual Migraine, but now ‘MRM’ i.e. Menstrual Related Migraine, Menstrual Tension Headache, Menstrual Hemicrania Continua, Cluster Headache associated with menstruation etc and this is just headache or migraine supposedly associated with the menstrual cycle

the ‘triptans’, supposedly developed to stop the migraine process are effective in other forms of headache e.g. Menstrual Migraine, Cluster Headache, Cervicogenic Headache, and Hemicrania Continua

different headache and migraine forms responding to a range of cervicogenic (neck) treatments e.g. greater occipital nerve blocks, cervical spine stimulators

Is a diagnosis important? As far as I can see, and given the research, a diagnosis does not optimise the management of headache or migraine – it remains a ‘let’s try this and wait and see’ approach – clearly an unsatisfactory situation.

Cheers

Dean

(Members’ Handbook. International Headache Society 2000 Scandinavian University Press)

© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.