Headache and Migraine Diagnosis and Treatment

August 16, 2009 by dean · Leave a Comment 

The neck can be the source of sensitisation

The neck can be the source of sensitisation

There are numerous case studies which have shown that injecting local anesthetic around the greater occipital nerve the pain of migraine is eased. This is also a key finding in cervicogenic headache and confirms the diagnosis of cervicogenic headache. So why is it that, in this situation, almost invariably the interpretation is that the sufferer has two types of headache that is:

cervicogenic headache,



I am always bemused by this, why can’t it be that the ‘migraine’ and cervicogenic are the same headache.

Why is it that the answer I often get is “… well we don’t know where migraine comes from but it can’t come from the neck.” Clearly this is a really unhelpful comment. Why is it that I need to demonstrate that the neck can be the source of sensitisation in migraine sufferers (my claim is based on over 21000 hours experience with headache and migraine sufferers)? Perhaps I should request from those who disagree to demonstrate that migraine cannot develop from a neck disorder ….



(Akin Takmaz et al. Greater occipital nerve block in migraine headache: Preliminary results of 10 patients. Agri. 2008 Jan;20(1):47-50

Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders, 2nd edn. Cephalalgia 2004; 24(suppl.1):1-151

Peres MF. et al Greater occipital nerve blockade for cluster headache. Cephalalgia 2002;22:520-522)

Rozen T. Cessation of Hemiplegic Migraine Auras With Greater Occipital Nerve Blockade. Headache 2007;47:917-919)

Sjaastad O, Fredricksen TA, Pfaffenrath V. Cervicogenic headache: diagnostic criteria. Headache 1998; 38:442-5

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

Young WB et al. Greater Occipital Nerve and Other Anesthetic Injections for Primary Headache Disorders. Headache 2008;48:112-1125

Young, W. et al The first 5 minutes after greater occipital nerve block. Headache 2008 July 48(7):1126-8)

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About dean
Consultant Headache & Migraine Physiotherapist; International Teacher; Director, The Headache Clinic & Watson Headache Institute; PhD Candidate Murdoch University, Western Australia; Adjunct Lecturer, Masters Program, Physiotherapy School, University of South Australia; MAppSc(Res) GradDipAdvManipTher Experienced health practitioners trained in the Watson Headache Approach perform the examination and treatment techniques developed by Dean Watson. These techniques are based on his extensive experience of 7000 headache patients (21,000 hours) over 21 years and are now taught internationally. For your nearest practitioner who has completed training in the ‘Watson Headache Approach’ please refer to the ‘Practitioner Directory’.

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