Worsening Migraine Attacks
If left untreated, cervicogenic headache becomes more frequent, more severe and eventually becomes continuous.
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.
The Brainstem
Blood Vessels - The Arteries and Veins of the Brain and Neck
I have mentioned the brainstem on a number of occasions.
But what is the brainstem?
The brainstem is an area at the top of the spinal cord, which receives input from (activity of) structures inside the head (including blood vessels) and also from structures of the upper neck (ligaments, joints and the capsules, and muscles) which are supplied by the top three spinal nerves.
The brainstem is also influenced by serotonin and a system known as the Diffuse Noxious Inhibitory Control system . Now all information or activity in relation to headache, head pain and migraine, passes through the brainstem to the higher brain centres where it is interpreted, where the decisions are made!
The Brainstem is the final common pathway for all headache and migraine information. It is to headache what the black box is to the airplane.
Cheers
Dean
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Watson Headache Course – Level I
I have been mentioning the courses I present to physiotherapists, chiropractors and osteopaths without explaining what it is that we cover.
The Level I course is called:
“The Role of CO-C3 Segmental Dysfunction in Primary Headache”
This course essentially looks at information from the top three spinal joints (which affects the brainstem, and we know the brainstem is sensitised in headache and migraine sufferers) and whether these joints are involved in the headache or migraine process.
The course looks at how the medical model of headache classifies headache and migraine; then I present the research i.e. what is in the literature, which actually contradicts the traditional medical model and supports my clinical experience of over 21000 hours, that is, the necks of all headache or migraine sufferers should be examined irrespective of the diagnosis.
As a result of my experience I have developed a verbal examination (often called the ‘subjective examination’) which includes the area of headache, history and behaviour of symptoms. From this we can tell if there is change in headache or migraine symptoms.
It is important that, before we examine the upper neck, tests of neck arteries are performed and also ligaments of the upper neck. I am not happy with the traditionally taught tests – I think they are too (and unnecessarily) aggressive on potentially already damaged ligaments. I demonstrate (and we practice) tests which are much less aggressive.
Then I demonstrate and we practice (on each other) techniques I have developed, which not only identify if neck disorders are the cause of headache or migraine symptoms but also which joint it is that is causing the problem. If we can identify the joint or spinal segment involved, the chances of getting a successful outcome increases significantly because treatment can then be directed at the source.
I finish the course by examining two headache or migraine sufferers, so course delegates can see everything put into practice.
Then after at least 6 months experience using this approach, course delegates then return for the Level II Advanced course.
Cheers
Dean
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Treating Headache and Migraine with Greater Occipital Nerve Blocks
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.
Menstrual Migraine – It’s Not Your Hormones!
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.
Tension As A Factor In Worsening Tension Headache And Migraine
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.
Exercise and Migraine
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 and Migraine Are Just Different Expressions of the Same Condition
After examining six clinical trials in which cluster headache sufferers were treated with various ‘triptan’ medications it was concluded that the ‘triptans’ were effective in preventing the debilitating pain of cluster headache – just further evidence to support that cluster headache and migraine share a common underlying disorder.
This disorder has been demonstrated to be a sensitised brainstem and of course the ‘triptans’ de-sensitise the brainstem.
Furthermore there is a significant body of research which suggests that influencing (anaesthetising/blocking) information from structures of the upper neck prevents migraine and cluster headache. This suggests that abnormal information from disorders of these structures can sensitise the brainstem and that therefore a skilled examination of the upper neck should be included in assessment of migraine and cluster headache sufferers.
Cheers
Dean
(Akin Takmaz et al. Greater occipital nerve block in migraine headache: Preliminary results of 10 patients. Agri. 2008 Jan;20(1):47-50
Hoskin KL, Kaube H, Goadsby PJ. Sumatriptan can inhibit trigeminal afferents by an exclusively neural mechanism. Brain 1996; 119:1419-28
Law S, Derry S, McQuay H, Moore A A systematic review of the triptan class of drugs for the treatment of cluster headache Cephalalgia 2009;29 (Suppl. 1):1–166
Nardone R et al Trigemino-Cervical Reflex Abnormalities in Patients with Migraine and Cluster Headache. Headache 2008; 48(4):578-585
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;47:917-928
Solomon S, Lipton RB, Newman LC. Nuchal features of cluster headache. Headache 1990;30:347-9obin J,Stephen Flitman S. Nerve Blocks: When and What to Inject? Headache 2009
Yi X et al Cervicogenic headache in patients with presumed migraine: missed diagnosis or misdiagnosis? J Pain. 2005 Oct;6(10):700-3
Young et al Greater occipital nerve and other anesthetic injections for primary headache disorders. Headache 2008;48:1122-1125
Young et al. The first 5 minutes after greater occipital nerve block. Headache 2008;48:1126-1139)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
CRAFTA Conference on Headache and Migraine
CRAFTA Conference Nuremburg
Just going on from my previous post, the title of first of my presentation:
“Diagnosing Headache is like a dog’s breakfast – it’s all over the place, and therefore is it clinically relevant?”
…… created a lot of discussion …… until the audience saw that the current research overwhelmingly supports the idea that the various forms of headache and migraine are just different presentations of the same condition.
A diagnosis is meaningless; the key to successful management of headache and migraine is to identify the source of the sensitisation of the brainstem and treat it.
Cheers
Dean
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Chronic Migraine and Episodic Migraine
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.