Menstrual Tension-type Headache?
August 14, 2009 by dean · Leave a Comment
Menstrual headaches can vary in severity from one cycle to the next
Now we have menstrual tension-type headache described. When will it all end – the last thing we need now is another headache type!
The authors interviewed 165 women with menstrual related headache and found that the characteristics of tension-type headache were evident in 21.
Isn’t this what some authorities are saying – that all headache and migraine arises from the same disorder?
Menstrual tension-type headache is just a less severe expression of menstrual migraine.
Don’t get me wrong, this is my clinical experience also. I see women whose menstrual headaches vary in severity from one cycle to the next, and some women whose headaches are less severe than those in other women, so Yes, it can present as what is considered a tension-type headache (but its not tension!).
What is needed is to determine the source of the sensitisation – and basic neuro anatomy and research tells us that neck disorders have the potential to sensitise the brainstem.
Cheers
Dean
(Arjona A et al. Menstrual Tension-Type headache: Evidence for Its Existence. Headache 2007;47:100-103)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
The ‘Triptans’ and Menstrual Migraine
August 13, 2009 by dean · Leave a Comment
It’s interesting to read that the ‘triptans’ are also effective in managing menstrual migraine, suggesting that the underlying cause for migraine, tension headache and menstrual migraine is similar, that is, a sensitised brainstem.
One underestimated source of sensitisation are neck disorders …. tired of playing around with your hormonal levels? Perhaps it is your neck that is sensitising your brainstem – a skilled examination will either confirm or eliminate this as a possibility.
Cheers
Dean
(Mannix LK, Files J. The use of triptans in the management of menstrual migraine. CNS drugs 2005;19(11):951-972)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
The Triptans, Migraine and Sinus Headache
August 7, 2009 by dean · Leave a Comment
It has been claimed that the effectiveness of the triptans in someone experiencing facial pain does not exclude a diagnosis of ‘sinus’ headache because it has been shown that the ‘triptans’ do relieve the pain of sinusitis. Whilst this is true (because abnormal information from a diseased, infected sinus will sensitise the brainstem and the ‘triptans’ desensitise the brainstem), the relief from pain will not continue once the effect of the ‘triptans’ has worn off if the facial pain were coming from an infectious condition – the triptans are not an antibiotic.
But why take a ‘triptan’ when an examination of the neck will confirm in most cases, in my clinical experience of over 13000 hours, a neck disorder as the sensitising source in the headache and migraine process?
Cheers
Dean
(Hoskin KL, Kaube H, Goadsby PJ. Sumatriptan can inhibit trigeminal afferents by an exclusively neural mechanism. Brain1996; 119:1419-28
Kari E, DelGaudio JM. Treatment of sinus headache as migraine: the diagnostic utility of triptans. Laryngoscope 2008 Dec;118(12) :2235-9
Kim H. The characteristics of sinus headache resembling the primary headaches. Nippon Rinsho 2005 Oct;63(10):1771-6)
Chronic Sinusitis is Uncommon
August 4, 2009 by dean · Leave a Comment
Neck disorders sensitise the brainstem
Over 90% of diagnosed sinus headaches present in the same way as migraine headache and that given that the majority of ‘sinus’ headaches respond to the ‘triptans’, they can be classified as migraine. Why then are 61% of patients given antibiotics for a non-infectious condition?!
It is more responsible to identify the source of the sensitisation and …. neck disorders sensitise the brainstem! All that is required is for a competent headache practitioner to examine your neck.
Cheers
Dean
(Cady RK, Schreiber CP. Sinus headache: a clinical conundrum. Otolaryngol Clin North Am 2004 Apr;37(2):267-88
Goldhammer L. Second cervical root neurofibroma and ipsilateral migraine headache. Cephalalgia 1993; 13:132
Jansen J, Markakis E, Rama B, Hildebrandt J. Hemicranial attacks or permanent hemicrania – a sequel of upper cervical root compression. Cephalalgia 1989; 9:123-30
Tepper SJ. New thoughts on sinus headache. Allergy Asthma Proc 2004 Mar-Apr;25(2):95-96 ;
Ward TN, Levine M. Headache caused by a spinal cord stimulator in the upper cervical spine. Headache 2000; 40:689-91)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Menstrual Migraine
July 31, 2009 by Dean Watson · Leave a Comment
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Identifying Headache and Migraine
July 29, 2009 by Dean Watson · Leave a Comment
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Diagnosing Headache and Migraine – Is It Useful?
July 18, 2009 by dean · Leave a Comment
Diagnosing headache and migraine provides a label – that is all.
Evidence is mounting to support the concept that headache and migraine originates from a single condition – sensitisation of the brainstem – and that the various types of headache and migraine are different presentations of this condition.
What is more important than a diagnosis is to determine the cause of the sensitisation and then address this.
Case reports demonstrating relief of migraine (and cluster headache) symptoms after blocking or suppressing (abnormal) information from the upper neck, clearly indicate that neck disorders are capable of sensitising the trigemino-cervical nucleus (brainstem) – this is easy to confirm or rule out – by having your neck examined by a practitioner experienced in assessment of the upper cervical spine.
Cheers
Dean
(Anderson CD, Franks RA. Migraine and tension headache: is there a physiological difference? Headache 1981; 21:63-71
Cady RK, Gutterman D, Saires JA, Beach ME. Responsiveness of non-IHS migraine and tesnion-type headache to sumatrptan. Cephalalgia 1997;17:588-90
Cady R, Schreiber C, Farmer K, Sheftell F. Primary headaches: a convergence hypothesis. Headache 2002; 42:204-16
Featherstone HJ. Migraine and muscle contraction headaches: a continuum. Headache 1985; 25:194-198
Featherstone HJ. Migraine and muscle contraction headaches: a continuum. Headache 1985; 25:194-8
Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders, 2nd edn. Cephalalgia 2004; 24(suppl.1):1-151
Jull G, Bogduk N, Marsland A. The accuracy of manual diagnosis for cervical zygapophyseal joint pain syndromes. Med J Aust. 1988 Mar 7;148(5):233-6
Katsavara Z, Lehnerdt G, Duda B, Ellrich J, Diener HC, Kaube H. Sensitization of trigeminal nociception specific for migraine but not pain of sinusitis. Neurology 2002; 59:1450-1453
Katsavara Z, Giffin N, Diener HC, Kaube H. Abnormal habituation of ‘nociceptive’ blink reflex in migraine – evidence for increased excitability of trigeminal nociception. Cephalalgia 2003; 23:814-819
Kaube H, Katasavara Z, Przywara S, Drepper J, Ellrich J, Diener HC. Acute migraine headache. Possible sensitization of neurons in the spinal trigeminal nucleus? Neurology 2002; 58:1234-1238
Marcus DA. Migraine and tension-type headaches: the questionable validity of current classification systems. Clin J Pain 1992; 8:28-36
Marcus D, Scharff L, Mercer S, Turk D. Musculoskeletal abnormalities in chronic headache: a controlled comparison of headache diagnostic groups. Headache 1999; 39:21-27
Mercer S, Marcus DA, Nash J. Cervical musculoskeletal disorders in migraine and tension-type headache. Paper presented at the 68th Annual Meeting of the American Physical Therapy Association; 1993; Cincinatti, Ohio
Milanov I, Bogdanova D. Trigemino-cervical reflex in patients with headache. Cephalalgia 2003; 23:35-38
Nardone R, Tezzon F. The trigemino-cervical reflex in tension-type headache. European Journal of Neurology 2003; 10(3):307-312
Nardone R et al Trigemino-Cervical Reflex Abnormalities in Patients with Migraine and Cluster Headache. Headache 2008; 48(4):578-585
Nelson CF. The tension headache, migraine headache continuum: A hypothesis J Manipulative Physiol Ther 1994; 17:156-167
Sandrini G, Cecchini AB, Milanov I, Tassorelli C, Buzzi MG, Nappi G. Electrophysiological evidence for trigeminal neuron sensitisation in patients with migraine. Neurosci Lett 2002; 317:135-138
Sjaastad O, Fredricksen TA, Pfaffenrath V. Cervicogenic headache: diagnostic criteria. Headache 1998; 38:442-5
Vernon H, Steiman I, Hagino C. Cervicogenic dysfunction in muscle contraction headache and migraine: A descriptive study. J Manipulative Physiol Ther 1992; 15:418-429)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Anaesthetising Neck Structures Cease the Hemiplegic Aura of Migraine
July 17, 2009 by dean · Leave a Comment
Selected neck structures were anaesthetised
In a recent report anaesthetising selected neck structures ceased the hemiplegic aura in a two migraine patients.
This patients’ auras comprised slight weakness, tingling and or numbness involving one side of the body, and face. Within 5 minutes of injecting a local anaesthetic the auras ceased and were not followed by their usual pain states.
I have on two occasions prevented auras from developing, in fact they ceased within 5 minutes after mobilising the upper cervical spine – and furthermore the usual pain did not occur. My experience and what is reported in this case study suggests that abnormal information from a neck disorder could be sensitising the brainstem and suppressing it, preventing the migraine occurring.
I have mentioned temporary reproduction of familiar pain as a key diagnostic sign for cervicogenic headache; in a significant proportion of patients suffering migraine with aura it is also possible to temporarily reproduce their auras with subsequent lessening (as the examination technique is sustained) when examining the upper neck – once again this is a good sign and confirms cervicogenic factors as the source of sensitisation.
It is not necessary for confirmation to have invasive (nerve block) procedures …
Cheers
Dean
(Jull G, Bogduk N, Marsland A. The accuracy of manual diagnosis for cervical zygapophyseal joint pain syndromes. Med J Aust. 1988 Mar 7;148(5):233-6
Rozen T. Cessation of hemiplegic migraine auras with greater occipital nerve blockade. Headache 2007;47:917-928)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Diagnosing Headache and Migraine From Symptoms is Complex
July 16, 2009 by dean · Leave a Comment
Diagnosing headache and migraine is complex primarily because of overlapping symptoms (which once again suggests that there is a common mechanism involved in headache and migraine), leading to misdiagnosis.
In a recent trial, four females with a diagnosis of migraine, and in whom migraine therapies had not any substantial effect, were found to have significant signs of cervical (neck) involvement. After anaesthetising (numbing) the occipital nerve with a local anaesthetic, which prevents information from selected neck structures entering the brainstem, all four patients achieved either complete or substantial relief for up to 2 months.
The authors concluded that at least some migraine is misdiagnosed and is in fact a cervicogenic (neck-related) headache – this can be easily determined by a skilled examination of the upper cervical spine and temporarily reproducing familiar headache or migraine pain.
I have done this in the presence of international research organisations, respected researchers and headache and migraine authorities in Australia, Norway and the UK – this is what I teach on my courses in the UK and Europe.
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
Jull G, Bogduk N, Marsland A. The accuracy of manual diagnosis for cervical zygapophyseal joint pain syndromes. Med J Aust. 1988 Mar 7;148(5):233-6
Katsavara Z, Giffin N, Diener HC, Kaube H. Abnormal habituation of ‘nociceptive’ blink reflex in migraine – evidence for increased excitability of trigeminal nociception. Cephalalgia 2003; 23:814-819
Katsavara Z, Lehnerdt G, Duda B, Ellrich J, Diener HC, Kaube H. Sensitization of trigeminal nociception specific for migraine but not pain of sinusitis. Neurology 2002; 59:1450-1453
Kaube H, Katasavara Z, Przywara S, Drepper J, Ellrich J, Diener HC. Acute migraine headache. Possible sensitization of neurons in the spinal trigeminal nucleus? Neurology 2002; 58:1234-1238
Milanov I, Bogdanova D. Trigemino-cervical reflex in patients with headache. Cephalalgia 2003; 23:35-38
Nardone R et al Trigemino-Cervical Reflex Abnormalities in Patients with Migraine and Cluster Headache. Headache 2008; 48(4):578-585
Nardone R, Tezzon F. The trigemino-cervical reflex in tension-type headache. European Journal of Neurology 2003; 10(3):307-312
Sandrini G, Cecchini AB, Milanov I, Tassorelli C, Buzzi MG, Nappi G. Electrophysiological evidence for trigeminal neuron sensitisation in patients with migraine. Neurosci Lett 2002; 317:135-138
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 misdiagnosis? J Pain. 2005 Oct;6(10):700-3)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Migraine and Cervicogenic Headache
June 29, 2009 by dean · Leave a Comment
Whilst teaching in the UK recently I had the privilege of attending a Headache and Migraine Clinic at one of the major teaching hospitals in London.
The consultant neurologist and I examined nine migraine sufferers and I was able to temporarily reproduce their migraine pain, and furthermore this pain lessened as I maintained the technique.
This in my experience confirms significant cervicogenic (neck) involvement and according to The International Headache Society is a key diagnostic feature of cervicogenic headache. The conclusion of the consultant neurologist was that these patients had cervicogenic headache as well as migraine!
Why can’t cervicogenic (neck) disorders be the cause of the key feature of migraine – a sensitised brainstem? The answer I am constantly given …. “whilst we don’t know where migraine comes from it can’t come from the neck.” This is not a particularly useful answer ….
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
Sjaastad O, Fredricksen TA, Pfaffenrath V. Cervicogenic headache: diagnostic criteria. Headache 1998; 38:442-5)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.