Exertional Headache, Migraine and the Neck
August 26, 2009 by dean · Leave a Comment
"Exertional Headache"
‘Benign’ (or harmless) Exertional Headache is defined as headache caused by exertion such as coughing, sneezing, bending, heavy lifting, running (how is this different to headache triggered by exercise?) or when straining at stool.
It is important that if your headache history is less than 3 months and is triggered or aggravated by these activities that you consult you doctor.
These activities create similar effects on the body as do the Valsalva manoeuvers.
Recent research1 found a wide range of symptoms in Exertional Headache, some with migrainous symptoms, and the authors suggested that the ‘triptans’ might be useful. As usual there is a lot of discussion as to the actual mechanism of Exertional Headache and indeed Exercise Induced Headache, but the causes remain unknown – why?
The Valsalva manoeuver is used (and has been for years) to identify problems or injury in the nerves of the cervical spine. Upon the exertion of pressure, pain may be felt, and may indicate increased pressure on the C2-3 intervertebral disc or other part of a cervicogenic (neck) disorder.
Clearly increased headache or headache or migraine triggered by exertion or exercise is likely to be caused by a neck disorder.
Cheers
Dean
(Chen S-P, Fuh J-L, Lu S-R, Wang S-J. Exertional headache – a survey of 1963 adolescents. Cephalalgia 2008; 29:401-407
Johnson RH, Smith AC, Spalding JM (February 1969). “Blood pressure response to standing and to Valsalva’s manoeuvre: independence of the two mechanisms in neurological diseases including cervical cord lesions”. Clin Sci 36 (1): 77–86)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Migraine Aura Eliminated by Blocking the Greater Occipital Nerve
August 10, 2009 by dean · Leave a Comment
Neck disorders can be significant in the headache and migraine process
Not only can the pain of migraine be relieved by injecting the greater occipital nerve but also the aura.
In two patients with hemiplegic migraine their aura symptoms were completely stopped within 5 minutes and without the usual following headache.
Interestingly this is very similar to my clinical experience. I have had the opportunity to treat two patients within 5 minutes of an (visual) aura starting. Within 5 minutes of mobilising their upper cervical spine, their auras had stopped and in both patients, the headache that usually follows did not happen.
This provides further support that neck disorders can be significant in the headache and migraine process.
Cheers
Dean
(Rozen T. Cessation of Hemiplegic Migraine Auras With Greater Occipital Nerve Blockade. Headache 2007;47:917-919)
© 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.
Are Cervicogenic Disorders the Common Cause of Headache and Migraine?
July 7, 2009 by dean · Leave a Comment
The Upper Cervical Segments
A study of tension headache and migraine sufferers has demonstrated significant abnormalities of the neck – including a loss of normal lordosis (the natural inward curve of the neck) and restricted movement of the upper two spinal segments. These findings suggest that both migraine and tension headache share a common cause – disorders of the cervical spine – supporting the premise that the neck plays an important, but largely ignored role in causing headache and migraine.
Meanwhile this debate doesn’t help you as a headache or migraine sufferer!
Temporary reproduction of familiar headache or migraine pain when gently stressing movements of the upper cervical spine can confirm cervicogenic dysfunction as the source of your headache or migraine.
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
Pavese N, Bibbiani F, Nuti A, Bonuccelli U. Sumatriptan in cervicogenic headache. Proceedings European Headache Federation 2nd International Conference 1994; Abstract 131
Sjaastad O, Fredricksen TA, Pfaffenrath V. Cervicogenic headache: diagnostic criteria. Headache 1998; 38:442-5
Vernon H, Steimann I, Hagino C. Cervicogenic dysfunction in muscle contraction headache and migraine: a descriptive study. J Manip Physiol Ther 1992 15:7: 418-29)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.