Neck Pain is the Cause of Worsening Migraine

October 14, 2009 by dean · Leave a Comment 

Neck Disorders can be part of the migraine process

Neck Disorders can be part of the migraine process

How refreshing to find other researchers who also believe that cervicogenic (neck) disorders can be part of the migraine process – we are few and far between!

Calhoun and Ford (whose research I have quoted recently), investigated the incidence of neck pain on wakening in 113 migraineurs. They found that the more chronic the migraine the more likely that neck pain would be present on wakening; and that the presence of neck pain on wakening increases the likelihood of waking with a migraine as well!

They concluded that either neck pain is a ‘migraine’ in the neck and/or that the presence of neck pain without a migraine is likely to lead to migraine becoming more chronic.

My clinical experience includes treating patients just with pain in the neck but whose neck pain responded to the ‘triptans’ i.e. their ‘migraine’ was in their neck!

Cheers

Dean

(Calhoun AH, Ford S. The prevalence of neck pain on awakening in a cohort of migraineurs Cephalalgia 2009;29(Suppl. 1):1–166)

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

Neck Disorders in Migraine and Chronic Migraine Headache

October 1, 2009 by dean · Leave a Comment 

Neck Disorders are frequently found in migraine sufferers

Neck Disorders are frequently found in migraine sufferers

More evidence from a study in the US which shows that cervicogenic (neck) disorders are frequently found in Migraine and Chronic Migraine sufferers.

Using a special device, muscle tenderness was assessed and found to be significantly increased in both the migraine and chronic migraine groups when compared to non headache subjects.

Why is it that the conclusion was that muscle tenderness results from the migraine process and not the cause of the process?!!!

Cheers  Dean

(Bevilaqua-Grossi D, Moreira VC, Canonica AC, Chaves TC, Goncalves MC, Florencio LL, Bordini CA2, Speciali JG, Bigal ME. Pain thresholds in craniocervical muscles in women with migraine, chronic migraine, and with no headaches. Cephalalgia 2009;29 (Suppl. 1):1–166)

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

Migraine – An Unrecognised Cervicogenic Headache?

September 15, 2009 by dean · Leave a Comment 

Migraine Sufferers have a significantly reduced range of neck movement

Migraine Sufferers have a significantly reduced range of neck movement

It is interesting to note that ongoing investigation into the role of cervicogenic (neck) disorders in migraine sufferers has revealed significantly reduced range of neck movement when compared to non headache sufferers. Just more information to add to the growing body of evidence which supports the possibility that the sensitisation of the brainstem in migraine sufferers may be caused by a neck disorder.

Cheers

Dean

(Bevilaqua-Grossi D, Pegoretti KS, Goncalves MC, Speciali JG, Bordini CA, Bigal ME. Cervical Mobility in Women With Migraine. Headache 2009;49:726-73)

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

Summary of the Watson Headache Institute

September 12, 2009 by dean · Leave a Comment 

The Watson Headache Institute was established to increase the awareness of cervicogenic (neck) disorders in headache and migraine by:

imparting my (and that of others) clinical experience and knowledge

and,

undertaking and supporting rigorous clinical and scientific research in this specialty (I am currently a PhD Candidate investigating the role of cervicogenic dysfunction in the mechanism of migraine at Murdoch University, Western Australia).

and,

in determining whether or not a neck (cervicogenic) disorder is the cause of or a significant contributing factor to headache or migraine.

It is recognised

that neck (cervicogenic) dysfunction is significantly underestimated

that a neck (cervicogenic) dysfunction can be the cause of various forms of headache and migraine.

that the necks of all (primary) headache and migraine sufferers should be examined

To this end it is my objective to pass on this experience to my colleagues and headache and migraine sufferers

because

it is irresponsible to treat irrelevant cervicogenic (neck) dysfunction in migraine and headache conditions.

However

given that the causes of migraine and tension headache are not clear, the advances in our knowledge of pain mechanisms and the not insignificant body research supporting cervicogenic factors as key players in the headache and migraine processes,

it is also irresponsible NOT to examine the necks of headache sufferers irrespective of the diagnosis.

Cheers

Dean

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

What Does Blocking The Greater Occipital Nerve Do?

August 3, 2009 by dean · Leave a Comment 

I have been mentioning the research which shows that by injecting and anaesthetising the greater occipital nerve the migraine process can be halted … so what does this do?

Anaesthetising the greater occipital nerve prevents information from (neck) structures supplied by the nerve from entering into the spinal cord (and the brainstem). The effect of this on migraine and headache symptoms suggests that this information being carried by the nerve was sensitising the brainstem and that by preventing it from reaching the brainstem, the brainstem is no longer sensitised.

This then is considered a diagnostic tool to confirm cervicogenic (neck) disorders in headache and migraine.

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

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;47:917-928

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

Tobin 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.

Is Your Migraine From Your Neck?

August 1, 2009 by dean · Leave a Comment 

Many clinicians have demonstrated that blocking or ‘numbing’ of the greater occipital nerve provides substantial relief from ‘migraine’ in many patients. Researchers have confirmed this experience. Whilst this approach is not available to everyone it does confirm that cervicogenic disorders can be responsible for ‘migraine‘.

OK so a neck disorder has been confirmed – what happens once the anaesthetic has worn off though? A skilled examination of the neck and appropriate treatment often means that ongoing injections will not be necessary (and anyway the number you can have is limited).

However it is not necessary for a nerve block in the first place – an assessment by competent clinicians can confirm or eliminate a neck disorder as the source of symptoms.

Cheers

Dean

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

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

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

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

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.