Is Migraine Inherited?

December 7, 2009 by dean · Leave a Comment 

Is migraine inherited?

Is migraine inherited?

In a previous post I mentioned a recent survey which reported that 40 per cent of females will experience migraine in their lifetime.

Why is it then, that if three females in a family of ten for example, the assumption is often made that migraine is inherited? This incidence is no more than what occurs in the general population.

This assumption immediately leads to “ …. well you just have to live with it; there’s nothing we can do but manage the attacks.” This is a life sentence and not necessarily the case.

A skilled examination of the neck will confirm or eliminate cervicogenic disorders as the cause of your migraine condition.

Cheers

Dean

(Stewart WF, Wood C, Reed ML, Roy J, Lipton RB. Cumulative lifetime migraine incidence i women and men. Cephalalgia 2008;28:1170-1178)

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

Exertional Headache, Migraine and the Neck

August 26, 2009 by dean · Leave a Comment 

"Exertional Headache"

"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.

Greater Occipital Nerve Blocks Relieve Migraine and Cluster Headache

August 11, 2009 by dean · Leave a Comment 

Another example of migraine headache being relieved within 30 seconds after injection of the greater occipital nerve.

Need I say more ….. just part of the overwhelming evidence for cervicogenic involvement in migraine …. but there is more!

Blocking the greater occipital nerve in 14 cluster headache patients substantially decreased their symptoms with the researchers suggesting that this procedure is a significant treatment option i.e. eliminating information from structures of the upper neck leads to relief from cluster headache …..

Cheers

Dean

(Young WB et al. Greater Occipital Nerve and Other Anesthetic Injections for Primary Headache Disorders. Headache 2008;48:112-1125 : Peres MF. et al Greater occipital nerve blockade for cluster headache. Cephalalgia 2002;22:520-522)

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

Tension and Headache

July 27, 2009 by Dean Watson · Leave a Comment 

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Treating the Neck Can Eliminate Migraine Symptoms

July 22, 2009 by dean · Leave a Comment 

Interesting to note that by blocking or ‘numbing’ the greater occipital nerve, the pain of migraine, sensitivity to light and tendereness are all significantly reduced – further evidence to support that abnormal cervicogenic (neck) information could be the source of sensitisation in the migraine process.

Cheers

Dean

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

Alternating Headache

July 21, 2009 by Dean Watson · Leave a Comment 

© 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 

Anaesthetising Neck Structures

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.

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.

Welcome Headache and Migraine Sufferers

June 9, 2009 by dean · Leave a Comment 

In 1991 I embarked on a path that was to become the greatest challenge of my life, establishing The Headache Clinic, www.headacheclinic.com.au, in Adelaide, South Australia, in 1991.   The fundamental purpose of The Headache Clinic was and is determining whether or not a neck (cervicogenic) disorder is the cause of or a significant contributing factor to headache or migraine.

We are the sum of our experiences — and my unparalleled clinical experience (having consulted over 7000 headache and migraine patients – in excess of 28000 treatments – with a range of diagnoses) suggests that neck (cervicogenic) dysfunction is significantly underestimated and can be the cause of various forms of headache and migraine. I believe therefore, that, in the presence of negative medical tests, the necks of all (primary) headache and migraine sufferers should be examined, irrespective of the diagnosis. Whilst this challenges traditionally held medical beliefs, it is incumbent to not only pass on this experience to my colleagues and headache and migraine sufferers, but to support this experience with rigorous scientific research (I am currently a PhD Candidate investigating the role of cervicogenic dysfunction in the mechanism of migraine at Murdoch University, Western Australia).

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. How much longer do we accept the notion that ‘whilst we do not know what causes migraine it can’t come from the neck’?

Over the past 15 years I have developed a series of techniques, which, by way of temporary reproduction of headache and easing of the headache as a technique is sustained, confirm that a neck disorder is the cause of or a significant factor in the mechanism of the headache or migraine – this a key diagnostic criterion for cervicogenic or neck involvement in headache according to the International Headache Society – importantly for the disorder to be related to the headache or migraine process the headache has to ease as the technique is maintained. If both reproduction and lessening are not possible then the neck may not be the source of the headache or migraine. Furthermore my experience has shown that if the techniques are performed in a specific manner it is possible to determine which spinal segment is the cause of or contributing significantly to headache and migraine. Having determined which spinal segment (or segments — there may be more than one) is involved then this significantly increases the chance of the treatment being successful because treatment can be directed at specific, relevant spinal segments.

The application of these techniques in Europe, United Kingdom and Australia has become known as the ‘Watson Headache Approach’ and forms the basis of courses I present for physiotherapists, chiropractors and osteopaths in Australia, New Zealand, Hong Kong, Singapore, United Kingdom, Northern Ireland, Belgium, The Netherlands, Switzerland, Germany, Norway and Spain — refer  www.headacheeducation.com and www.headacheandmigraine.com for International Practioner Directory.

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.

Dean Watson

Consultant Headache and Migraine Physiotherapist; Adjunct Lecturer, Masters Program, School of Physiotherapy, University of South Australia; PhD Candidate, Murdoch University, Western Australia

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