The Headache and Migraine Sufferers Bill of Rights (cont)

December 2, 2009 by dean · Leave a Comment 

The first ‘bill’ is that the headache sufferer has the right to know his/her headache diagnosis as precisely as possible, and to know the nature of the headache disorder, its prognosis and the possible types of treatment.

I have discussed the first point regarding diagnosis; now

to know the nature of the headache disorder

Clearly there is a substantial body of research which shows that the brainstems of Migraine, Tension Headache and Menstrual Migraine sufferers are sensitised.

We know that the ‘triptans’ desensitise the brainstem and are effective in preventing Migraine, Tension Headache, Cluster Headache, Hemicrania Continua, Menstrual Migraine, Cervicogenic (neck-related) Headache (which shows that cervicogenic disorders can sensitise the brainstem) ……

The underlying disorder is sensitisation of the brainstem; optimal management therefore is identifying the reason for the sensitisation ….

Stay tuned,

Cheers

Dean

(Members’ Handbook. International Headache Society 2000 Scandinavian University Press)

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

Headache and Migraine Sufferers ‘Bill of Rights’

December 1, 2009 by dean · Leave a Comment 

is likely to respond to treatment of relevant neck disorders.

Is a diagnosis important?

Some time ago (2000), the International Headache Society, published a Headache Sufferers ‘Bill of Rights’.

The first ‘bill’ is that the headache sufferer has the right to know his/her headache diagnosis as precisely as possible, and to know the nature of the headache disorder, its prognosis and the possible types of treatment.

I would like to spend the next few posts looking more closely at these points:-

“the headache sufferer has the right to know his/her headache diagnosis as precisely as possible”

diagnosis is difficult because it is based on a set of signs and symptoms, and the signs and symptoms of many different headache and migraine forms overlap – perhaps that is why many headache sufferers have been given 2, 3 or even 4 different diagnoses

not only do we have ‘Pure’ Menstrual Migraine, but now ‘MRM’ i.e. Menstrual Related Migraine, Menstrual Tension Headache, Menstrual Hemicrania Continua, Cluster Headache associated with menstruation etc and this is just headache or migraine supposedly associated with the menstrual cycle

the ‘triptans’, supposedly developed to stop the migraine process are effective in other forms of headache e.g. Menstrual Migraine, Cluster Headache, Cervicogenic Headache, and Hemicrania Continua

different headache and migraine forms responding to a range of cervicogenic (neck) treatments e.g. greater occipital nerve blocks, cervical spine stimulators

Is a diagnosis important? As far as I can see, and given the research, a diagnosis does not optimise the management of headache or migraine – it remains a ‘let’s try this and wait and see’ approach – clearly an unsatisfactory situation.

Cheers

Dean

(Members’ Handbook. International Headache Society 2000 Scandinavian University Press)

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

Hemicrania Continua and Cluster Headache

November 25, 2009 by dean · Leave a Comment 

One sided headache is like to respond to neck treatment

One sided headache is likely to respond to neck treatment

Are They Related to Cervicogenic Headache?

A diagnosis of Hemicrania Continua just means you have constant pain on one side of your head (just like Cluster Headache) and shares other similar symptoms with Cluster Headache.

Cervicogenic (neck-related) headache, according to the medical model of headache and migraine, is also a one sided headache.

Research shows that Cluster Headache can be relieved by treating the neck and therefore because of the similarity of Hemicrania Continua to Cluster Headache, Hemicrania Continua.

To review the list of posts related to Hemicrania Continua go to the ‘Home Page’ and you can key in ‘ Hemicrania Continua’.

Cheers

Dean

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

Chronic Paroxysmal Headache and Cluster Headache

November 20, 2009 by dean · Leave a Comment 

Just because Chronic Paroxysmal Headache responds the non steroidal anti inflammatory medication and Cluster Headache does not, is no reason to consider it to be no more than just a different expression of the same condition.

To review my posts on Chronic Paroxysmal Headache refer to the ‘Home Page’ and key in ‘Chronic Paroxysmal Headache’ to view the list.

Cheers

Dean

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

Cluster Headache – Another Headache or Migraine

November 12, 2009 by dean · Leave a Comment 

Tension Headache and Migraine are recognised as the most common forms of headache.

Cluster headache is one of the third ‘group’ of headaches – the other headache types in this group are Hemicrania Continua, Chronic Paroxysmal Hemicrania, and SUNCT.

All of the headache types in this third group share similar symptoms with Cluster Headache and either blocking or modifying information from the neck has a beneficial effect on Cluster Headache suggesting that neck disorders not only play a significant role in Cluster headache but perhaps the others(?)

To review the posts on Cluster Headache return to the ‘Home Page’ and key in the search term ‘Cluster Headache’.

Cheers

Dean

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

Treating Headache and Migraine with Greater Occipital Nerve Blocks

November 10, 2009 by dean · Leave a Comment 

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.

Diagnosing Cluster Headache

November 9, 2009 by dean · Leave a Comment 

Diagnosing Cluster Headache

Diagnosing Cluster Headache

I have mentioned before that diagnosing headache can be difficult and that many headache sufferers on their journey have been given more than one diagnosis. I recently came across some statistics, which although were in relation to diagnosing Cluster Headache, illustrate the complexities and frustrations of headache and migraine diagnosis.

Klapper et al1 using an internet survey investigated the process of diagnosing Cluster Headache. It was revealed that there was an average of 6.6 years’ delay in correct diagnosis. Eighty-seven per cent of Cluster Headache sufferers met the International Headache Society’s criteria for Cluster Headache (and should have been diagnosed by the first physician); an average of 4.3 physicians were seen and an average 3.9 incorrect diagnoses made before diagnosis of Cluster Headache and because of incorrect initial diagnosis, 4% of patients underwent unnecessary surgery.

I find this hard to comprehend. Cluster Headache, because of the redness of the eye and nasal symptoms, is easily recognised.

Cheers

Dean

(Klapper JA, Klapper A, Voss T. The misdiagnosis of cluster headache: a nonclinic, population-based, internet survey. Headache 2000; 40:730–5.)

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

Examining The Neck of a Cluster Headache Sufferer

November 8, 2009 by dean · Leave a Comment 

I was talking to a neurologist when in the UK recently and he mentioned that he was writing a case study of a cluster headache sufferer who has been free of cluster headache since his neck was treated. This is not a surprise to me as cluster headache frequently responds to treatment of relevant neck disorders.

This discussion reminded me of patient I saw when in The Netherlands about 5 years ago. This gentleman was 55 years of age and had suffered cluster headache since he was 25 years of age. His episodes lasted 6 months and occurred every 5 years.

I have mentioned that a key diagnostic finding when examining the upper neck structures is the temporary reproduction of headache and for headache to lessen as the technique is sustained. I examined this man when he was not experiencing an attack. Not only was I able to reproduce his head pain, but his eye started to water and his nose started to run, just as if he was in the middle of an attack – those of you who are cluster headache sufferers will identify with this!

Unfortunately I lost touch with this gentleman so I am not sure of the outcome or if in fact he sought treatment ….. but I would be confident of a successful outcome in experienced hands.

Cheers

Dean

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

Cluster Headache After Mild Head Trauma

October 18, 2009 by dean · Leave a Comment 

Horrible day

Cluster Headache after mild head trauma

In this case study a 48 year old woman developed signs and symptoms of cluster headache after hitting her head on an iron ladder.

The authors consider various possibilities as to the cause, but all related to intra cranial, i.e. inside the head, factors … this pre occupation with intra cranial causes is frustrating on two counts.

Firstly, this woman is still suffering 19 years (Yes – 19!) later, and secondly, that a neck injury has not been considered. Research has shown that symptoms of cluster headache are treated successfully by blocking information from the upper neck indicating that neck disorders can be the source of symptoms.

In instances such as this when there is a blow to the head by a stationary object, clearly the head stops (suddenly and momentarily), and the body continues to move, leaving the neck to absorb the strain, effectively to put the brakes on! This patient has experienced a neck injury and even a minor incident can be much than what it seems especially when the blow is unexpected.

Cheers

Dean

(Lambru G, Castellini P, Manzoni GC, Torelli P. Traumatic Cluster Headache: From the Periphery to the Central Nervous System? Headache 2009;49:1059-1072

Peres MF. et al Greater occipital nerve blockade for cluster headache. Cephalalgia 2002;22:520-522

Solomon S, Lipton RB, Newman LC. Nuchal features of cluster headache. Headache 1990;30:347-9

Tobin J,Stephen Flitman S. Nerve Blocks: When and What to Inject? Headache 2009

Treleaven J, Jull G, Atkinson L. Cervical musculoskeletal dysfunction in post-concussional headache. Cephalalgia 1994;14:273-9)

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

Cluster Headache and Migraine Are Related

October 8, 2009 by dean · Leave a Comment 

Cluster headache sufferers experience one or more migrainous features

Cluster headache sufferers experience one or more migrainous features

In 155 cluster headache patients almost 25% experienced one or more migrainous features, including nausea/vomiting were present in 18.1%, photophobia (sensitivity to light) in 12.3%, phonophobia (sensitivity to sound) in 5.2%, osmophobia (sensitivity to smells) in 0.6% and aura in 2.6% of patients.

The authors suggest that migrainous features are common in cluster headache sufferers and that they are underestimated.

The results of this survey support my clinical experience, and the recent research, which demonstrates that the various forms of headache and migraine share a similar mechanism.

Cheers

Dean

(Zidverc-Trajkovic J, Sundic A, Radojicic A and Sternic N. Cluster headache: the signi?cance of the ‘‘migraineous’’ phenomena Cephalalgia 2009;29 (Suppl. 1):1–166)

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