Are Whiplash Associated Headache, Cervicogenic Headache and Tension-Type Headache the same? Yes!

September 24, 2009 by dean · Leave a Comment 

A motor vehicle injury can result in allodynia

A motor vehicle injury can result in allodynia

Five patients who had developed headaches following a head and neck injury after a motor vehicle injury – the headaches had the same characteristics of tension-type headache.

Furthermore on examination it was found that they were all experiencing ‘allodynia’ (excessive tenderness to normal pressure). Allodynia is considered to be a sign of sensitisation of the brainstem. The area of allodynia suggested that it was as result of abnormal information from injuries sustained by structures in the neck.

This study further confirms that disorders of the neck are responsible for so-called ‘tension-type’ headache and that abnormal information from injured neck structures can sensitise the brainstem – a phenomenon which is evident not only in tension headache but also migraine, menstrual migraine and cluster headache ….. and that whiplash associated  headache exists!

Cheers

Dean

(Baruah JK and Baruah GR. Post traumatic headache and allodynia. Cephalalgia, 2009; 29(Suppl. 1):1–166

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

Varlibas A, Erdemoglu Ak. Altered trigeminal system excitability in menstrual migraine patients. The Journal of Headache and Pain 2009; 10(4):277-282)

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

Sensitisation in Headache and Migraine

September 22, 2009 by dean · Leave a Comment 

I have mentioned in my previous blogs that sensitisation of the brainstem has been demonstrated in migraine, tension headache, menstrual migraine and cluster headache.

What I may not have made clear is that this sensitised state is present even when you are free of your headache or migraine, that is, your brainstem is sensitised constantly.

Then what happens is that you eat or drink something, your hormonal levels change, you smell a perfume – and this triggers your headache or migraine. These events lead to increased (but normal) activity of structures (including blood vessels) inside your head.

This increased activity is wrongly interpreted as being much more than what it actually is and pain results. If it wasn’t for your sensitised brainstem, what you eat, drink, smell or hormonal fluctuations would not result in the disabling headache or migraine.

If you are going to be free of your headache or migraine, the source of sensitisation has to be determined. Whilst the triptans desensitise the brainstem and are effective for many of you, they do not eliminate the cause of the sensitisation.

Information from neck disorders can sensitise the brainstem and of all the various investigations you may have for your headache of migraine, a skilled examination of your upper neck is relatively inexpensive and non invasive, and may change your life significantly.

Cheers

Dean

(Goldhammer L. Second cervical root neurofibroma and ipsilateral migraine headache. Cephalalgia 1993; 13:132

Hoskin KL, Kaube H, Goadsby PJ. Sumatriptan can inhibit trigeminal afferents by an exclusively neural mechanism. Brain1996; 119:1419-28

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

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

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

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.

Migraine And Cluster Headache Are ‘First Cousins’!

September 19, 2009 by dean · Leave a Comment 

Migraine sufferers experience many symptoms

Migraine sufferers experience many symptoms

As I have mentioned in many of my previous reports, my clinical experience agrees with the research which shows that the many different forms of headache and migraine share the same ‘heritage’ or disorder i.e. a sensitised brainstem.

This recent study which surveyed 76 Cluster Headache sufferers showed that nausea, vomiting, photophobia and phonophobia were reported by 41%, 24%, 49% and 46% respectively of the patients. Aura occurred in 28% of the patients and visual symptoms were reported most frequently.

Those of you who are migraine sufferers will be familiar with the symptoms mentioned above (!)

This is further evidence supporting a common, shared mechanism for headache and migraine.

Cheers

Dean

(Wober C and Knopf A. Migrainous features in cluster headache. Cephalalgia 2009;29 (Suppl. 1):1–166)

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

Cluster Headache Eased By Treating Cervicogenic (Neck) Disorders

September 17, 2009 by dean · Leave a Comment 

Cluster Headache is a severe, nasty, form of headache

Cluster Headache is a severe, nasty, form of headache

Cluster Headache is a very severe, nasty, form of headache which is often unresponsive to traditional (typically medication) treatments.

My clinical experience (examining the upper neck) comprising temporary reproduction of headache and also of the associated features i.e. watery eye, blocked, congested or runny nostril, and subsequent successful treatment, suggests that cervicogenic disorders can be responsible for this debilitating type of headache.

Cluster headache sufferers who either could not tolerate the side effects of the medication or their headaches were not responsive to medication, responded to blocking information from structures (joints, ligaments, muscles etc) of the upper neck. These studies support my clinical experience and my claim that the upper necks of cluster headache sufferers should be examined for relevant disorders.

Cheers

Dean

(Gaul C, Muller O, Gasser T, Diener H-C, Katsarava Z. Bilateral occipital nerve stimulation for chronic cluster headache. Cephalalgia 2009;29 (Suppl. 1):1–166

Lara Lara M, Paz Solis J, Ortega-Casarubios MA, Palao , Tarrero A, Heredero J, Diez-Tejedor E. Occipital nerve stimulacion: is peripheral approach effective in cluster headache? Cephalalgia 2009;29 (Suppl. 1):1–166)

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

Cluster Headache In 2 Year Old Girl!

September 13, 2009 by dean · Leave a Comment 

Cluster Headache in 2.5 year old

Cluster Headache in 2year old

This is amazing!

Whilst I have treated a 3 year-old girl with ‘migraine’ (i.e.one-sided headache with nausea and vomiting) I have never come across this before.

The authors describe that it was difficult to make a diagnosis in such a young patient (given that in adults it is fraught with difficulty!) due to the lack of patient’s inability to describe symptoms well. However it appears that it was the associated symptoms (redness of the eye, tearing of the eye, swelling of the eyelid and itching of the nostril) which enabled a clear diagnosis of cluster headache to be made.

Cheers

Dean

(M Kacinski, A Nowak, S Kroczka & A Gergont. Cluster headache in 2-year-old Polish girl. Cephalalgia 2009;29:1091-1094)

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


The Enormous Amount of Research

September 6, 2009 by dean · Leave a Comment 

Despite the enormous amount of research into the various forms of headache and migraine their cause remains a mystery.

To help you, the headache or migraine sufferer know the source of you pain as precisely as possible, latest research into headache and migraine is summarised on this website.

This includes research into migraine, tension-type headache, cluster headache, paroxysmal headache, hemicrania continua, post-traumatic headache, menstrual migraine, sinus headache and cervicogenic (neck) headache.

Cheers

Dean

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

Chronic Paroxysmal Hemicrania, Hemicrania Continua and Cluster Headache – All From The Same Disorder?

September 2, 2009 by dean · Leave a Comment 

In recent times the International Headache Society has added a third primary group of headache(s) to the two primary headache types – migraine and tension-type headache.

This third primary group includes Cluster headache, Chronic Paroxysmal Hemicrania, and SUNCT (Short lasting Unilateral Neuralgia form headache attack with Conjunctival injection and Tearing!) and Hemicrania Continua.

Chronic Paroxysmal Hemicrania is very similar to Cluster Headache and is often described as the female equivalent of Cluster Headache (Cluster Headache is more frequent in males).

It is interesting to note a report demonstrating that both chronic Paroxysmal Hemicrania and Hemicrania Continua (thought to be two different types of headache) respond to the same medication – Indomethacin. (Indomethacin is a non steroidal anti inflammatory drug used to reduce pain)

I have written before that Cluster Headache and Hemicrania Continua respond to blocking or injecting of the greater occipital nerve i.e. a feature of Cervicogenic (neck-related) Headache – just more evidence to support the role of neck disorders in many different headache forms …..

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, Antonaci F. Paroxysmal Hemicrania (CPH) and Hemicrania Continua: Transition From One Stage to Another. Headache 1993;(33)10:551-554)

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

Headache, Migraine and Auras

August 23, 2009 by dean · Leave a Comment 

As I have mentioned previously, recent and substantial research demonstrates that the different types of headache and migraine develop from a common, shared disorder, and that this disorder is sensitisation of the brainstem.

Auras, which initially were thought to only accompany migraine and menstrual migraine, have now been reported in Cluster Headache and Hemicrania Continua, and provides further evidence that the various forms of headache and migraine are likely to originate from common disorder.

Cheers

Dean

(Bahra A, May A, Goadsby PJ. Cluster headache: a prospective clinical study with diagnostic implications. Neurology 2002;58:354-361

Peres MFP, Siow HC, Rozen TD. Hemicrania continua with aura. Cephalalgia 2002;22:246-248

Silberstein SD, Niknam R, Rozen TD, Young WB. Cluster headache with aura. Neurology 2000;54:219-221)

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

Cluster Headache Following Trauma

August 12, 2009 by dean · Leave a Comment 

Clinical experience suggests a skilled examination of the neck in cluster headache sufferers

Clinical experience suggests a skilled examination of the neck in cluster headache sufferers

My experience with cluster headache includes a patient who developed cluster headache 2-3 months after a whiplash accident – and treatment of his subsequent neck disorder has meant that he has been pain-free for 5 years.

A recent case study describes the onset of cluster headache after mild head trauma – and whilst most attention is given to the possibility of some trauma to structures inside the head, the neck has to stop either the moving head in relation to the body or the body in relation to the head and (the neck) is likely to be injured.

My clinical experience suggests that it is important for a skilled examination of the neck in cluster headache sufferers.

Cheers

Dean

(Lambru G et al. Post-Traumatic Cluster Headache: From the Periphery to the Central Nervous System? Headache 2009;(49)7:1059-1061)

© 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.