Identifying Headache and Migraine
July 29, 2009 by Dean Watson · Leave a Comment
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Headache, Migraine and Facial Surgery
July 28, 2009 by dean · Leave a Comment
In survey of 75 patients who had undergone surgery for facial pain all had ongoing symptoms. The researchers concluded that the causes of symptoms were migraine, cluster headache, paroxysmal hemicrania and tension headache, and that sinus surgery in the large majority of patients presenting with facial pain should avoid surgery; that all surgeons when assessing facial pain should be aware of non-sinuonasal diagnoses.
An enlightened ENT Specialist refers patients to me to determine if facial pain is referred from disorders of the upper neck – and more often it is! Temporary reproduction and easing of familiar facial pain when upper neck structures are gently stressed confirms this in the large majority of patients with facial pain.
Cheers
Dean
(Jones NS, Cooney TR. Facial pain and sinonasal surgery. Rhinology 2003 Dec;41(4):193-200)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Cervicogenic (Neck) Involvement in Cluster Headache
July 4, 2009 by dean · Leave a Comment
Research has shown that neck symptoms are common in cluster headache sufferers.
In 100 cluster headache sufferers, 40 and 47 reported neck stiffness and pain respectively whilst neck tenderness was evident in 29. Movement of the neck triggered the attack in 9 sufferers, 16 reported aggravation of symptoms by neck movements (particularly forward bending), whilst neck extension (backward bending) eased symptoms in 16.
Further evidence to support the examination of the neck in cluster headache sufferers … and my clinical experience.
Cheers
Dean
(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)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Headache and Migraine Treatment and the ‘Watson Headache Approach’
June 28, 2009 by dean · Leave a Comment
Further to the article in ‘Frontline’ and in reference to the approach I have developed it is important to clarify that whilst my approach does include a series of techniques which restore movement and maintain natural posture of the upper cervical spine, and whilst they are powerful, they are a small part of what I have developed.
My clinical experience of over 21000 hours with headache and migraine sufferers has demonstrated that neck disorders, as the cause of sensitisation, are significantly underestimated in migraine, tension and cluster headache, menstrual migraine…. sufferers.
There are many ways to treating headache and migraine. My approach is a powerful treatment tool if chosen by Practitioners. What I am primarily passionate about is that many of you are suffering unnecessarily because your necks have not been examined comprehensively and this is the main thrust of my approach.
It is about identifying whether your neck is the source of your headache or migraine before you commence treatment.
How much longer are we to accept the explanation that … “whilst we don’t know where migraine comes from it can’t come from neck disorders” … it is irresponsible, after other investigations have ruled out other causes, for the neck not to be examined. Information from the neck is one of four systems that has the potential to potential to sensitise the brainstem – the feature (sensitisation) that is evident in the common forms of headache and migraine.
Cheers
Dean
(Hunt L. When headache is a pain in the neck. Frontline 2009 17 June; 22-25)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Cluster Headache, Migraine and Tension Headache are related – more evidence ….
June 25, 2009 by dean · Leave a Comment
The brainstem sits at the bottom of the brain
Clinical correspondence in the latest Cephalalgia journal reports the presence of ‘cutaneous allodynia’ in two cluster headache patients.
What is cutaneous allodynia? Cutaneous (relating to or affecting the skin) allodynia (is a painful response to a normally non painful stimulus) so in this case there is a heightened, painful sensitivity to touch. This increased sensitivity to touch, along with other symptoms for e.g. photo-phobia (heightened sensitivity to light) and phono-phobia (heightened sensitivity to sound) is a sign of sensitisation of the brainstem.
Research shows quite clearly that the brainstems of migraineurs and tension headache sufferers are also sensitised …. and what do the ‘triptans’ do? they desensitise the brainstem and that is why they are effective in alleviating the pain in migraine, tension and cluster headache – all three headaches originate from the same condition i.e. a sensitised brainstem.
Cheers
Dean
(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
Nardone R, Tezzon F. The trigemino-cervical reflex in tension-type headache. European Journal of Neurology 2003; 10(3):307-312
Nardone R et al Trigemino-Cervical Reflex Abnormalities in Patients with Migraine and Cluster Headache. Headache 2008; 48(4):578-585
Milanov I, Bogdanova D. Trigemino-cervical reflex in patients with headache. Cephalalgia 2003; 23:35-38
Riederer F, Selekler HM, Sandor PS, Wober C. Cutaneous allodynia during cluster headache attacks. Cephalalgia 2009;29:796-798
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)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Tension Headache, Migraine and Cluster Headache
June 22, 2009 by dean · Leave a Comment
The research clearly shows that the brainstems in tension headache sufferers and migraineurs are sensitised. One of the signs of sensitisation of the brainstem is ‘allodynia’ and therefore is present in tension headache and migraine patients.
What is ‘allodynia’? ‘Allodynia’ refers to excessive tenderness to physical pressure or touch.
Recent, interesting and exciting research has shown that cluster headache sufferers, also present with ‘allodynia’ – suggesting that those who endure cluster headache have sensitised brainstems. This, along with the fact that the ‘triptans’ are also effective in eliminating cluster headache, supports those authorities who suggest that the various types of headache and migraine originate from one condition or disorder – a sensitised brainstem.
Cheers
Dean
(Ashkenazi A, YoungWB. Dynamic mechanical (brush) allodynia in cluster headache. Headache 2004;44:1010-1012.
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, Tezzon F. The trigemino-cervical reflex in tension-type headache. European Journal of Neurology 2003; 10(3):307-312
Nardone R et al Trigemino-Cervical Reflex Abnormalities in Patients with Migraine and Cluster Headache. Headache 2008; 48(4):578-585
Riederer F, Selekler HM, Sandor PS, Wober C. Cutaneous allodynia during cluster headache attacks. Cephalalgia 2009; 29:796–798
Rozen TD, Haynes GV, Saper JR, SheftellFD. Abrupt onset and termination of cutaneous allodynia (central sensitization) during attacks of SUNCT. Headache 2005;45:153-155
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)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Blood Vessels and Migraine
June 11, 2009 by dean · Leave a Comment
Blood Vessels of the Neck and Brain
The medical model of headache and migraine recognizes two conditions – migraine and tension-type headache. Recently the International Headache Society introduced a third ‘group’ of headaches; this group comprises Cluster Headache, Chronic Paroxysmal Hemicrania, SUNCT, and Hemicrania Continua.
In this model, the pain of migraine is considered to be from dilating or expanding arteries inside the head – an assumption based largely on the nature of pain – a throbbing, pulsating pain.
However research has shown:
Blood vessel dilatation persists after head pain has resolved – if dilatation were the cause of the pain one would expect pain to be there if dilatation was present, but this is not the case.
Blood vessel dilatation is not present in all migraineurs during an attack – if it was the cause one would expect it to be present in all sufferers.
Blood vessel dilatation is estimated to be about nine percent – too small to cause the significant pain of migraine?
Pain leads to or causes dilatation, not dilatation first, followed by pain.
Clearly this body of research demonstrates that dilatation of arteries is not the cause of migraine pain – why is it then that some authorities and information sources perpetuate this assumption?
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
Tegeler CH, Davidai G, Gengo FM, Knappertz VA,Troost BT, Gabriel H, Davis RL. Middle cerebral artery velocity correlates with nitroglcerin-induced headache onset. J Neuroimaging 1996; 6(2): 81-6
Thomsen LL, Iverson HK, Olesen J. Cerebral bloodflow velocities are reduced during attacks of unilateral migraine without aura. Cephalalgia 1995; 15(2): 109-116
Thomsen LL. Investigations into the role of nitric oxide and the large intracranial arteries in migraine headache. Cephalalgia 1997; 17:873-95)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.