Successful Headache and Migraine Treatment

December 10, 2009 by dean · Leave a Comment 

Several authorities recently summarised the reasons why headache and migraine treatment often fails.

Amongst other factors, they suggested that the diagnosis is incomplete or incorrect and that this could occur for various reasons.

One of the reasons is ‘misdiagnosis’. I have mentioned this research before but diagnosing headache and migraine is like ‘a dog’s breakfast’; it is all over the place with many patients receiving 2 or 3 diagnoses or patients being misdiagnosed – diagnosed as migraine when in fact it was a cervicogenic (neck-related) headache …..!

The medical profession refuses to acknowledge cervicogenic factors – why? Because relating to it does not fit the medical model and anything that does not fit into the medical model is discarded as unworthy of serious consideration.

The entire diagnostic process needs to be reviewed as well as approaches to treatment. Until cervicogenic factors are considered, headache and migraine treatment will remain unsatisfactory with the only option for you, the headache sufferer, being pharmacological management.

Cheers

Dean

(Lipton RB, Silberstein SD, Saper JR, Bigal ME, Goadsby PJ. Why headache treatment fails. Neurology 2003;60:1064-1070

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.

Optimising Headache and Migraine Treatment

December 6, 2009 by dean · Leave a Comment 

Whilst I was in the UK recently I had the opportunity to meet with several of my accredited practitioners.

I am pleased to say that the results of treatment/feedback from headache and migraine sufferers was amazing. This has increased their (the practitioners’) enthusiasm for a more substantial course (I am already doing two and one day courses).

There was unanimous agreement that it should be a ten day course for small groups of already accredited practitioners. In this course or ‘Master -Class’, the aim would be to examine and treat headache and migraine sufferers on 3-4 occasions, and how to progress from one treatment session to the next.

It was always my aim to develop the best possible teaching model – here it comes! (and it is being driven by practitioners wanting the best possible outcomes for you the headache or migraine sufferer).

Cheers

Dean

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

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.

Migraine and Dizziness

November 29, 2009 by dean · Leave a Comment 

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Dizziness is a symptom that many headache and migraine sufferers experience

Are migraine and dizziness different presentations of a common disorder?

Some patients of mine have presented with dizziness as their only symptom and whilst they are are grateful they do not have to endure the awful pain of migraine or headache, significant dizziness can be disabling …. and of course dizziness is another symptom that many of my headache and migraine patients experience.

Many of those patients in whom dizziness was as the only symptom have responded to mobilisation of the upper three spinal segments (particularly C2-3 – the segment formed by the second and third vertebrae) – the same segments which have the potential to (and I believe do) sensitise the brainstem in migraine and headache conditions.

So I am not surprised by the recent findings of Japanese researchers which indicates that migraine- associated vertigo (dizziness) and Meniere’s Disease share a common condition.

Just as in migraine (I don’t know why!), the cause of Meniere’s Disease is unknown (and controversial) – could it be that the Meniere’s condition arises from a senstised brainstem?

….. all I know it is worthwhile seeking a skilled examination of your neck!

Cheers

Dean

(Murofushi T, Ozeki H, Inoue A, Sakata A. Does migraine-associated vertigo share a common pathophysiology with Meniere’s disease? Study with vestibular-evoked myogenic potential. Cephalalgia 2009;29:1259-1266)

© 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.

Do You Experience Headache or Migraine?

November 19, 2009 by dean · Leave a Comment 

Do you have a question or a comment you wold like to make about headache or migraine?

Do you have a question or a comment you would like to make about headache or migraine?

If you do experience headache or migraine and you have a question that you would like answered or would like to comment on your headache or migraine experience then please feel free to post it below.

Whilst it may not be possible to address all questions or comments these will be addressed in future posts in some way.

It is our aim to help all headache or migraine sufferers to know and understand their headache or migraine experience as clearly and as precisely as possible .

Cheers  Dean

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

Treating Migraine with Greater Occipital Nerve Blocks

November 11, 2009 by dean · Leave a Comment 

A skilled examination of the neck need not be an after thought

A skilled examination of the neck need not be an after thought

Whilst the primary of this study was to assess the effectiveness of greater occipital nerve blocks on ‘medication overuse headache’, it also demonstrated that of 108 nerve blocks, 78% of headache sufferers responded with an average 83% decrease in severity which lasted almost 7 weeks.

The greatest effect was in those patients whose headaches developed after being concussed (100%), then 89% for episodic migraine and less effect on those with chronic migraine (61%).

Once again more evidence that examination of the upper neck in headache and migraine sufferers should not be an ‘after-thought’ – it should be routine – it borders on irresponsibility if an examination of the neck is not performed once all other investigations have been carried out ….

Cheers

Dean

(Tobin JA, Flitman SS. Nerve Blocks: Effect of Symptomatic Medication Overuse and Headache Type on Failure Rate. Headache 2009;49(10);1479-1485)

© 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.

A Migraine Sufferer’s World

November 6, 2009 by dean · Leave a Comment 

A Receptionist at The Headache Clinic recounted this description of headache and migraine told by one of our patients.

This migraine sufferer suggested that if someone has a pain in their toe it remains fairly localised. Unlike the pain of migraine which seemed to expand outwardly, beyond the head, as the pain of migraine increased. By this she meant the pain moved from the person suffering the headache, into their family, workplace, community until the pain became so intense it was the sufferer’s whole world. In fact (and often) at this stage the sufferer has isolated themselves from their daily life, often retreating to bed or seeking help via Accident and Emergency …… unfortunately an all too common story.

However our goal is for this to be a less common story, achieved without ongoing medication and with a skilled examination of the neck.

Cheers

Dean

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

Level I Headache and Migraine Course in Cambridge

November 1, 2009 by dean · Leave a Comment 

Level I Course Cambridge, England

Level I Course Cambridge, England

I have been presenting Level I courses in Cambridge for the past 3 years and it has been a popular venue – not only for physiotherapists in the UK but also physiotherapists from the continent.

A couple of years ago a physiotherapist came from Spain, however this year over half of the course delegates on the Level I course were from various countries including Belgium, Italy, Greece and Portugal.

This of course is pleasing, not only do headache and migraine sufferers in these countries now have another (drug-free) option, but also other opportunities which provide further support to physiotherapists in these countries who have a desire to treat headache and migraine – I am now not only presenting in Spain regularly, but also have been invited to present at a national conference in Spain and to present courses in Greece and Portugal.

Cheers

Dean

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