Level II Headache and Migraine Course in Cambridge

October 30, 2009 by dean · Leave a Comment 

Level II Course Cambridge, England

Level II Course Cambridge, England

Whilst in Cambridge for Level I course I also presented a Level II course which like the Level I course had an international flavour – it is encouraging to have delegates from Level I returning to complete the Advanced Level II despite the distances (Italy) involved and that the the course is in English!

Those delegates who have completed the Level II course now qualify to be listed on the international register list of practitioners at www.headacheandmigraine.com

Cheers

Dean

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

Migraine, Tension Headache and Stress

October 24, 2009 by dean · Leave a Comment 

Managing stress helps headache and migraine

Managing stress helps headache and migraine

Why is it that when stress and migraine and tension headache are discussed studies all sorts of unproven mechanisms are discussed at length – despite all of the research and billions of dollars there is no proven causal mechanism – ‘it may be this …. or ‘it may be that‘ etc.

Muscle tension is evident in the necks of ‘tension headache‘ sufferers and migraineurs – it is tensed, shortened musculature acting on joint stiffness which leads to head pain.1

Research has shown that stress management approaches, including Relaxation Therapy and cognitive behavioural therapy consistently improve migraine 2 – if you are less stressed then stiff spinal segments sit quietly without any significant movement expected of them. Biofeedback is also helpful in managing migraine 2 for the same reason.

It can be very difficult to manage stress in our lives (for a whole lot of reasons including heart disease, depression, and other mental health disorders) and whilst is is important to take measures to do this, from a headache and migraine point of view, identifying and eliminating relevant neck disorders is crucial.

Cheers

Dean

(1. Bakal DA, Kaganov JA. Muscle Contraction and Migraine Headache: Psychophysiologic Comparison. Headache 1977;17(5):208215

2. Rains JC, Penzien DB, McCrory DC, Gray RN. Behavioral headache treatment: History, review of the empirical literature, and methodological critique. Headache. 2005;45(Suppl. 2): S92-S109.)

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

‘Tension Headache’ or ‘Migraine Without Aura’ or ‘Mixed’ Headache?

October 12, 2009 by dean · Leave a Comment 

Diagnosis cannot be done from symptoms alone

Diagnosis cannot be done from symptoms alone

This study from Spain demonstrates that diagnosing headache and migraine cannot be done from symptoms alone.

One hundred and five GPs were asked to examine and treat a patient who was considered (according to the International Headache Society’s diagnostic criteria) to be suffering migraine without aura.

Forty six diagnosed migraine correctly, 41 diagnosed the patient as tension-type headache, whilst 17 concluded ‘mixed’ headache and one GP was unable to diagnose the patient. One hundred and three recommended anti inflammatory medication as symptomatic treatment. Triptans were recommended by 67 GPs (including 15 of the 41 who had diagnosed the patient as tension-type headache). Preventive treatment was not considered by 30 GPs. A total of 66 GPs would prescribe beta-blockers (13 of the 41 who diagnosed tension-type headache), 35 amitriptyline (of whom 23 diagnosed tension-type headache) and the remaining 9, other treatments.

I have always maintained that a ‘diagnosis’ is not particularly useful – this study supports my clinical experience – what is the point of a diagnosis. The key to successful management is finding the source of the sensitisation; whilst the triptans may decrease the sensitisation they do not remove the source.

A skilled examination of the structures of the upper neck can identify relevant disorders – this involves temporary reproduction (and easing as the technique is sustained) of familiar head pain.

Cheers

Dean

(Pascual J, Sanchez A, Castillo J Dif?culties for diagnosing and treating migraine among general practitioners Cephalalgia 2009;29(Suppl. 1):1–166)

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

A Tale of the Medical Practitioner and the Headache/Migraine Physiotherapist

October 11, 2009 by dean · Leave a Comment 

I have mentioned the importance of educating you the headache and migraine sufferer as to what we as physiotherapists have to offer. This reminded me of a physiotherapist in The Netherlands who has completed both of my Level I and Advanced Level II courses.

When he returned to do the Level II course he recounted how when he had gone back to his village after the Level I course he wrote to his local doctors. He explained to them that he had done a ‘Watson Headache Course’, and that he was interested in treating their headache patients.

He described that initially only a couple of headache and migraine patients were referred and when they got better, he was referred more and then as his good results continued …. and now his work is almost exclusively headache and migraine.

A good result and a receptive and enlightened medical practitioner!

Cheers

Dean

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

Cluster Headache and Migraine Are Just Different Expressions of the Same Condition

October 9, 2009 by dean · Leave a Comment 

After examining six clinical trials in which cluster headache sufferers were treated with various ‘triptan’ medications it was concluded that the ‘triptans’ were effective in preventing the debilitating pain of cluster headache – just further evidence to support that cluster headache and migraine share a common underlying disorder.

This disorder has been demonstrated to be a sensitised brainstem and of course the ‘triptans’ de-sensitise the brainstem.

Furthermore there is a significant body of research which suggests that influencing (anaesthetising/blocking) information from structures of the upper neck prevents migraine and cluster headache. This suggests that abnormal information from disorders of these structures can sensitise the brainstem and that therefore a skilled examination of the upper neck should be included in assessment of migraine and cluster headache sufferers.

Cheers

Dean

(Akin Takmaz et al. Greater occipital nerve block in migraine headache: Preliminary results of 10 patients. Agri. 2008 Jan;20(1):47-50

Hoskin KL, Kaube H, Goadsby PJ. Sumatriptan can inhibit trigeminal afferents by an exclusively neural mechanism. Brain 1996; 119:1419-28

Law S, Derry S, McQuay H, Moore A A systematic review of the triptan class of drugs for the treatment of cluster headache Cephalalgia 2009;29 (Suppl. 1):1–166

Nardone R et al Trigemino-Cervical Reflex Abnormalities in Patients with Migraine and Cluster Headache. Headache 2008; 48(4):578-585

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

Rozen T. Cessation of hemiplegic migraine auras with greater occipital nerve blockade. Headache 2007;47:917-928

Solomon S, Lipton RB, Newman LC. Nuchal features of cluster headache. Headache 1990;30:347-9obin J,Stephen Flitman S. Nerve Blocks: When and What to Inject? Headache 2009

Yi X et al Cervicogenic headache in patients with presumed migraine: missed diagnosis or misdiagnosis? J Pain. 2005 Oct;6(10):700-3

Young et al Greater occipital nerve and other anesthetic injections for primary headache disorders. Headache 2008;48:1122-1125

Young et al. The first 5 minutes after greater occipital nerve block. Headache 2008;48:1126-1139)

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

A Key Diagnostic Feature of Cervicogenic (Neck) Headache

September 25, 2009 by dean · Leave a Comment 

A key diagnostic feature of cervicogenic (neck) involvement in headache is the temporary reproduction of headache and migraine pain when examining structures of the upper neck. This diagnostic feature is recognised by The International Headache Society, The International Association for the Study of Pain and The International Cervicogenic Research Group.

However, in my experience and neuro anatomical principles indicate that, reproduction of headache alone is not enough to confirm that the disorder is the cause of headache.  There also needs to be lessening of the reproduced headache as the technique is sustained.

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.

Advanced Headache and Migraine Courses

September 23, 2009 by dean · Leave a Comment 

Level 11 course in The Netherlands

Level 11 Course in Roermond, The Netherlands

Following on from the Level I course in Roermond, I presented an Advanced (Level II) course.

Level II is a two day course where delegates (primarily physiotherapists) are introduced to the recent research in relation to headache and migraine (which suggests that headache and migraine are not different conditions but are just different different expressions of the same condition) and also to the approach I have developed which not only confirms if a neck disorder is the source of headache or migraine but also which spinal segment is the cause.

After at least 6 months of using my approach, the course delegates are invited to attend a one day (Level II) course where the approach is revised, and importantly questions and issues are answered/discussed. I am pleased that these courses are always fully subscribed and often go on beyond 5.00 p.m.!

Whilst I examine and treat patients on both Level I & II courses, I have now been asked to present longer courses in which patients are examined and treated over a 2 week period ….. now that will be a ‘Master Class’!

Cheers

Dean

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

Summary of the Watson Headache Institute

September 12, 2009 by dean · Leave a Comment 

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 (I am currently a PhD Candidate investigating the role of cervicogenic dysfunction in the mechanism of migraine at Murdoch University, Western Australia).

and,

in determining whether or not a neck (cervicogenic) disorder is the cause of or a significant contributing factor to headache or migraine.

It is recognised

that neck (cervicogenic) dysfunction is significantly underestimated

that a neck (cervicogenic) dysfunction can be the cause of various forms of headache and migraine.

that the necks of all (primary) headache and migraine sufferers should be examined

To this end it is my objective to pass on this experience to my colleagues and headache and migraine sufferers

because

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.

Cheers

Dean

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

Hemicrania Continua – The Challenges of Diagnosis!

September 7, 2009 by dean · Leave a Comment 

One Sided Headache

A Constant One Sided Headache

Hemicrania continua is defined as a constant one sided (and always on the same side) headache of moderate intensity with exacerbations and which responds to Indomethacin. Other possible symptoms include redness of the eye, a watery or teary eye, a blocked or runny nostril and drooping of the eyelid.

But we have case reports which show that this supposedly one sided (always the same side) headache can occur on the other side and can also be on both sides at the same time.

Interestingly the traditional classification system of headache and migraine states that Cervicogenic (neck-related) Headache as a one sided headache (and always the same side) also. However my experience of over 21000 hours with headache and migraine patients is that a one sided headache that can occur on the other side is a Cervicogenic Headache. Does this mean that I am saying Hemicrania Continua is likely to be Cervicogenic Headache – Yes!

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

Marano E, Giampiero V, Gennaro DR, di Stasio E, Bonusa S, Sorge F. ‘Hemicrania continua’: a possible case with alternating sides. Cephalalgia 1994; 14:307–8.

Matharu MS, Boes CJ, Goadsby PJ. Management of trigeminal autonomic cephalalgias and hemicrania continua. Drugs 2003; 63:1637–77.

Matharu MS, Bradbury P, Swash M. Hemicrania continua: side alternation and response to topiramate. Cephalalgia 2005; 26: 341-344

Newman LC, Lipton RB, Russell M, Solomon S. Hemicrania continua: attacks may alternate sides. Headache 1992; 32:237–8.

Newman LC, Spears RC, Lay CL. Hemicrania continua: a third case in which attacks alternate sides. Headache 2004; 44:821–3.

Sjaastad O, Fredricksen TA, Pfaffenrath V. Cervicogenic headache: diagnostic criteria. Headache 1998; 38:442-5)

© 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.