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.

Migraine – An Unrecognised Cervicogenic Headache?

September 15, 2009 by dean · Leave a Comment 

Migraine Sufferers have a significantly reduced range of neck movement

Migraine Sufferers have a significantly reduced range of neck movement

It is interesting to note that ongoing investigation into the role of cervicogenic (neck) disorders in migraine sufferers has revealed significantly reduced range of neck movement when compared to non headache sufferers. Just more information to add to the growing body of evidence which supports the possibility that the sensitisation of the brainstem in migraine sufferers may be caused by a neck disorder.

Cheers

Dean

(Bevilaqua-Grossi D, Pegoretti KS, Goncalves MC, Speciali JG, Bordini CA, Bigal ME. Cervical Mobility in Women With Migraine. Headache 2009;49:726-73)

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

Not Tonight … I Have A Migraine!

September 3, 2009 by dean · Leave a Comment 

Not tonight....I have a migraine!

Not tonight....I have a migraine!

Here we have an interesting study which confirms what we already knew – women frequently use migraine as an excuse … just joking!

Seriously whilst ‘not tonight, I have a headache’ is a cliche´, the excuse to avoid sexual activity is frequently attributed to women.

After interviewing 60 women (30 migraine sufferers and 30 non headache sufferers) it was found that only 10% of migraineurs and 30% in the non headache group had used headache as an excuse whilst not having a headache. Twenty-nine of the 30 migraine sufferers reported that their partners always respected them on these occasions (now that is refreshing!).

Another and arguably more important finding in this study was that 67% in the migraine group said that their sexual relationship was affected adversely, with 24% indicating that they had interrupted sexual activity because of headache – it is still a significant problem!

Cheers

Dean

(Carvalho JJF, Magalhaes AG, Morais LC, Menezes NS. How often women use headache as an excuse to avoid sex? Cephalalgia 2009;29(Suppl. 1):1–166)

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

Welcome to my Journey in Headache and Migraine

April 6, 2009 by dean · Leave a Comment 

Welcome to my journey.

My journey started in 1987 when I commenced a Masters research program at the University of South Australia. The results of this research were published in the international headache journal, Cephalalgia, and have influenced the management of cervicogenic (neck-related) headache sufferers.

In 1991, I established The Headache Clinic in Adelaide, South Australia, which became recognised nationally and internationally. Since then I have treated headache and migraine sufferers exclusively.  I have now examined the necks of over 7000 headache and migraine sufferers and completed in excess of 28000 treatments. Now traditional medicine does not consider disorders of the neck to be involved in the headache and migraine process, but my clinical experience suggests very strongly that they do!

dean18

During this time my fundamental purpose has been and is to determine whether or not a neck disorder is the cause of or a significant contributing factor to headache or migraine – I believe that every headache sufferer has the right to know their headache diagnosis as precisely as possible, to know the nature of their headache disorder, its outcome and possible types of treatment.

Whilst my emphasis is on the neck as a source of headache, this does not blind me to the possibility of other factors as the cause of headache – I recognise that not all headache comes from disorders of the neck and that headache may have more than one cause. However given that the cause of migraine and other forms of headache are unknown it seems logical and reasonable that a skilled examination of your neck occurs after an assessment by your GP or Neurologist (and generally all the tests are negative) and before medication is prescribed – this may prevent a lifetime tied to medication, a lifetime of checking whether you have your headache or migraine medication in your handbag before you leave the house!

Current research shows that migraine is not a problem with the blood vessels and that tension headache is not caused by increased tension in the muscles of the scalp and forehead! More of that next time ….

Until then,

Dean

Dean Watson

Consultant Headache and Migraine Physiotherapist; Adjunct Lecturer, Masters Program, School of Physiotherapy, University of South Australia; PhD Candidate, Murdoch University, Western Australia

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

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.