Headache, Migraine and Depression

November 30, 2009 by dean · Leave a Comment 

It is of no surprise to me that a recent survey showed that headache sufferers were almost 3 times as likely to be depressed than non headache sufferers but who had other issues in their lives.

Let’s consider the lot of a headache sufferer:

little is known about what causes headache or migraine

headache sufferers either experience constant or near constant pain or severe pain

the only management appears to be medication which at best relieves the pain, but doesn’t change the cause (because the cause is unknown)

the doctor is despairing (because he or she doesn’t know what to do next)

Arguably the aforementioned points are more significant than some other issues(?) ….. not much hope is there?

Actually there is … it is amazing that, when after examination of the upper neck reveals the source of headache or migraine symptoms, ‘depression’ lifts – just knowing where the headache comes from leads to significant improvement in one’s outlook.



(Marlow RA, Kegowicz CL, Starkey KN. Prevalence of depression symptoms in outpatients with a complaint of headache. J Am Board Fam Med 2009 Nov-Dec(6):602-3)

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

Post-traumatic Headache

November 21, 2009 by dean · Leave a Comment 

Neck disorders can be responsible for headache

Neck disorders can be responsible for headache

Whiplash or post-traumatic headache for some reason seems to be a controversial headache – perhaps because the only explanation for it might be that it results from a neck injury – and there is reluctance by some authorities to accept that neck disorders can be responsible for headache (especially given that post-traumatic or whiplash associated headache presents just like a migraine or tension-type headache?)

To review my previous posts on post-traumatic or whiplash associated headache. Please go to the ‘Home Page’ and key in either ‘Post-Traumatic Headache’ or ‘Whiplash Headache’.

Cheers  Dean

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

Cluster Headache – Another Headache or Migraine

November 12, 2009 by dean · Leave a Comment 

Tension Headache and Migraine are recognised as the most common forms of headache.

Cluster headache is one of the third ‘group’ of headaches – the other headache types in this group are Hemicrania Continua, Chronic Paroxysmal Hemicrania, and SUNCT.

All of the headache types in this third group share similar symptoms with Cluster Headache and either blocking or modifying information from the neck has a beneficial effect on Cluster Headache suggesting that neck disorders not only play a significant role in Cluster headache but perhaps the others(?)

To review the posts on Cluster Headache return to the ‘Home Page’ and key in the search term ‘Cluster Headache’.



© 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 ….



(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.



(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.

Post-traumatic Headache and Migraine or Tension Headache – What’s The Difference?

November 3, 2009 by dean · Leave a Comment 

It was shown that headache sufferers had neck disorders after concussion

Research showed post concussion headache sufferers had neck disorders

In a recent study of 348 patients who had experienced concussion it was found that ongoing headache after 3 months was not caused by head or brain injury – but resembled Tension Headache or migraine possibly brought on by stress.1

Other research has shown sufferers of headache following concussion have significant disorders of their upper necks.2

These studies along with surveys which show that post-traumatic headache can be classified as either migraine or tension-type headache3-5 suggest that the underlying mechanism of migraine or tension headache is a neck disorder/injury.

Just more evidence indicating that neck disorders are likely to be the source of not only post-traumatic headache but also migraine and tension-type headache.



(5. De Benedittis G, De Santis A. Chronic post-traumatic headache: clinical, psychopathological features and outcome determinants. J Neurosug Sci 1983;27(3):177-186

3. Haas DC. Chronic post-traumatic headaches classified and compared with natural headaches. Cephalalgia 1996;16:486-93

1. Stovnera L, Schradera L, Mickeviciene D, Surkienec D, Sand T. Headache after concussion. Eur J Neurol. 2009;16:112-120.

2. Treleaven J, Jull G, Atkinson L. Cervical musculoskeletal dysfunction in post-concussional headache. Cephalalgia 1994;14:273-9

4. Weiss HD, Stern BJ, Goldberg J. Post-traumatic migraine: chronic migraine precipitated by minor head or neck trauma. Headache 1991;31(7):451-456)

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

Depression, Migraine and Tension Headache

October 28, 2009 by dean · Leave a Comment 

Depression may be the result of headache and migraine experience

Depression may be the result of headache and migraine's isolating experience

Every time I hear that depression is causing migraine or headache I get really frustrated – I would be depressed if I went through what my patients were experiencing!

Migraine and other forms of headache are significant stressors in themselves. However, it is more than coping with the pain, nausea, and vomiting etc. It is also about one’s inability to participate in life – to be able to plan a social life.

Depression is not the cause of headache or migraine … it results from it! It is amazing the change in a person’s demeanor once their headache or migraine has not necessarily resolved, but just improved!

Have you considered that your (upper) neck may be the cause of your depression?



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

Tension As A Factor In Worsening Tension Headache And Migraine

October 26, 2009 by dean · Leave a Comment 

The stress of "everyday life"

The stress and tension of "everyday life"

Research has shown that as many as 1 out of 10 migraine sufferers will develop daily migraine and whilst factors such as stressful life events, ongoing lesser every-day stressors and depression have been identified,1-6 neck disorders are not discussed.

Clearly significant life events such as divorce, death of a loved one, redundancy etc can cause significant tension for months/years and shortening of muscles in the upper neck can result. Then the stress of everyday life ‘stuff’ leads to more temporary further shortening of already shortened muscles, ligaments and capsules, exerting pressure on stiff joints leading to increased frequency of headache or migraine.

Once the daily stress lessens, headache and migraine eases, but the shortening which resulted from the stress of the major life event/s remains (this ongoing stiffness in the spinal segments is likely to result in sensitisation of the brainstem,7 which is now widely recognised as a key disorder in headache and migraine) waiting for the hassles of the next day, causing pressure on the stiff joints once again and migraine or headache results.

Headache or migraine which is increasing in frequency suggests that a neck disorder is worsening – if this is happening for you, I recommend that a skilled examination of your upper neck structures be performed as my experience suggests very strongly that your neck is the problem.



(6. De Benedittis G, Lorenzetti A. Minor stressful life events (daily hassles) in chronic primary headache: Relationship with MMPI personality patterns. Headache. 1992;32:330-334.

1. Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders: 2nd edn. Cephalalgia. 2004;24(Suppl. 1):9-160.

3. Henry P, Auray JP, Gaudin AF, et al. Prevalence and clinical characteristics of migraine in France. Neurology. 2002;59:232-237.

4. Lanteri-Minet M, Auray JP, El HA, et al. Prevalence and description of chronic daily headache in the general population in France. Pain. 2003;102:143-149.

2. Scher AI, Stewart WF, Liberman J, Lipton RB. Prevalence of frequent headache in a population sample. Headache. 1998;38:497-506.

5. Scher AI, Stewart WF, Buse D, Krantz DS, Lipton RB. Major life changes before and after the onset of chronic daily headache: A population-based study. Cephalalgia. 2008;28:868-87)

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

Migraine and Stress

October 22, 2009 by dean · Leave a Comment 

When stressed, muscles shorten, joints move abnormally, pain is referred to the head

When stressed, muscles shorten, joints move abnormally, pain is referred to the head

One of the most common triggers reported by individuals with migraine is stress.1-5 Approximately 76% of migraine suffers report identifiable triggers and of those 80% report stress as a common trigger.6

When we get stressed our muscles shorten ‘asking’ the vertebra to which they are attached, to move. If however the joint is stiff, messages from shortened structures for example capsules, ligaments and muscles, which are there to prevent the joint from moving too much, are not allowing the joints to move normally and pain is referred to your head – stress without a neck disorder does not result in headache.

A skilled examination of the movements of the upper neck can confirm this for you.



(2. Chabriat H, Danchot J, Michel P, Joire JE, Henry P. Precipitating factors of headache. A prospective study in a national control-matched survey in migraineurs and nonmigraineurs. Headache. 1999;39:335-338.

1. Hung CI, Liu CY, Wang SJ. Precipitating or aggravating factors for headache in patients with major depressive disorder. J Psychosom Res. 2008;64:231-235.

4. Karli N, Zarifoglu M, Calisir N, Akgoz S. Comparison of pre-headache phases and trigger factors of migraine and episodic tension-type headache: Do they share similar clinical pathophysiology? Cephalalgia. 2005;25:444-451.

6. Kelman L. The triggers or precipitants of the acute migraine attack. Cephalalgia. 2007;27:394-402.

5. Martin PR, Milech D, Nathan PR. Towards a functional model of chronic headaches: Investigation of antecedents and consequences. Headache. 1993;33:461-470

3. Rasmussen BK. Migraine and tension-type headache in a general population: Psychosocial factors. Int J Epidemiol. 1992;21:1138-1143)

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Migraine Headache and Cervicogenic Headache

October 15, 2009 by dean · Leave a Comment 

The authors of this study have previously shown :

that neck pain is very common in migraine and is more often present during migraine than nausea

the presence of neck pain at the time of migraine treatment significantly decreases the chances of becoming pain-free within 2 hours

the presence of neck pain is likely to increase migraine-related disability irrespective of headache frequency and severity.

In the this study 127 migraine sufferers recorded 762 migraines and it was found that those with neck pain were less likely to achieve a pain free state and tended to have poorer outcomes than those with headache only i.e. without neck pain.

The authors considered that the presence of neck pain on the day before the migraine is associated with poorer treatment response; that neck pain before migraine is a better predictor of a poor treatment outcome than is headache only …. of course it is if the neck is not treated!

Clearly the reason for sensitisation can be abnormal information from neck disorders and if this is not addressed then treatment outcomes will be less than satisfactory.



(Calhoun AH, Ford S. Headache or neck pain the day before: impact on migraine treatment outcome Cephalalgia 2009;29(Suppl. 1):1–166)

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