Headache, Migraine and Depression

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.

Cheers

Dean

(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

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.

Watson Headache Course – Level I

I have been mentioning the courses I present to physiotherapists, chiropractors and osteopaths without explaining what it is that we cover.

The Level I course is called:

“The Role of CO-C3 Segmental Dysfunction in Primary Headache”

This course essentially looks at information from the top three spinal joints (which affects the brainstem, and we know the brainstem is sensitised in headache and migraine sufferers) and whether these joints are involved in the headache or migraine process.

The course looks at how the medical model of headache classifies headache and migraine; then I present the research i.e. what is in the literature, which actually contradicts the traditional medical model and supports my clinical experience of over 21000 hours, that is, the necks of all headache or migraine sufferers should be examined irrespective of the diagnosis.

As a result of my experience I have developed a verbal examination (often called the ‘subjective examination’) which includes the area of headache, history and behaviour of symptoms. From this we can tell if there is change in headache or migraine symptoms.

It is important that, before we examine the upper neck, tests of neck arteries are performed and also ligaments of the upper neck. I am not happy with the traditionally taught tests – I think they are too (and unnecessarily) aggressive on potentially already damaged ligaments. I demonstrate (and we practice) tests which are much less aggressive.

Then I demonstrate and we practice (on each other) techniques I have developed, which not only identify if neck disorders are the cause of headache or migraine symptoms but also which joint it is that is causing the problem. If we can identify the joint or spinal segment involved, the chances of getting a successful outcome increases significantly because treatment can then be directed at the source.

I finish the course by examining two headache or migraine sufferers, so course delegates can see everything put into practice.

Then after at least 6 months experience using this approach, course delegates then return for the Level II Advanced course.

Cheers

Dean

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

Cluster Headache – Another Headache or Migraine

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’.

Cheers

Dean

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

Treating Migraine with Greater Occipital Nerve Blocks

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

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.

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

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.

Cheers

Dean

(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

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?

Cheers

Dean

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

Tension As A Factor In Worsening Tension Headache And Migraine

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.

Cheers

Dean

(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

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.

Cheers

Dean

(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)

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

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