Not Tonight … I Have A Migraine!
September 3, 2009 by dean · Leave a Comment
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.
Chronic Paroxysmal Hemicrania, Hemicrania Continua and Cluster Headache – All From The Same Disorder?
September 2, 2009 by dean · Leave a Comment
In recent times the International Headache Society has added a third primary group of headache(s) to the two primary headache types – migraine and tension-type headache.
This third primary group includes Cluster headache, Chronic Paroxysmal Hemicrania, and SUNCT (Short lasting Unilateral Neuralgia form headache attack with Conjunctival injection and Tearing!) and Hemicrania Continua.
Chronic Paroxysmal Hemicrania is very similar to Cluster Headache and is often described as the female equivalent of Cluster Headache (Cluster Headache is more frequent in males).
It is interesting to note a report demonstrating that both chronic Paroxysmal Hemicrania and Hemicrania Continua (thought to be two different types of headache) respond to the same medication – Indomethacin. (Indomethacin is a non steroidal anti inflammatory drug used to reduce pain)
I have written before that Cluster Headache and Hemicrania Continua respond to blocking or injecting of the greater occipital nerve i.e. a feature of Cervicogenic (neck-related) Headache – just more evidence to support the role of neck disorders in many different headache forms …..
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, Antonaci F. Paroxysmal Hemicrania (CPH) and Hemicrania Continua: Transition From One Stage to Another. Headache 1993;(33)10:551-554)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Migraine and Headache After Trauma – Post Traumatic Headache (PTH)
August 30, 2009 by dean · Leave a Comment
MRI results are used to reveal abnormalities after trauma
Headache is the most common symptom after a head injury. Post traumatic headaches, like non traumatic migraine and tension headache for some reason pose a significant challenge for clinicians and are surrounded by controversy. Because the neurological examination after mild head injury is normal and standard tests as well as imaging studies (such as MRI or CT of the head) fail to reveal abnormalities, it is often thought that the symptoms following mild head injury are psychological.
Why is it then that in the presence of any abnormal findings the focus on the head continues?
It is important that after a blow to the head an intracranial (within the head) cause of headache or migraine be ruled out. However once an intracranial cause has been eliminated, why then does the source of the headache or migraine become such a mystery?
If the head hits the windscreen for example, the body keeps moving; it is the neck which connects the head to a moving body and absorbs a significant amount of stress.
It is very important then that a skilled examination of the upper three spinal segments be performed and that prior to examination of the upper neck, assessment of crucial ligaments be undertaken – this is mandatory.
An examination of this nature may prevent years of frustration and unnecessary medication.
Cheers
Dean
(Packard RC. Chronic Post-traumatic headache: Associations with mild traumatic brain injury, concussion, and post-concussive disorder. Current Pain and Headache Reports 2008; (12)1:67-73
Treleaven J, Jull G, Atkinson L. Cervical musculoskeletal dysfunction in post-concussional headache. Cephalalgia 1994;14:273-9)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Hemicrania Continua – What Is It?
August 29, 2009 by dean · Leave a Comment
I have mentioned Hemicrania Continua a few times in my blogs assuming that you are familiar with this condition.
Hemicrania Continua is a headache characterised by constant pain on one side of the head (and always on the same side), of moderate severity, with episodes of aggravation. Hemicrania responds to the medication known as Indomethacin.
Hemicrania Continua is included (along with Cluster headache, Chronic Paroxysmal Hemicrania, and SUNCT) in the third primary group of headache classified by the International headache Society.
As with all of the headache and migraine types, Hemicrania Continua is based on a set of signs and symptoms with no indication as to the cause.
Cheers
Dean
(Peres MFP, Siow HC, Rozen TD. Hemicrania continua with aura. Cephalalgia 2002;22:246-248)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Migraine, Headache And The Brainstem
August 27, 2009 by dean · Leave a Comment
There is clear clinical and experimental evidence that the BRAINSTEM plays a pivotal role in the migraine process.
Migraine and headache are conditions in which normal light is unpleasant, normal sound uncomfortable, and where there is an abnormal interpretation of activity – one in which normal pulsing of arteries is felt as pain.
Information from the visual and auditory systems along with activity of structures from inside the head are transmitted through the brainstem to the cortex where it is interpreted – it seems as though the cortex is misled by a sensitised or hyper excitable brainstem.
The key to successful treatment is determining the source of the sensitisation of the brainstem – information from neck disorders is neglected by traditional medicine as a potential source. Whilst it is important and responsible that other possibilities be investigated, given the clinical and experimental evidence, it is irresponsible that the neck not be considered.
Cheers
Dean
(Goadsby PJ. Migraine pathophysiology: The brainstem governs the cortex. Cephalalgia 2003;23:565-566
Knight Y. Brainstem modulation of caudal trigeminal nucleus: A model for understanding migraine biology and future drug targets. Headache Currents 2005 Vol. 2, No. 5:108-118)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Migraine, Tension Headache, the Neck and Sensitisation of the Brainstem
August 22, 2009 by dean · Leave a Comment
Information from the neck - is a neck disorder relevant?
It is generally agreed and it has been demonstrated that the brainstems in migraineurs and tension headache sufferers are sensitised.
The brainstem is influenced by 4 systems:
information from structures inside the head – head scans which fortunately in over 95% of headache and migraine sufferers the scans are clear, will eliminate this factor
the diffuse noxious inhibitory control system – this is poorly understood, but it is the mechanism which acts when you hit your thumb with a hammer and your headache seems less painful – hardly an attractive treatment option!
the serotonin system – serotonin desensitises the brainstem – if there is not enough then the brainstem becomes sensitised – so it makes sense to optimise your production of serotonin – diet, exercise, sunlight and perhaps a L-tryptophan supplement (after checking with your doctor)
information from the neck – get your neck checked. Many of us have a neck disorder, but is it relevant? This can be determined by, when examining the neck, temporarily reproducing familiar head pain which lessens as the technique is sustained. In my 21000 hours of experience this occurs in over 90% of headache and migraine conditions. My approach as a diagnostic tool is unparalleled in the manual therapy area and is in accordance with the views of traditional medicine.
Why does it have to be complicated?
The last two systems are within your control – you can take steps to address these.
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
Katsavara Z, Giffin N, Diener HC, Kaube H. Abnormal habituation of ‘nociceptive’ blink reflex in migraine – evidence for increased excitability of trigeminal nociception. Cephalalgia 2003; 23:814-819
Katsavara Z, Lehnerdt G, Duda B, Ellrich J, Diener HC, Kaube H. Sensitization of trigeminal nociception specific for migraine but not pain of sinusitis. Neurology 2002; 59:1450-1453
Kaube H, Katasavara Z, Przywara S, Drepper J, Ellrich J, Diener HC. Acute migraine headache. Possible sensitization of neurons in the spinal trigeminal nucleus? Neurology 2002; 58:1234-1238
Jull G, Bogduk N, Marsland A. The accuracy of manual diagnosis for cervical zygapophyseal joint pain syndromes. Med J Aust. 1988 Mar 7;148(5):233-6
Milanov I, Bogdanova D. Trigemino-cervical reflex in patients with headache. Cephalalgia 2003; 23:35-38
Nardone R, Tezzon F. The trigemino-cervical reflex in tension-type headache. European Journal of Neurology 2003; 10(3):307-312
Nardone R et al Trigemino-Cervical Reflex Abnormalities in Patients with Migraine and Cluster Headache. Headache 2008; 48(4):578-585
Sandrini G, Cecchini AB, Milanov I, Tassorelli C, Buzzi MG, Nappi G. Electrophysiological evidence for trigeminal neuron sensitisation in patients with migraine. Neurosci Lett 2002; 317:135-138
Sjaastad O, Fredricksen TA, Pfaffenrath V. Cervicogenic headache: diagnostic criteria. Headache 1998; 38:442-5)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Headache and Migraine Diagnosis and Treatment
August 16, 2009 by dean · Leave a Comment
The neck can be the source of sensitisation
There are numerous case studies which have shown that injecting local anesthetic around the greater occipital nerve the pain of migraine is eased. This is also a key finding in cervicogenic headache and confirms the diagnosis of cervicogenic headache. So why is it that, in this situation, almost invariably the interpretation is that the sufferer has two types of headache that is:
cervicogenic headache,
and
migraine
I am always bemused by this, why can’t it be that the ‘migraine’ and cervicogenic are the same headache.
Why is it that the answer I often get is “… well we don’t know where migraine comes from but it can’t come from the neck.” Clearly this is a really unhelpful comment. Why is it that I need to demonstrate that the neck can be the source of sensitisation in migraine sufferers (my claim is based on over 21000 hours experience with headache and migraine sufferers)? Perhaps I should request from those who disagree to demonstrate that migraine cannot develop from a neck disorder ….
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
Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders, 2nd edn. Cephalalgia 2004; 24(suppl.1):1-151
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;47:917-919)
Sjaastad O, Fredricksen TA, Pfaffenrath V. Cervicogenic headache: diagnostic criteria. Headache 1998; 38:442-5
Yi, X. et al Cervicogenic headache in patients with presumed migraine: missed diagnosis or mis diagnosis? J Pain 2005 Oct;6(10):700-3
Young WB et al. Greater Occipital Nerve and Other Anesthetic Injections for Primary Headache Disorders. Headache 2008;48:112-1125
Young, W. et al The first 5 minutes after greater occipital nerve block. Headache 2008 July 48(7):1126-8)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Paroxysmal Hemicrania Related to Menstruation
August 15, 2009 by dean · Leave a Comment
Here we go again – another headache type that occurs within the menstrual period! Last count it was migraine, tension-type headache, cluster headache …
This case study describes a 43 year old woman who initially had menstrual related migraine which later developed into a typical paroxysmal hemicrania (similar to cluster headache). So here we have menstrual migraine and menstrual paroxysmal hemicrania in the one person, both of which responded to the ‘triptans’.
Just further evidence supporting that headache and migraine develops from one condition – sensitisation of the brainstem (remember that the ‘triptans’ desensitise the brainstem).
Cheers
Dean
(Maggioni F. Menstrual paroxysmal hemicrania, a possible new entity? Cephalalgia 2007;27:1085-1087)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Menstrual Tension-type Headache?
August 14, 2009 by dean · Leave a Comment
Menstrual headaches can vary in severity from one cycle to the next
Now we have menstrual tension-type headache described. When will it all end – the last thing we need now is another headache type!
The authors interviewed 165 women with menstrual related headache and found that the characteristics of tension-type headache were evident in 21.
Isn’t this what some authorities are saying – that all headache and migraine arises from the same disorder?
Menstrual tension-type headache is just a less severe expression of menstrual migraine.
Don’t get me wrong, this is my clinical experience also. I see women whose menstrual headaches vary in severity from one cycle to the next, and some women whose headaches are less severe than those in other women, so Yes, it can present as what is considered a tension-type headache (but its not tension!).
What is needed is to determine the source of the sensitisation – and basic neuro anatomy and research tells us that neck disorders have the potential to sensitise the brainstem.
Cheers
Dean
(Arjona A et al. Menstrual Tension-Type headache: Evidence for Its Existence. Headache 2007;47:100-103)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Greater Occipital Nerve Blocks Relieve Migraine and Cluster Headache
August 11, 2009 by dean · Leave a Comment
Another example of migraine headache being relieved within 30 seconds after injection of the greater occipital nerve.
Need I say more ….. just part of the overwhelming evidence for cervicogenic involvement in migraine …. but there is more!
Blocking the greater occipital nerve in 14 cluster headache patients substantially decreased their symptoms with the researchers suggesting that this procedure is a significant treatment option i.e. eliminating information from structures of the upper neck leads to relief from cluster headache …..
Cheers
Dean
(Young WB et al. Greater Occipital Nerve and Other Anesthetic Injections for Primary Headache Disorders. Headache 2008;48:112-1125 : Peres MF. et al Greater occipital nerve blockade for cluster headache. Cephalalgia 2002;22:520-522)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.