The Headache and Migraine Sufferers Bill of Rights (cont)

December 2, 2009 by dean · Leave a Comment 

The first ‘bill’ is that the headache sufferer has the right to know his/her headache diagnosis as precisely as possible, and to know the nature of the headache disorder, its prognosis and the possible types of treatment.

I have discussed the first point regarding diagnosis; now

to know the nature of the headache disorder

Clearly there is a substantial body of research which shows that the brainstems of Migraine, Tension Headache and Menstrual Migraine sufferers are sensitised.

We know that the ‘triptans’ desensitise the brainstem and are effective in preventing Migraine, Tension Headache, Cluster Headache, Hemicrania Continua, Menstrual Migraine, Cervicogenic (neck-related) Headache (which shows that cervicogenic disorders can sensitise the brainstem) ……

The underlying disorder is sensitisation of the brainstem; optimal management therefore is identifying the reason for the sensitisation ….

Stay tuned,

Cheers

Dean

(Members’ Handbook. International Headache Society 2000 Scandinavian University Press)

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

Headache and Migraine Sufferers ‘Bill of Rights’

December 1, 2009 by dean · Leave a Comment 

is likely to respond to treatment of relevant neck disorders.

Is a diagnosis important?

Some time ago (2000), the International Headache Society, published a Headache Sufferers ‘Bill of Rights’.

The first ‘bill’ is that the headache sufferer has the right to know his/her headache diagnosis as precisely as possible, and to know the nature of the headache disorder, its prognosis and the possible types of treatment.

I would like to spend the next few posts looking more closely at these points:-

“the headache sufferer has the right to know his/her headache diagnosis as precisely as possible”

diagnosis is difficult because it is based on a set of signs and symptoms, and the signs and symptoms of many different headache and migraine forms overlap – perhaps that is why many headache sufferers have been given 2, 3 or even 4 different diagnoses

not only do we have ‘Pure’ Menstrual Migraine, but now ‘MRM’ i.e. Menstrual Related Migraine, Menstrual Tension Headache, Menstrual Hemicrania Continua, Cluster Headache associated with menstruation etc and this is just headache or migraine supposedly associated with the menstrual cycle

the ‘triptans’, supposedly developed to stop the migraine process are effective in other forms of headache e.g. Menstrual Migraine, Cluster Headache, Cervicogenic Headache, and Hemicrania Continua

different headache and migraine forms responding to a range of cervicogenic (neck) treatments e.g. greater occipital nerve blocks, cervical spine stimulators

Is a diagnosis important? As far as I can see, and given the research, a diagnosis does not optimise the management of headache or migraine – it remains a ‘let’s try this and wait and see’ approach – clearly an unsatisfactory situation.

Cheers

Dean

(Members’ Handbook. International Headache Society 2000 Scandinavian University Press)

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

Menstrual Migraine – It’s Not Your Hormones!

November 4, 2009 by dean · Leave a Comment 

As a clinician I am often asked why I recommend the necks of menstrual migraine sufferers be examined when menstrual migraine supposedly results from hormonal imbalances or abnormal fluctuations etc.

As I have mentioned in previous posts research shows that menstrual migraine sufferers do not have irregular hormonal profiles or fluctuations and that the brainstems of menstrual migraine sufferers are sensitised just as they are in tension headache and migraine sufferers – and one source of sensitisation is abnormal information from neck disorders.

Review other posts about Menstrual Migraine by keying in Menstrual Migraine on the ‘Home Page’.

Cheers

Dean

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

Are Whiplash Associated Headache, Cervicogenic Headache and Tension-Type Headache the same? Yes!

September 24, 2009 by dean · Leave a Comment 

A motor vehicle injury can result in allodynia

A motor vehicle injury can result in allodynia

Five patients who had developed headaches following a head and neck injury after a motor vehicle injury – the headaches had the same characteristics of tension-type headache.

Furthermore on examination it was found that they were all experiencing ‘allodynia’ (excessive tenderness to normal pressure). Allodynia is considered to be a sign of sensitisation of the brainstem. The area of allodynia suggested that it was as result of abnormal information from injuries sustained by structures in the neck.

This study further confirms that disorders of the neck are responsible for so-called ‘tension-type’ headache and that abnormal information from injured neck structures can sensitise the brainstem – a phenomenon which is evident not only in tension headache but also migraine, menstrual migraine and cluster headache ….. and that whiplash associated  headache exists!

Cheers

Dean

(Baruah JK and Baruah GR. Post traumatic headache and allodynia. Cephalalgia, 2009; 29(Suppl. 1):1–166

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

Milanov I, Bogdanova D. Trigemino-cervical reflex in patients with headache. Cephalalgia 2003; 23:35-38

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

Nardone R, Tezzon F. The trigemino-cervical reflex in tension-type headache. European Journal of Neurology 2003; 10(3):307-312

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

Varlibas A, Erdemoglu Ak. Altered trigeminal system excitability in menstrual migraine patients. The Journal of Headache and Pain 2009; 10(4):277-282)

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

Sensitisation in Headache and Migraine

September 22, 2009 by dean · Leave a Comment 

I have mentioned in my previous blogs that sensitisation of the brainstem has been demonstrated in migraine, tension headache, menstrual migraine and cluster headache.

What I may not have made clear is that this sensitised state is present even when you are free of your headache or migraine, that is, your brainstem is sensitised constantly.

Then what happens is that you eat or drink something, your hormonal levels change, you smell a perfume – and this triggers your headache or migraine. These events lead to increased (but normal) activity of structures (including blood vessels) inside your head.

This increased activity is wrongly interpreted as being much more than what it actually is and pain results. If it wasn’t for your sensitised brainstem, what you eat, drink, smell or hormonal fluctuations would not result in the disabling headache or migraine.

If you are going to be free of your headache or migraine, the source of sensitisation has to be determined. Whilst the triptans desensitise the brainstem and are effective for many of you, they do not eliminate the cause of the sensitisation.

Information from neck disorders can sensitise the brainstem and of all the various investigations you may have for your headache of migraine, a skilled examination of your upper neck is relatively inexpensive and non invasive, and may change your life significantly.

Cheers

Dean

(Goldhammer L. Second cervical root neurofibroma and ipsilateral migraine headache. Cephalalgia 1993; 13:132

Hoskin KL, Kaube H, Goadsby PJ. Sumatriptan can inhibit trigeminal afferents by an exclusively neural mechanism. Brain1996; 119:1419-28

Jansen J, Markakis E, Rama B, Hildebrandt J. Hemicranial attacks or permanent hemicrania – a sequel of upper cervical root compression. Cephalalgia 1989; 9:123-30

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

Milanov I, Bogdanova D. Trigemino-cervical reflex in patients with headache. Cephalalgia 2003; 23:35-38

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

Nardone R, Tezzon F. The trigemino-cervical reflex in tension-type headache. European Journal of Neurology 2003; 10(3):307-312

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

Ward TN, Levine M. Headache caused by a spinal cord stimulator in the upper cervical spine. Headache 2000; 40:689-91)

© 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.

Triptans, Migraine and Menstrual Migraine – Further Evidence That Hormones Are Not The Cause!

August 24, 2009 by dean · Leave a Comment 

Photophobia means sensitivity to light

Photophobia means sensitivity to light

Interesting to note that a recent study when reviewing migraine-associated characteristics including aura, allodynia-associated (excessive tenderness to touch) symptoms, photophobia (sensitivity to light), phonophobia (sensitivity to noise), and nausea were similar for both menstrual migraine and non menstrual migraine sufferers.

Furthermore the triptans were equally effective for both menstrual related migraine and non menstrual migraine patients.

I have also mentioned before, research which demonstrates that the triptans desensitise the brainstem – a case for sensitised brainstems in menstrual migraine sufferers.

Cheers

Dean

(Diamond ML, Cady RK, Mao L, Biondi DM, Finlayson G, Greenberg SJ, Wright P. Characteristics of migraine attacks and responses to almotriptan treatment: a comparison of menstrually related and nonmenstrually related migraines. Headache 2008 Feb;48(2):248-58)

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

Headache, Migraine and Auras

August 23, 2009 by dean · Leave a Comment 

As I have mentioned previously, recent and substantial research demonstrates that the different types of headache and migraine develop from a common, shared disorder, and that this disorder is sensitisation of the brainstem.

Auras, which initially were thought to only accompany migraine and menstrual migraine, have now been reported in Cluster Headache and Hemicrania Continua, and provides further evidence that the various forms of headache and migraine are likely to originate from common disorder.

Cheers

Dean

(Bahra A, May A, Goadsby PJ. Cluster headache: a prospective clinical study with diagnostic implications. Neurology 2002;58:354-361

Peres MFP, Siow HC, Rozen TD. Hemicrania continua with aura. Cephalalgia 2002;22:246-248

Silberstein SD, Niknam R, Rozen TD, Young WB. Cluster headache with aura. Neurology 2000;54:219-221)

© 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

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.

The ‘Triptans’ and Menstrual Migraine

August 13, 2009 by dean · Leave a Comment 

It’s interesting to read that the ‘triptans’ are also effective in managing menstrual migraine, suggesting that the underlying cause for migraine, tension headache and menstrual migraine is similar, that is, a sensitised brainstem.

One underestimated source of sensitisation are neck disorders …. tired of playing around with your hormonal levels? Perhaps it is your neck that is sensitising your brainstem – a skilled examination will either confirm or eliminate this as a possibility.

Cheers

Dean

(Mannix LK, Files J. The use of triptans in the management of menstrual migraine. CNS drugs 2005;19(11):951-972)

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