Worsening Migraine Attacks

December 9, 2009 by dean · Leave a Comment 

Worsening Migraine Attacks are decreased significantly by cervicogenic (neck) treatment. Recent evidence suggests that migraine is an increasing condition in which over time, the attacks become more frequent, more severe, less responsive to medication, and perhaps lasting longer.

Research has shown that by decreasing information (surgically) from cervical (neck) nerves deceases the long term worsening of the migraine process. The natural progression of cervicogenic (neck) headache is exactly the same – if it is left untreated, cervicogenic headache becomes more frequent, more severe and eventually becomes continuous. This indicates that with the passage of time the neck disorder is gradually worsening (and it is likely to be loss of function or stiffness). This research supports the idea that cervicogenic (neck) disorders are the reason for not only worsening of the migraine process but also for the migraine process in the first place i.e. sensitisation of the brainstem.

Now I am not suggesting that migraine sufferers rush off and have the relatively minor surgery performed in this study (in fact I respectfully suggest that skilled treatment of the neck would have achieved the same result), but this research clearly demonstrates disorders of the upper neck are significantly involved in the migraine process.

Cheers

Dean

(Perry CJ, Blake P and Goadsby PJ Intervention altering the natural history of chronic migraine. Is chroni?cation of migraine headache a harbinger of peripheral afferent nerve involvement? Cephalalgia 2009; 29 (Suppl. 1):1–166)

© 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.

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.

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

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.

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.

Exercise and Migraine

October 20, 2009 by dean · Leave a Comment 

Exercise encourages serotonin production

Exercise encourages serotonin production

In a recent study 30 female migraineurs undertook an aerobic exercise program.

Measures of pain and psychological assessment (including body image, depression and quality if life) were assessed before and after completion of the 6 week exercise and exercise program.

The program led to a significant reduction migraine pain intensity. This is not surprising as exercise encourages serotonin production which desensitises the brainstem. Interestingly there was also an improvement in the depression related symptoms (I would be happier to if my migraine was less severe!), but the psychological factors were no different (good to see my experience confirmed i.e. migraine sufferers are psychologically normal!)

Sensitisation of the brainstem in my experience occurs because of a neck disorder and whilst increased serotonin is likely to improve symptoms the cause of the senstisation is still there. It is important that this (the neck) be confirmed and addressed – but start (and keep) exercising as well!

Cheers

Dean

(Dittrich SM, Guünther V, Franz G, Burtscher M, Holzner B, Kopp M. Clin J Sport Med. 2008;18:363-365 Aerobic exercise with relaxation: Influence on pain and psychological well-being in female patients. Clin J Sport Med. 2008;18:363-365)

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

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.

Cheers

Dean

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

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

Neck Disorders in Migraine and Chronic Migraine Headache

October 1, 2009 by dean · Leave a Comment 

Neck Disorders are frequently found in migraine sufferers

Neck Disorders are frequently found in migraine sufferers

More evidence from a study in the US which shows that cervicogenic (neck) disorders are frequently found in Migraine and Chronic Migraine sufferers.

Using a special device, muscle tenderness was assessed and found to be significantly increased in both the migraine and chronic migraine groups when compared to non headache subjects.

Why is it that the conclusion was that muscle tenderness results from the migraine process and not the cause of the process?!!!

Cheers  Dean

(Bevilaqua-Grossi D, Moreira VC, Canonica AC, Chaves TC, Goncalves MC, Florencio LL, Bordini CA2, Speciali JG, Bigal ME. Pain thresholds in craniocervical muscles in women with migraine, chronic migraine, and with no headaches. Cephalalgia 2009;29 (Suppl. 1):1–166)

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

Chronic Migraine and Episodic Migraine

September 27, 2009 by dean · Leave a Comment 

In the 1980s it was suggested that the migraine state was a progressive condition.1

Over recent years there has been significant research which shows that this in fact is the case – that migraine is a continuum or spectrum disorder, i.e. a process in which episodic migraine may or may not evolve into chronic migraine.2,3 Indeed, the findings of various physiological and imaging (of the brain) investigative techniques suggest that the features of the ‘mis-behaving’ brain during episodic migraine are present persistently in chronic migraine sufferers.4 Three per cent of individuals with episodic migraine progress to chronic migraine over the course of a year.3

This brain dysfunction (or mis-behaviour) has been shown to be sensitisation of the brainstem and one of the sensitising factors could be abnormal information from a neck disorder or injury. Confirmation of this is not difficult or costly – a skilled examination of the upper neck is all that is required.

Cheers

Dean

(Aurora SK. Is chronic migraine one end of a spectrum of migraine or a separate entity? Cephalalgia 2009;29:597-605

Bigal ME, Lipton RB. Concepts and mechanisms of migraine chronification. Headache 2008; 48:7–15.

Cady RK, Schreiber CP, Farmer KU. Understanding the patient with migraine: the evolution from episodic headache to chronic neurologic disease. A proposed classification of patients with headache. Headache 2004; 44:426–35.

Mathew NT, Stubits E, Nigam MP. Transformation of episodic migraine into daily headache: analysis of factors. Headache 1982; 22:66–8)

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

Migraine And Cluster Headache Are ‘First Cousins’!

September 19, 2009 by dean · Leave a Comment 

Migraine sufferers experience many symptoms

Migraine sufferers experience many symptoms

As I have mentioned in many of my previous reports, my clinical experience agrees with the research which shows that the many different forms of headache and migraine share the same ‘heritage’ or disorder i.e. a sensitised brainstem.

This recent study which surveyed 76 Cluster Headache sufferers showed that nausea, vomiting, photophobia and phonophobia were reported by 41%, 24%, 49% and 46% respectively of the patients. Aura occurred in 28% of the patients and visual symptoms were reported most frequently.

Those of you who are migraine sufferers will be familiar with the symptoms mentioned above (!)

This is further evidence supporting a common, shared mechanism for headache and migraine.

Cheers

Dean

(Wober C and Knopf A. Migrainous features in cluster headache. Cephalalgia 2009;29 (Suppl. 1):1–166)

© 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.