Not Tonight … I Have A Migraine!

September 3, 2009 by dean · Leave a Comment 

Not tonight....I have a migraine!

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.

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.

Diagnosing Cervicogenic Headache is Easy

August 17, 2009 by dean · Leave a Comment 

I mentioned recently that blocking the greater occipital nerve and eliminating head pain is key sign of cervicogenic or neck headache and that this has been demonstrated repeatedly in migraine sufferers.

This procedure (injecting nerves) however is not necessary to diagnose cervicogenic headache which is just as well because after all it is invasive, not readily available and relatively expensive.

The ability to temporarily reproduce familiar head pain when examining joints of the upper neck is recognised by traditional medicine as one of the most important indicators of cervicogenic headache (actually, I have to disagree with this, reproduction alone is not enough – there needs to be lessening of the head pain as the examination technique is sustained – more of that later).

It is irresponsible to recommend treatment of the neck for headache or migraine when it is not the cause and therefore it is crucial that reproduction and lessening of head pain occurs during the examination.

The examination approach I have developed on the basis of 21000 hours experience is unparalleled – in recent research familiar head pain was reproduced in 100% of tension headache sufferers and 94% of migraineurs …. now I could be cynical and say that 100% had tension headache and cervicogenic headache and 94% migraine sufferers had cervicogenic headache as well.

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

Rozen T. Cessation of hemiplegic migraine auras with greater occipital nerve blockade. Headache 2007;47:917-928

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 misdiagnosis? J Pain. 2005 Oct;6(10):700-3

Young et al Greater occipital nerve and other anesthetic injections for primary headache disorders. Headache 2008;48:1122-1125

Young et al. The first 5 minutes after greater occipital nerve block. Headache 2008;48:1126-1139 )

© 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

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.

A Treatment Technique for Migraine Sufferers

July 22, 2009 by dean · Leave a Comment 

How Clinical Research Physiotherapist, Dr Ian Davidson at Manchester University, is leading a clinical trial testing the effectiveness of fellow Physiotherapist Dean Watson’s treatment technique for migraine sufferers.

The study, which began recruiting in April 2007, is being carried out in three private physiotherapy practices in the northwest (two in Lancashire and one in Cheshire). The study was awarded £95,000 by Physio First through its charitable trust, the Private Physiotherapy Educational Foundation.

Patients have been recruited through the Migraine Action Association, local universities and GPs. Dr Davidson says around 90 are needed to complete the trial and 76 have been recruited so far, adding that a high attrition rate has made progress difficult. ‘We are about a year and a half away from completing,’ he says.

Patients are screened and asked to complete a diary before being referred for six physiotherapy sessions based on Mr Watson’s technique. ‘I hope the study does help towards developing an evidence base for headache physiotherapy,’ says Dr Davidson, adding: ‘I would hope from this trial I would be able to put in a proposal for a larger national trial.’

Quoted in Frontline Magazine, Issue 17th June 2009, the official journal of the Chartered Society of Physiotherapy in the United Kingdom, Titled “When Headache is a Pain the Neck” by Louise Hunt.

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

Migraine and Cervicogenic Headache

June 29, 2009 by dean · Leave a Comment 

Whilst teaching in the UK recently I had the privilege of attending a Headache and Migraine Clinic at one of the major teaching hospitals in London.

The consultant neurologist and I examined nine migraine sufferers and I was able to temporarily reproduce their migraine pain, and furthermore this pain lessened as I maintained the technique.

This in my experience confirms significant cervicogenic (neck) involvement and according to The International Headache Society is a key diagnostic feature of cervicogenic headache. The conclusion of  the consultant neurologist was that these patients had cervicogenic headache as well as migraine!

Why can’t cervicogenic (neck) disorders be the cause of the key feature of migraine – a sensitised brainstem? The answer I am constantly given …. “whilst we don’t know where migraine comes from it can’t come from the neck.” This is not a particularly useful answer ….

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, Fredricksen TA, Pfaffenrath V. Cervicogenic headache: diagnostic criteria. Headache 1998; 38:442-5)

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

Headache and Migraine Article in Frontline

June 27, 2009 by dean · Leave a Comment 

In the recent ‘Frontline’ journal (which is the official journal of the Chartered Society of Physiotherapists in the UK) an article was published which discussed my approach and also the clinical trial being conducted by Dr Ian Davidson at the University of Manchester. The trial is investigating the effectiveness of my approach in migraine sufferers.

One of the participants of the trial, Sonja Lord, reported dramatic results describing “I feel like I’ve had a spring clean in my head. Colours are really vibrant.” Ms Lord had had years of medication and dietary advice without success. This is a story I hear all too often – if other approaches have failed and your neck has not been examined for relevant disorders (unlike Sonja’s), then your painful journey may continue when it need not.

Cheers

Dean

(Hunt L. When headache is a pain in the neck. Frontline 2009 17 June; 22-25)

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

Migraine and the University of Manchester (UK) Study

June 26, 2009 by dean · Leave a Comment 

Dr Ian Davidson, University of Manchester  (UK), is conducting a clinical trial involving over 100 migraine sufferers. This trial is investigating the outcomes of treatment using the approach I have developed.

Whilst the study began recruiting in April 2007, the results of the trial will not be known for at least 12 months – as you can imagine I am observing with keen interest!

Cheers

Dean

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

Welcome to my Journey in Headache and Migraine

April 6, 2009 by dean · Leave a Comment 

Welcome to my journey.

My journey started in 1987 when I commenced a Masters research program at the University of South Australia. The results of this research were published in the international headache journal, Cephalalgia, and have influenced the management of cervicogenic (neck-related) headache sufferers.

In 1991, I established The Headache Clinic in Adelaide, South Australia, which became recognised nationally and internationally. Since then I have treated headache and migraine sufferers exclusively.  I have now examined the necks of over 7000 headache and migraine sufferers and completed in excess of 28000 treatments. Now traditional medicine does not consider disorders of the neck to be involved in the headache and migraine process, but my clinical experience suggests very strongly that they do!

dean18

During this time my fundamental purpose has been and is to determine whether or not a neck disorder is the cause of or a significant contributing factor to headache or migraine – I believe that every headache sufferer has the right to know their headache diagnosis as precisely as possible, to know the nature of their headache disorder, its outcome and possible types of treatment.

Whilst my emphasis is on the neck as a source of headache, this does not blind me to the possibility of other factors as the cause of headache – I recognise that not all headache comes from disorders of the neck and that headache may have more than one cause. However given that the cause of migraine and other forms of headache are unknown it seems logical and reasonable that a skilled examination of your neck occurs after an assessment by your GP or Neurologist (and generally all the tests are negative) and before medication is prescribed – this may prevent a lifetime tied to medication, a lifetime of checking whether you have your headache or migraine medication in your handbag before you leave the house!

Current research shows that migraine is not a problem with the blood vessels and that tension headache is not caused by increased tension in the muscles of the scalp and forehead! More of that next time ….

Until then,

Dean

Dean Watson

Consultant Headache and Migraine Physiotherapist; Adjunct Lecturer, Masters Program, School of Physiotherapy, University of South Australia; PhD Candidate, Murdoch University, Western Australia

(Bakal DA, Kaganov JA. Muscle Contraction and Migraine Headache: Psychophysiologic Comparison. Headache 1977;17(5):208215

Tegeler CH, Davidai G, Gengo FM, Knappertz VA,Troost BT, Gabriel H, Davis RL. Middle cerebral artery velocity correlates with nitroglcerin-induced headache onset. J Neuroimaging 1996; 6(2): 81-6

Thomsen LL, Iverson HK, Olesen J. Cerebral bloodflow velocities are reduced during attacks of unilateral migraine without aura. Cephalalgia 1995; 15(2): 109-116

Thomsen LL. Investigations into the role of nitric oxide and the large intracranial arteries in migraine headache. Cephalalgia 1997; 17:873-95)

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