Treating Headache and Migraine with Greater Occipital Nerve Blocks

November 10, 2009 by dean · Leave a Comment 

Blocking the greater occipital nerve (which prevents information from the neck influencing the brainstem) continues to attract attention.

The authors after reviewing 21 pieces of research, whilst recommending that further research needs to be done, concluded that blocking or anaesthetising the greater occipital nerve is a worthwhile treatment approach for cervicogenic (neck-related) headache, cluster headache and migraine.

The positive results obtained through this procedure suggest that neck disorders are involved in the mechanisms of these headache conditions …. but blocks are not necessary … a skilled examination and treatment of relevant neck disorders can achieve the same result, without injections!



(Tobin J, Flitman S.Occipital Nerve Blocks: When and What to Inject? Headache 2009;49:1521 - 1533)

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

Neck Muscles and Migraine

November 5, 2009 by dean · Leave a Comment 

Neck muscle tenderness connected to migraine in this research

Research suggests neck muscle tenderness is connected to migraine

It is interesting to note that injecting tender neck muscles with trihexyphenidyl (used for muscle disorders and in managing the muscle tremors in Parkinson’s disease) prevented migraine attacks from occurring.

The authors suggested that neck muscle tenderness was closely connected to the migraine process!



(Teramoto J. New therapy to prevent migraine attacks just before onset. Cephalalgia, 29 (Suppl. 1) (2009) 1–166)

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

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

November 3, 2009 by dean · Leave a Comment 

It was shown that headache sufferers had neck disorders after concussion

Research showed post concussion headache sufferers had neck disorders

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.



(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.

Physicians’ Communication With Migraine Patients

November 2, 2009 by dean · Leave a Comment 

At last some research which investigates whether patients’ questions are being adequately heard.

The authors looked at the most commonly asked question “What causes migraine?” and asked 30 neurologists and migraine specialists for their explanations. Four were selected and edited and then given to 100 migraine sufferers.

The neurologists rated the importance of “It is important to provide patients explanations of what causes migraine?” at 4.3 (5= strongly agree); the patients rated “How important is it for physician to provide you with an explanation of what causes migraine?” as 4.7 (5=strongly agree).

Of the explanations put to the patients, most (56) preferred the longest (245 words) and the least (4) choosing the shortest (25 words).

These responses confirm that an understanding of the migraine process is important and that a detailed response is what is preferred.

Unfortunately what is being demonstrated through research is not being explained in the clinical situation – to you the headache or migraine sufferer; my goal is to relate the latest research findings in non medical terms, what they mean … and in a balanced way.

Knowledge is self-empowering – armed with knowledge you are then in a position to make well-informed decisions.



(Randolph W. Evans, MD; Rochelle E. Evans, MA .What Causes Migraine: Which Physician Explanation Do Patients Prefer and Understand? Headache 2009;49:1536-1540)

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

Depression, Migraine and Tension Headache

October 28, 2009 by dean · Leave a Comment 

Depression may be the result of headache and migraine experience

Depression may be the result of headache and migraine's isolating experience

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?



© 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.



(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, Tension Headache and Stress

October 24, 2009 by dean · Leave a Comment 

Managing stress helps headache and migraine

Managing stress helps headache and migraine

Why is it that when stress and migraine and tension headache are discussed studies all sorts of unproven mechanisms are discussed at length – despite all of the research and billions of dollars there is no proven causal mechanism – ‘it may be this …. or ‘it may be that‘ etc.

Muscle tension is evident in the necks of ‘tension headache‘ sufferers and migraineurs – it is tensed, shortened musculature acting on joint stiffness which leads to head pain.1

Research has shown that stress management approaches, including Relaxation Therapy and cognitive behavioural therapy consistently improve migraine 2 – if you are less stressed then stiff spinal segments sit quietly without any significant movement expected of them. Biofeedback is also helpful in managing migraine 2 for the same reason.

It can be very difficult to manage stress in our lives (for a whole lot of reasons including heart disease, depression, and other mental health disorders) and whilst is is important to take measures to do this, from a headache and migraine point of view, identifying and eliminating relevant neck disorders is crucial.



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

2. Rains JC, Penzien DB, McCrory DC, Gray RN. Behavioral headache treatment: History, review of the empirical literature, and methodological critique. Headache. 2005;45(Suppl. 2): S92-S109.)

© 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.



(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!



(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.



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

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