Neck Pain is the Cause of Worsening Migraine
October 14, 2009 by dean · Leave a Comment
Neck Disorders can be part of the migraine process
How refreshing to find other researchers who also believe that cervicogenic (neck) disorders can be part of the migraine process – we are few and far between!
Calhoun and Ford (whose research I have quoted recently), investigated the incidence of neck pain on wakening in 113 migraineurs. They found that the more chronic the migraine the more likely that neck pain would be present on wakening; and that the presence of neck pain on wakening increases the likelihood of waking with a migraine as well!
They concluded that either neck pain is a ‘migraine’ in the neck and/or that the presence of neck pain without a migraine is likely to lead to migraine becoming more chronic.
My clinical experience includes treating patients just with pain in the neck but whose neck pain responded to the ‘triptans’ i.e. their ‘migraine’ was in their neck!
Cheers
Dean
(Calhoun AH, Ford S. The prevalence of neck pain on awakening in a cohort of migraineurs Cephalalgia 2009;29(Suppl. 1):1–166)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Migraine and Blood Vessels
October 13, 2009 by dean · Leave a Comment
“Migraine and Blood Vessels – The Myth!” outlines the diagnosis of migraine and poses the question “What does it Mean?”
Go to Articles on the Home Page and scroll down before clicking on the article title to be taken straight to it or click on …
Cheers
Dean
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Cervicogenic Headache is Rare – You Have Got to be Kidding (?)
October 7, 2009 by dean · Leave a Comment
In a study coming out of Norway the incidence of cervicogenic (neck) headache was found to be rare – only 0.17% of the population.
It is interesting to note that the diagnosis was made based only on the features of headache. It is widely accepted that features of headache alone are not sensitive enough to differentiate cervicogenic headache from migraine and from tension headache.
To diagnose cervicogenic headache, a thorough and skilled examination of the upper neck needs to be performed for temporary reproduction (and resolution) of familiar headache.
A physical examination was performed on only those headache sufferers selected on the basis of their headache features (and did include the above!). If it had it would have confirmed cervicogenic headache. However this is not the point, the physical examination was performed on only a select few!
Similarly, greater occipital nerve (GON) blocks blocks were performed only on those selected from their headache features – the blocks were effective in over 90% – I am not surprised. As with the physical examination, the blocks needed to be performed before a diagnosis of cervicogenic headache was made.
I have written before of the numerous studies demonstrating that headaches with a diagnosis of migraine are relieved by blocking the GON (greater occipital nerve) – who knows how many of the headache sufferers were excluded based on features and who had cervicogenic headache (?)
Previous research has shown that cervicogenic (neck) headache is as common as migraine.
Cheers
Dean
(Knackstedt H. Cervicogenic headache in the general population. the Akershus study of chronic headache. Cephalalgia 2009;29 (Suppl. 1):1–166
Nilsson N. The prevalence of cervicogenic headache in a random population sample of 20-59 year olds. Spine 1995;20:1884-1888
Rozen T. Cessation of hemiplegic migraine auras with greater occipital nerve blockade. Headache 2007;47:917-928
Takmaz, S. et al Greater occipital nerve block in migraine headache: Preliminary results of 10 patients. Agri 2008 Jan;20(1):47-50
Yi X et al Cervicogenic headache in patients with presumed migraine: missed diagnosis or misdiagnosis? J Pain. 2005 Oct;6(10):700-3
Young WB, Marmura M, Ashkenazi A, Evans RW. Expert opinion: 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.
Migraine: To Treat or Not To Treat – The Dilemma!
October 5, 2009 by dean · Leave a Comment
….. this was the title of my second presentation at the CRAFT Conference in Nuremberg.
The traditional medical model is largely dismissive of the role of neck disorders in the migraine process. However my clinical experience of over 21000 hours with headache and migraine sufferers contradicts this view.
Now I do not expect people to accept my perspective without question but when the reply I get is:
“Well we don’t know where migraine comes from or what it is, but it can’t come from the neck.”
I get a just a little frustrated ….. think about this for a minute ….. if you don’t know where something is coming from you cannot say it does not come from the neck!
My reply is:
“Can you show me it doesn’t come from the neck?”
….. which of course they can’t.
In this presentation I put forward the evidence, the research (of which there is plenty), which shows quite clearly that neck disorders can be the key to the migraine process and how we as physiotherapists can identify this.
Cheers
Dean
© 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
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.
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
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.
Migraine And Cluster Headache Are ‘First Cousins’!
September 19, 2009 by dean · Leave a Comment
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.
Cluster Headache In 2 Year Old Girl!
September 13, 2009 by dean · Leave a Comment
Cluster Headache in 2year old
This is amazing!
Whilst I have treated a 3 year-old girl with ‘migraine’ (i.e.one-sided headache with nausea and vomiting) I have never come across this before.
The authors describe that it was difficult to make a diagnosis in such a young patient (given that in adults it is fraught with difficulty!) due to the lack of patient’s inability to describe symptoms well. However it appears that it was the associated symptoms (redness of the eye, tearing of the eye, swelling of the eyelid and itching of the nostril) which enabled a clear diagnosis of cluster headache to be made.
Cheers
Dean
(M Kacinski, A Nowak, S Kroczka & A Gergont. Cluster headache in 2-year-old Polish girl. Cephalalgia 2009;29:1091-1094)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.