The Headache and Migraine Sufferers Bill of Rights (cont)

December 4, 2009 by dean · Leave a Comment 

The second ‘bill’:

“The headache sufferer has the right to be taken seriously by the healthcare providers, whose duty it is to take down a relevant history (I have no issues with these!), conduct a relevant physical examination, provide advice and reassurance and prescribe the treatment most advantageous and acceptable to the patient according to current knowledge.”

The issue I have here is with:

conduct a relevant physical examination

It is appropriate that a neurologist conduct the aspects of the physical examination which rule out serious causes of headache – however and with respect the neurologist, physician, or general practitioner are not skilled in examination of the structures of the upper neck – this is where the ‘system’ fails you, the headache or migraine sufferer …. the prognosis, treatment, advice are dependent on the examination, which at this point in time is incomplete; incomplete because your neck has not been examined comprehensively.

So let’s summarise from the first 2 of the 4 ‘bills’ of rights’:

a precise diagnosis is not possible (and besides, does it mean anything)

the nature of the disorder is a sensitised brainstem

the prognosis and best treatment options are dependent on identifying the reason for the sensitisation

the examination you will get will most likely be incomplete because your neck will not be comprehensively examined and therefore one of the most likely reasons for sensitisation (a neck disorder) will not identified ….

…. which means you are likely to be destined to a lifetime of medication which at best manages the symptoms and not the cause.

It is appropriate that as headache or migraine sufferer that you consult your medical practitioner to exclude serious causes of headache (which are extremely rare) but once the various tests have been carried out and there is nothing to find, then a skilled examination of your neck is indicated. Research has shown that information from neck disorders can sensitise the brainstem.

Cheers

Dean

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

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

Cluster Headache – Another Headache or Migraine

November 16, 2009 by dean · Leave a Comment 

Tension Headache and Migraine are recognised as the most common forms of headache.

Cluster headache is one of the third ‘group’ of headaches – the other headache types in this group are Hemicrania Continua, Chronic Paroxysmal Hemicrania, and SUNCT.

All of the headache types in this third group share similar symptoms with Cluster Headache and either blocking or modifying information from the neck has a beneficial effect on Cluster Headache suggesting that neck disorders not only play a significant role in Cluster headache but perhaps the others(?)

To review the posts on Cluster Headache key in ‘Cluster Headache’ on the ‘Home Page’ and all associated posts will be listed for you to review.

Cheers

Dean

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

Cluster Headache – Another Headache or Migraine

November 12, 2009 by dean · Leave a Comment 

Tension Headache and Migraine are recognised as the most common forms of headache.

Cluster headache is one of the third ‘group’ of headaches – the other headache types in this group are Hemicrania Continua, Chronic Paroxysmal Hemicrania, and SUNCT.

All of the headache types in this third group share similar symptoms with Cluster Headache and either blocking or modifying information from the neck has a beneficial effect on Cluster Headache suggesting that neck disorders not only play a significant role in Cluster headache but perhaps the others(?)

To review the posts on Cluster Headache return to the ‘Home Page’ and key in the search term ‘Cluster Headache’.

Cheers

Dean

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

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!

Cheers

Dean

(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.

Examining The Neck of a Cluster Headache Sufferer

November 8, 2009 by dean · Leave a Comment 

I was talking to a neurologist when in the UK recently and he mentioned that he was writing a case study of a cluster headache sufferer who has been free of cluster headache since his neck was treated. This is not a surprise to me as cluster headache frequently responds to treatment of relevant neck disorders.

This discussion reminded me of patient I saw when in The Netherlands about 5 years ago. This gentleman was 55 years of age and had suffered cluster headache since he was 25 years of age. His episodes lasted 6 months and occurred every 5 years.

I have mentioned that a key diagnostic finding when examining the upper neck structures is the temporary reproduction of headache and for headache to lessen as the technique is sustained. I examined this man when he was not experiencing an attack. Not only was I able to reproduce his head pain, but his eye started to water and his nose started to run, just as if he was in the middle of an attack – those of you who are cluster headache sufferers will identify with this!

Unfortunately I lost touch with this gentleman so I am not sure of the outcome or if in fact he sought treatment ….. but I would be confident of a successful outcome in experienced hands.

Cheers

Dean

© 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, 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.

Cheers

Dean

(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.

Cluster Headache After Mild Head Trauma

October 18, 2009 by dean · Leave a Comment 

Horrible day

Cluster Headache after mild head trauma

In this case study a 48 year old woman developed signs and symptoms of cluster headache after hitting her head on an iron ladder.

The authors consider various possibilities as to the cause, but all related to intra cranial, i.e. inside the head, factors … this pre occupation with intra cranial causes is frustrating on two counts.

Firstly, this woman is still suffering 19 years (Yes – 19!) later, and secondly, that a neck injury has not been considered. Research has shown that symptoms of cluster headache are treated successfully by blocking information from the upper neck indicating that neck disorders can be the source of symptoms.

In instances such as this when there is a blow to the head by a stationary object, clearly the head stops (suddenly and momentarily), and the body continues to move, leaving the neck to absorb the strain, effectively to put the brakes on! This patient has experienced a neck injury and even a minor incident can be much than what it seems especially when the blow is unexpected.

Cheers

Dean

(Lambru G, Castellini P, Manzoni GC, Torelli P. Traumatic Cluster Headache: From the Periphery to the Central Nervous System? Headache 2009;49:1059-1072

Peres MF. et al Greater occipital nerve blockade for cluster headache. Cephalalgia 2002;22:520-522

Solomon S, Lipton RB, Newman LC. Nuchal features of cluster headache. Headache 1990;30:347-9

Tobin J,Stephen Flitman S. Nerve Blocks: When and What to Inject? Headache 2009

Treleaven J, Jull G, Atkinson L. Cervical musculoskeletal dysfunction in post-concussional headache. Cephalalgia 1994;14:273-9)

© 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.