Your Headache Solutions » neck disorders

The Headache and Migraine Sufferers Bill of Rights (cont)

dean — Fri, 04 Dec 2009 00:05:16 +0000

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)

Watson Headache Course – Level I

dean — Wed, 18 Nov 2009 00:15:25 +0000

I have been mentioning the courses I present to physiotherapists, chiropractors and osteopaths without explaining what it is that we cover.

The Level I course is called:

“The Role of CO-C3 Segmental Dysfunction in Primary Headache”

This course essentially looks at information from the top three spinal joints (which affects the brainstem, and we know the brainstem is sensitised in headache and migraine sufferers) and whether these joints are involved in the headache or migraine process.

The course looks at how the medical model of headache classifies headache and migraine; then I present the research i.e. what is in the literature, which actually contradicts the traditional medical model and supports my clinical experience of over 21000 hours, that is, the necks of all headache or migraine sufferers should be examined irrespective of the diagnosis.

As a result of my experience I have developed a verbal examination (often called the ‘subjective examination’) which includes the area of headache, history and behaviour of symptoms. From this we can tell if there is change in headache or migraine symptoms.

It is important that, before we examine the upper neck, tests of neck arteries are performed and also ligaments of the upper neck. I am not happy with the traditionally taught tests – I think they are too (and unnecessarily) aggressive on potentially already damaged ligaments. I demonstrate (and we practice) tests which are much less aggressive.

Then I demonstrate and we practice (on each other) techniques I have developed, which not only identify if neck disorders are the cause of headache or migraine symptoms but also which joint it is that is causing the problem. If we can identify the joint or spinal segment involved, the chances of getting a successful outcome increases significantly because treatment can then be directed at the source.

I finish the course by examining two headache or migraine sufferers, so course delegates can see everything put into practice.

Then after at least 6 months experience using this approach, course delegates then return for the Level II Advanced course.

Cheers

Dean

Cluster Headache – Another Headache or Migraine

dean — Mon, 16 Nov 2009 00:15:40 +0000

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

Cluster Headache – Another Headache or Migraine

dean — Thu, 12 Nov 2009 09:42:04 +0000

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.

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

Cheers

Dean

Treating Headache and Migraine with Greater Occipital Nerve Blocks

dean — Tue, 10 Nov 2009 01:32:55 +0000

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)

Examining The Neck of a Cluster Headache Sufferer

dean — Sun, 08 Nov 2009 00:45:46 +0000

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

Level I and II Headache and Migraine Course in Sydney

dean — Sat, 07 Nov 2009 21:45:53 +0000

Level I and Level II Courses, Sydney

Having just completed a Level II course in Sydney all that remains on the teaching schedule for 2009 is the Level I course. I am pleased to say that this course is also fully subscribed with a waiting list so another course is likely early in 2010.

This is encouraging; I sense there is an increased level of interest in the neck and its role in headache and migraine at least within physiotherapy (and I suspect chiropractic and osteopathic) circles. This can only benefit headache and migraine sufferers as another option (i.e. skilled examination and treatment of relevant neck disorders) becomes increasingly available.

Cheers Dean

Menstrual Migraine – It’s Not Your Hormones!

dean — Wed, 04 Nov 2009 05:04:37 +0000

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

Tension As A Factor In Worsening Tension Headache And Migraine

dean — Mon, 26 Oct 2009 00:51:00 +0000

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)

Migraine, Tension Headache and Stress

dean — Sat, 24 Oct 2009 00:40:50 +0000

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.)