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.

Cheers

Dean

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

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

A Key Diagnostic Feature of Cervicogenic (Neck) Headache

September 25, 2009 by dean · Leave a Comment 

A key diagnostic feature of cervicogenic (neck) involvement in headache is the temporary reproduction of headache and migraine pain when examining structures of the upper neck. This diagnostic feature is recognised by The International Headache Society, The International Association for the Study of Pain and The International Cervicogenic Research Group.

However, in my experience and neuro anatomical principles indicate that, reproduction of headache alone is not enough to confirm that the disorder is the cause of headache.  There also needs to be lessening of the reproduced headache as the technique is sustained.

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.

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.

Summary of the Watson Headache Institute

September 12, 2009 by dean · Leave a Comment 

The Watson Headache Institute was established to increase the awareness of cervicogenic (neck) disorders in headache and migraine by:

imparting my (and that of others) clinical experience and knowledge

and,

undertaking and supporting rigorous clinical and scientific research in this specialty (I am currently a PhD Candidate investigating the role of cervicogenic dysfunction in the mechanism of migraine at Murdoch University, Western Australia).

and,

in determining whether or not a neck (cervicogenic) disorder is the cause of or a significant contributing factor to headache or migraine.

It is recognised

that neck (cervicogenic) dysfunction is significantly underestimated

that a neck (cervicogenic) dysfunction can be the cause of various forms of headache and migraine.

that the necks of all (primary) headache and migraine sufferers should be examined

To this end it is my objective to pass on this experience to my colleagues and headache and migraine sufferers

because

it is irresponsible to treat irrelevant cervicogenic (neck) dysfunction in migraine and headache conditions.

However

given that the causes of migraine and tension headache are not clear, the advances in our knowledge of pain mechanisms and the not insignificant body research supporting cervicogenic factors as key players in the headache and migraine processes,

it is also irresponsible NOT to examine the necks of headache sufferers irrespective of the diagnosis.

Cheers

Dean

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

A Thorough Examination of Your Neck

September 9, 2009 by dean · Leave a Comment 

A skilled examination of the neck

A skilled examination of the neck

A thorough examination of your neck by a skilled practitioner may be the missing link in finding the root cause of your headache or migraine.

It is appropriate that the first step is for your headache or migraine to be assessed by your doctor who will then determine if a neurological opinion is required and whether a scan of your head is necessary. In the vast majority of cases a scan is negative, that is, no abnormality is present. Subsequently, what usually happens is that medication is suggested, and then starts a ‘merry-go-round’ of trying different medication regimes; you as a headache or migraine sufferer are (perhaps unnecessarily) destined to a lifetime of medication.

At this point, what is missing is a thorough examination of the structures of the upper neck.

Cheers

Dean

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

‘Hair Wash Headache’!

September 5, 2009 by dean · Leave a Comment 

Weight of hair can pull the upper neck backwards

Weight of hair can pull the upper neck backwards

In recent correspondence to an acclaimed international headache journal, a doctor located in India reported on migrainous headache occurring after washing of the hair – as the author explains this has either not been noticed in other countries or it may be that similar headache presentations in other countries occur but are called something else.

As reported by this doctor, the crucial factor here is that many ladies from India have long hair that is plaited and it is time consuming to dry their hair (it is uncommon to use a hairdryer). Consequently many women do not wet their hair daily. On the days that they wash their hair however they describe throbbing headache developing within 10’-15’ ; their history of these headaches is usually quite long; this is the only headache they get; usage of perfumes or shampoos is uncommon … therefore the author (doctor) considers there are no other triggering factors …..

Are you thinking what I’m thinking? Imagine the weight on the back of the head of all the wet hair pulling the upper neck backwards – the stress on the neck structures would be significant …. could this be an unrecognised cervicogenic headache?

Cheers

Dean

(Ravishanka K. ‘Hair-wash headache’—an unusual trigger for migraine in Indian patients Cephalalgia 2005;(25)12:1184-1185

Ravishanka. Unusual Indian migraine trigger factors. Headache World 2000. Poster Presentation. Cephalalgia 2000; 20:359)

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

Supporting You, Along With Your Doctor

September 1, 2009 by dean · Leave a Comment 

Determining the cause of your head pain and symptoms

Determining the cause of your head pain and symptoms

Supporting you, along with your doctor, in determining the cause of your head pain and symptoms is one of the goals of the Watson Headache Institute.

It also provides a network of highly trained practitioners who are dedicated to achieving a successful treatment outcome for headache and migraine sufferers.

If you have had medical tests such as an MRI, Cat Scan and X-ray which have proved negative, then before undertaking ongoing medication, a skilled examination of the neck is an important step to understanding the nature of your pain as precisely as possible.

Identifying whether you have any spinal segment involvement in your headache or migraine can be achieved by seeking the advice of a practitioner skilled in assessing the role of the neck in your headache or migraine pain.

If you would you like an Internationally Trained Practitioner to assist you with your Headache or Migraine pain please go to the home page and read the information under the heading of ‘Practitioner’.

Cheers

Dean

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

Hemicrania Continua and Cervicogenic (neck-related) Headache – Are They The Same Condition?

August 31, 2009 by dean · Leave a Comment 

Interesting to note a case study reporting that the head pain of a patient suffering hemicrania continua was temporarily reproduced and resolved by neck movements and later by blocking or injecting the greater occipital nerve. These two features are key diagnostic signs of cervicogenic or neck related headache and indeed this respected researcher concludes this.

Cheers

Dean

(Rothbart P. Unilateral Headache with Features of Hemicrania Continua and Cervicogenic Headache – A Case Report. Headache 1992;(32)9;459-60)

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

Neck X-Rays, Headache and Migraine

August 28, 2009 by dean · Leave a Comment 

Neck X-Ray

Neck X-Ray

Generally routine neck xrays are uninformative for headache or migraine sufferers. However, this does not exclude neck disorders as the source of headache or migraine.

Therefore xrays as a form of diagnosis are not highly regarded. Nevertheless it is very important that neck xrays be undertaken in the event of any significant head or neck trauma or injury.

It is information from structures supplied by the upper three cervical nerves which have access to the brainstem and therefore the potential to sensitise the brainstem. Consequently abnormalities seen on neck xrays, involving spinal segments below C3 (third cervical vertebra) are likely to be irrelevant. This is why it is crucial that when having a CT or MRI scan of your neck for headache that the upper 3 spinal segments are included.

Degenerative changes or spondylosis of C5-6 for example is irrelevant to the sensitisation process; information from this level does not have direct access to the brainstem.

Cheers

Dean

(Goldhammer L. Second cervical root neurofibroma and ipsilateral migraine headache. Cephalalgia 1993; 13:132

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

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.

Exertional Headache, Migraine and the Neck

August 26, 2009 by dean · Leave a Comment 

"Exertional Headache"

"Exertional Headache"

‘Benign’ (or harmless) Exertional Headache is defined as headache caused by exertion such as coughing, sneezing, bending, heavy lifting, running (how is this different to headache triggered by exercise?) or when straining at stool.

It is important that if your headache history is less than 3 months and is triggered or aggravated by these activities that you consult you doctor.

These activities create similar effects on the body as do the Valsalva manoeuvers.

Recent research1 found a wide range of symptoms in Exertional Headache, some with migrainous symptoms, and the authors suggested that the ‘triptans’ might be useful. As usual there is a lot of discussion as to the actual mechanism of Exertional Headache and indeed Exercise Induced Headache, but the causes remain unknown – why?

The Valsalva manoeuver is used (and has been for years) to identify problems or injury in the nerves of the cervical spine. Upon the exertion of pressure, pain may be felt, and may indicate increased pressure on the C2-3 intervertebral disc or other part of a cervicogenic (neck) disorder.

Clearly increased headache or headache or migraine triggered by exertion or exercise is likely to be caused by a neck disorder.

Cheers

Dean

(Chen S-P, Fuh J-L, Lu S-R, Wang S-J. Exertional headache – a survey of 1963 adolescents. Cephalalgia 2008; 29:401-407

Johnson RH, Smith AC, Spalding JM (February 1969). “Blood pressure response to standing and to Valsalva’s manoeuvre: independence of the two mechanisms in neurological diseases including cervical cord lesions”. Clin Sci 36 (1): 77–86)

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