Headache and Migraine Causes
August 25, 2009 by dean · Leave a Comment
The recent research has shown convincingly that migraine and headache is underpinned by sensitisation of the brainstem or central sensitisation.
One of the potential sources of senstisation of the brainstem is abnormal information from a disorders of structures within the head, structures which are supplied by the trigeminal nerve. It is then interesting to find that headache persists after blocking information carried by the trigeminal nerve. This clearly demonstrates that headache or migraine can come from other sources, for example neck disorders, and that the triptans act on structures other than in the head to ease headache or migraine … a sensitised brainstem … sensitised from another source … perhaps a neck disorder?
This can be easily confirmed by a skilled examination of the upper neck structures.
Cheers
Dean
(Matharu MS, Goadsby PJ. Persistence of attacks of cluster headache after trigeminal nerve root resection. Brain 2002;125(pt5):976-984)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Migraine, Tension Headache, the Neck and Sensitisation of the Brainstem
August 22, 2009 by dean · Leave a Comment
Information from the neck - is a neck disorder relevant?
It is generally agreed and it has been demonstrated that the brainstems in migraineurs and tension headache sufferers are sensitised.
The brainstem is influenced by 4 systems:
information from structures inside the head – head scans which fortunately in over 95% of headache and migraine sufferers the scans are clear, will eliminate this factor
the diffuse noxious inhibitory control system – this is poorly understood, but it is the mechanism which acts when you hit your thumb with a hammer and your headache seems less painful – hardly an attractive treatment option!
the serotonin system – serotonin desensitises the brainstem – if there is not enough then the brainstem becomes sensitised – so it makes sense to optimise your production of serotonin – diet, exercise, sunlight and perhaps a L-tryptophan supplement (after checking with your doctor)
information from the neck – get your neck checked. Many of us have a neck disorder, but is it relevant? This can be determined by, when examining the neck, temporarily reproducing familiar head pain which lessens as the technique is sustained. In my 21000 hours of experience this occurs in over 90% of headache and migraine conditions. My approach as a diagnostic tool is unparalleled in the manual therapy area and is in accordance with the views of traditional medicine.
Why does it have to be complicated?
The last two systems are within your control – you can take steps to address these.
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
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
Jull G, Bogduk N, Marsland A. The accuracy of manual diagnosis for cervical zygapophyseal joint pain syndromes. Med J Aust. 1988 Mar 7;148(5):233-6
Milanov I, Bogdanova D. Trigemino-cervical reflex in patients with headache. Cephalalgia 2003; 23:35-38
Nardone R, Tezzon F. The trigemino-cervical reflex in tension-type headache. European Journal of Neurology 2003; 10(3):307-312
Nardone R et al Trigemino-Cervical Reflex Abnormalities in Patients with Migraine and Cluster Headache. Headache 2008; 48(4):578-585
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
Sjaastad O, Fredricksen TA, Pfaffenrath V. Cervicogenic headache: diagnostic criteria. Headache 1998; 38:442-5)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
The Uncertainty of Treating Migraine
August 21, 2009 by dean · Leave a Comment
“ … little does it concern the patient that there is an underlying cause … if the practitioner is unable to relieve his pain.” (Persian Avicienna – Critchley 1967)
This statement was made 2000 years ago and remains true today – patients are seeking treatment, but since the cause of migraine remains unclear, treatment is provided on a less than solid scientific foundation, on a ‘we’ll try this and see what affect it has’ basis.
However what is becoming increasingly clear (except to those who continue to support the notion that headache and migraine are separate entities) is that headache and migraine arise from the same (sensitised brainstem) disorder – the evidence is there – this is the underlying cause. Not only can we confirm relevant neck disorders as the source but we can offer a way of addressing it, based not on guesswork but on sound scientific evidence.
Cheers
Dean
(Anderson CD, Franks RA. Migraine and tension headache: is there a physiological difference? Headache 1981; 21:63-71
Critchley M. Migraine from cappadocia to queens square. In: Smith R, ed. Background to Migraine. London: Heinemann;1967:28
Cady RK, Gutterman D, Saires JA, Beach ME. Responsiveness of non-IHS migraine and tesnion-type headache to sumatrptan. Cephalalgia 1997;17:588-90
Cady R, Schreiber C, Farmer K, Sheftell F. Primary headaches: a convergence hypothesis. Headache 2002; 42:204-16
Featherstone HJ. Migraine and muscle contraction headaches: a continuum. Headache 1985; 25:194-198
Marcus D, Scharff L, Mercer S, Turk D. Musculoskeletal abnormalities in chronic headache: a controlled comparison of headache diagnostic groups. Headache 1999; 39:21-27
Mercer S, Marcus DA, Nash J. Cervical musculoskeletal disorders in migraine and tension-type headache. Paper presented at the 68th Annual Meeting of the American Physical Therapy Association; 1993; Cincinatti, Ohio
Marcus DA. Migraine and tension-type headaches: the questionable validity of current classification systems. Clin J Pain 1992; 8:28-36
Nelson CF. The tension headache, migraine headache continuum: A hypothesis J Manipulative Physiol Ther 1994; 17:156-167
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)
Vernon H, Steiman I, Hagino C. Cervicogenic dysfunction in muscle contraction headache and migraine: A descriptive study. J Manipulative Physiol Ther 1992; 15:418-429
Yi X et al Cervicogenic headache in patients with presumed migraine: missed diagnosis or misdiagnosis? J Pain. 2005 Oct;6(10):700-3
Young et al 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.
Avoiding Chocolate to Prevent Migraine is Not Necessary
August 18, 2009 by dean · Leave a Comment
Chocolate can be eaten without a migraine
Avoiding chocolate to prevent migraine is not necessary – it isn’t about the chocolate!
The thought of living without chocolate is unbearable but I know that for many of you, the experience is not worth it!
However, many of my patients are now eating chocolate, in fact this is what I ask them to do after 3-4 treatments – and you can imagine their (and mine!) delight when they do so without headache or migraine.
But why is it that I can eat chocolate without headache – I’m sure that chocolate has the same effect on me as it does on someone else who ends up with a headache. For example phenylethylamine (PEA) is a chemical in chocolate that causes blood vessels to expand and contract – this probably happens for everyone, but not everyone gets headache or migraine. Some might say that the chocolate sensitises their system, whilst some authorities suggest that their system is already sensitised before the chocolate came along.
I suspect that just as in migraine and tension headache sufferers, the brainstems of those whose headache or migraines are triggered by chocolate, are already sensitised. The normal response of the blood vessels to PEA is to expand, but the pain interpreting centres in the brain understands this (normal) increased activity to be much more than what it is and pain results.
What’s causing the sensitisation? It is easy to confirm a neck disorder because temporary reproduction and lessening of head pain occurs when examining the joints of the upper neck – it is important to confirm the source of sensitisation …
… then you can enjoy the benefits of eating (good quality and dark) chocolate:
a natural mood enhancer
a stress reliever
a memory enhancer
improves your levels of serotonin (which will desensitise your brainstem).
Cheers
Dean
(Marcus DA, Scharff L, Turk D, Gourley LM. A double-blind provocative study of chocolate as a trigger of headache. Cephalalgia;17(8):855-62
Scharff L, Turk DC, Marcus DA. Triggers of Headache Episodes and Coping Responses of Headache Diagnostic Groups. Headache 1995;35:397-403 )
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Diagnosing Cervicogenic Headache is Easy
August 17, 2009 by dean · Leave a Comment
I mentioned recently that blocking the greater occipital nerve and eliminating head pain is key sign of cervicogenic or neck headache and that this has been demonstrated repeatedly in migraine sufferers.
This procedure (injecting nerves) however is not necessary to diagnose cervicogenic headache which is just as well because after all it is invasive, not readily available and relatively expensive.
The ability to temporarily reproduce familiar head pain when examining joints of the upper neck is recognised by traditional medicine as one of the most important indicators of cervicogenic headache (actually, I have to disagree with this, reproduction alone is not enough – there needs to be lessening of the head pain as the examination technique is sustained – more of that later).
It is irresponsible to recommend treatment of the neck for headache or migraine when it is not the cause and therefore it is crucial that reproduction and lessening of head pain occurs during the examination.
The examination approach I have developed on the basis of 21000 hours experience is unparalleled – in recent research familiar head pain was reproduced in 100% of tension headache sufferers and 94% of migraineurs …. now I could be cynical and say that 100% had tension headache and cervicogenic headache and 94% migraine sufferers had cervicogenic headache as well.
Cheers
Dean
( Akin Takmaz et al. Greater occipital nerve block in migraine headache: Preliminary results of 10 patients. Agri. 2008 Jan;20(1):47-50
Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders, 2nd edn. Cephalalgia 2004; 24(suppl.1):1-151
Rozen T. Cessation of hemiplegic migraine auras with greater occipital nerve blockade. Headache 2007;47:917-928
Sjaastad O, Fredricksen TA, Pfaffenrath V. Cervicogenic headache: diagnostic criteria. Headache 1998; 38:442-5
Yi X et al Cervicogenic headache in patients with presumed migraine: missed diagnosis or misdiagnosis? J Pain. 2005 Oct;6(10):700-3
Young et al 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.
Headache and Migraine Diagnosis and Treatment
August 16, 2009 by dean · Leave a Comment
The neck can be the source of sensitisation
There are numerous case studies which have shown that injecting local anesthetic around the greater occipital nerve the pain of migraine is eased. This is also a key finding in cervicogenic headache and confirms the diagnosis of cervicogenic headache. So why is it that, in this situation, almost invariably the interpretation is that the sufferer has two types of headache that is:
cervicogenic headache,
and
migraine
I am always bemused by this, why can’t it be that the ‘migraine’ and cervicogenic are the same headache.
Why is it that the answer I often get is “… well we don’t know where migraine comes from but it can’t come from the neck.” Clearly this is a really unhelpful comment. Why is it that I need to demonstrate that the neck can be the source of sensitisation in migraine sufferers (my claim is based on over 21000 hours experience with headache and migraine sufferers)? Perhaps I should request from those who disagree to demonstrate that migraine cannot develop from a neck disorder ….
Cheers
Dean
(Akin Takmaz et al. Greater occipital nerve block in migraine headache: Preliminary results of 10 patients. Agri. 2008 Jan;20(1):47-50
Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders, 2nd edn. Cephalalgia 2004; 24(suppl.1):1-151
Peres MF. et al Greater occipital nerve blockade for cluster headache. Cephalalgia 2002;22:520-522)
Rozen T. Cessation of Hemiplegic Migraine Auras With Greater Occipital Nerve Blockade. Headache 2007;47:917-919)
Sjaastad O, Fredricksen TA, Pfaffenrath V. Cervicogenic headache: diagnostic criteria. Headache 1998; 38:442-5
Yi, X. et al Cervicogenic headache in patients with presumed migraine: missed diagnosis or mis diagnosis? J Pain 2005 Oct;6(10):700-3
Young WB et al. Greater Occipital Nerve and Other Anesthetic Injections for Primary Headache Disorders. Headache 2008;48:112-1125
Young, W. et al The first 5 minutes after greater occipital nerve block. Headache 2008 July 48(7):1126-8)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
The ‘Triptans’ and Menstrual Migraine
August 13, 2009 by dean · Leave a Comment
It’s interesting to read that the ‘triptans’ are also effective in managing menstrual migraine, suggesting that the underlying cause for migraine, tension headache and menstrual migraine is similar, that is, a sensitised brainstem.
One underestimated source of sensitisation are neck disorders …. tired of playing around with your hormonal levels? Perhaps it is your neck that is sensitising your brainstem – a skilled examination will either confirm or eliminate this as a possibility.
Cheers
Dean
(Mannix LK, Files J. The use of triptans in the management of menstrual migraine. CNS drugs 2005;19(11):951-972)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Cluster Headache Following Trauma
August 12, 2009 by dean · Leave a Comment
Clinical experience suggests a skilled examination of the neck in cluster headache sufferers
My experience with cluster headache includes a patient who developed cluster headache 2-3 months after a whiplash accident – and treatment of his subsequent neck disorder has meant that he has been pain-free for 5 years.
A recent case study describes the onset of cluster headache after mild head trauma – and whilst most attention is given to the possibility of some trauma to structures inside the head, the neck has to stop either the moving head in relation to the body or the body in relation to the head and (the neck) is likely to be injured.
My clinical experience suggests that it is important for a skilled examination of the neck in cluster headache sufferers.
Cheers
Dean
(Lambru G et al. Post-Traumatic Cluster Headache: From the Periphery to the Central Nervous System? Headache 2009;(49)7:1059-1061)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Migraine Aura Eliminated by Blocking the Greater Occipital Nerve
August 10, 2009 by dean · Leave a Comment
Neck disorders can be significant in the headache and migraine process
Not only can the pain of migraine be relieved by injecting the greater occipital nerve but also the aura.
In two patients with hemiplegic migraine their aura symptoms were completely stopped within 5 minutes and without the usual following headache.
Interestingly this is very similar to my clinical experience. I have had the opportunity to treat two patients within 5 minutes of an (visual) aura starting. Within 5 minutes of mobilising their upper cervical spine, their auras had stopped and in both patients, the headache that usually follows did not happen.
This provides further support that neck disorders can be significant in the headache and migraine process.
Cheers
Dean
(Rozen T. Cessation of Hemiplegic Migraine Auras With Greater Occipital Nerve Blockade. Headache 2007;47:917-919)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Migraine, Sinus Headache and the ‘Triptans’ – There’s More!
August 9, 2009 by dean · Leave a Comment
Further to my comment earlier, the ‘triptans’ have been shown to be useful in differentiating migraine from sinus headache.
As in past studies patients with a self-diagnosis or physician-diagnosis of ‘sinus’ headache were assessed. An overwhelming 82% had a significant reduction in their headache symptoms.
This extraordinary response provides further (not that any more is required!) evidence that the significant majority of ‘sinus’ headaches are migraine and that the ‘triptans’ aid diagnosis.
Don’t want to take a ‘triptan’? That’s OK because a skilled examination of your upper neck will quickly tell you that it isn’t ‘sinus’ headache, but an unrecognised cervicogenic (neck) headache.
Cheers
Dean
(Kari E, DelGaudio JM. treatment of sinus headache as migraine: the diagnostic utility of triptans. Larygoscope 2008 Dec;118(12):2235-9)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.