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 – An Unrecognised Cervicogenic Headache?

September 15, 2009 by dean · Leave a Comment 

Migraine Sufferers have a significantly reduced range of neck movement

Migraine Sufferers have a significantly reduced range of neck movement

It is interesting to note that ongoing investigation into the role of cervicogenic (neck) disorders in migraine sufferers has revealed significantly reduced range of neck movement when compared to non headache sufferers. Just more information to add to the growing body of evidence which supports the possibility that the sensitisation of the brainstem in migraine sufferers may be caused by a neck disorder.

Cheers

Dean

(Bevilaqua-Grossi D, Pegoretti KS, Goncalves MC, Speciali JG, Bordini CA, Bigal ME. Cervical Mobility in Women With Migraine. Headache 2009;49:726-73)

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

Worsening Migraine Attacks Decreased Significantly By Cervicogenic (Neck) Treatment

September 11, 2009 by dean · Leave a Comment 

Long term worsening of the migraine process

Long term worsening of the migraine process

Recent evidence suggests that migraine is an increasing condition in which over time, the attacks become more frequent, more severe, less responsive to medication, and perhaps lasting longer.

Research has shown that by decreasing information (surgically) from cervical (neck) nerves deceases the long term worsening of the migraine process. The natural progression of cervicogenic (neck) headache is exactly the same – if it is left untreated, cervicogenic headache becomes more frequent, more severe and eventually becomes continuous. This indicates that with the passage of time the neck disorder is gradually worsening (and it is likely to be loss of function or stiffness). This research supports the idea that cervicogenic (neck) disorders are the reason for not only worsening of the migraine process but also for the migraine process in the first place i.e. sensitisation of the brainstem.

Now I am not suggesting that migraine sufferers rush off and have the relatively minor surgery performed in this study (in fact I respectfully suggest that skilled treatment of the neck would have achieved the same result), but this research clearly demonstrates disorders of the upper neck are significantly involved in the migraine process.

Cheers

Dean

(Perry CJ, Blake P and Goadsby PJ Intervention altering the natural history of chronic migraine. Is chroni?cation of migraine headache a harbinger of peripheral afferent nerve involvement? Cephalalgia 2009; 29 (Suppl. 1):1–166)

© 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.

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.

Headache, Migraine and Auras

August 23, 2009 by dean · Leave a Comment 

As I have mentioned previously, recent and substantial research demonstrates that the different types of headache and migraine develop from a common, shared disorder, and that this disorder is sensitisation of the brainstem.

Auras, which initially were thought to only accompany migraine and menstrual migraine, have now been reported in Cluster Headache and Hemicrania Continua, and provides further evidence that the various forms of headache and migraine are likely to originate from common disorder.

Cheers

Dean

(Bahra A, May A, Goadsby PJ. Cluster headache: a prospective clinical study with diagnostic implications. Neurology 2002;58:354-361

Peres MFP, Siow HC, Rozen TD. Hemicrania continua with aura. Cephalalgia 2002;22:246-248

Silberstein SD, Niknam R, Rozen TD, Young WB. Cluster headache with aura. Neurology 2000;54:219-221)

© 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 

Is a neck disorder relevant?

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.

Headache and Migraine Diagnosis and Treatment

August 16, 2009 by dean · Leave a Comment 

The neck can be the source of sensitisation

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.

Paroxysmal Hemicrania Related to Menstruation

August 15, 2009 by dean · Leave a Comment 

Here we go again – another headache type that occurs within the menstrual period!  Last count it was migraine, tension-type headache, cluster headache …

This case study describes a 43 year old woman who initially had menstrual related migraine which later developed into a typical paroxysmal hemicrania (similar to cluster headache). So here we have menstrual migraine and menstrual paroxysmal hemicrania in the one person, both of which responded to the ‘triptans’.

Just further evidence supporting that headache and migraine develops from one condition – sensitisation of the brainstem (remember that the ‘triptans’ desensitise the brainstem).

Cheers

Dean

(Maggioni F. Menstrual paroxysmal hemicrania, a possible new entity? Cephalalgia 2007;27:1085-1087)

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