Menstrual Tension-type Headache?
August 14, 2009 by dean · Leave a Comment
Menstrual headaches can vary in severity from one cycle to the next
Now we have menstrual tension-type headache described. When will it all end – the last thing we need now is another headache type!
The authors interviewed 165 women with menstrual related headache and found that the characteristics of tension-type headache were evident in 21.
Isn’t this what some authorities are saying – that all headache and migraine arises from the same disorder?
Menstrual tension-type headache is just a less severe expression of menstrual migraine.
Don’t get me wrong, this is my clinical experience also. I see women whose menstrual headaches vary in severity from one cycle to the next, and some women whose headaches are less severe than those in other women, so Yes, it can present as what is considered a tension-type headache (but its not tension!).
What is needed is to determine the source of the sensitisation – and basic neuro anatomy and research tells us that neck disorders have the potential to sensitise the brainstem.
Cheers
Dean
(Arjona A et al. Menstrual Tension-Type headache: Evidence for Its Existence. Headache 2007;47:100-103)
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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.
Chronic Sinusitis is Uncommon
August 4, 2009 by dean · Leave a Comment
Neck disorders sensitise the brainstem
Over 90% of diagnosed sinus headaches present in the same way as migraine headache and that given that the majority of ‘sinus’ headaches respond to the ‘triptans’, they can be classified as migraine. Why then are 61% of patients given antibiotics for a non-infectious condition?!
It is more responsible to identify the source of the sensitisation and …. neck disorders sensitise the brainstem! All that is required is for a competent headache practitioner to examine your neck.
Cheers
Dean
(Cady RK, Schreiber CP. Sinus headache: a clinical conundrum. Otolaryngol Clin North Am 2004 Apr;37(2):267-88
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
Tepper SJ. New thoughts on sinus headache. Allergy Asthma Proc 2004 Mar-Apr;25(2):95-96 ;
Ward TN, Levine M. Headache caused by a spinal cord stimulator in the upper cervical spine. Headache 2000; 40:689-91)
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Identifying Headache and Migraine
July 29, 2009 by Dean Watson · Leave a Comment
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Tension and Headache
July 27, 2009 by Dean Watson · Leave a Comment
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Blood Vessels and Migraine
July 25, 2009 by Dean Watson · Leave a Comment
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Treating the Neck Can Eliminate Migraine Symptoms
July 22, 2009 by dean · Leave a Comment
Interesting to note that by blocking or ‘numbing’ the greater occipital nerve, the pain of migraine, sensitivity to light and tendereness are all significantly reduced – further evidence to support that abnormal cervicogenic (neck) information could be the source of sensitisation in the migraine process.
Cheers
Dean
(Young, W. et al The first 5 minutes after greater occipital nerve block. Headache 2008 July 48(7):1126-8)
Diagnosing Headache and Migraine – Is It Useful?
July 18, 2009 by dean · Leave a Comment
Diagnosing headache and migraine provides a label – that is all.
Evidence is mounting to support the concept that headache and migraine originates from a single condition – sensitisation of the brainstem – and that the various types of headache and migraine are different presentations of this condition.
What is more important than a diagnosis is to determine the cause of the sensitisation and then address this.
Case reports demonstrating relief of migraine (and cluster headache) symptoms after blocking or suppressing (abnormal) information from the upper neck, clearly indicate that neck disorders are capable of sensitising the trigemino-cervical nucleus (brainstem) – this is easy to confirm or rule out – by having your neck examined by a practitioner experienced in assessment of the upper cervical spine.
Cheers
Dean
(Anderson CD, Franks RA. Migraine and tension headache: is there a physiological difference? Headache 1981; 21:63-71
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
Featherstone HJ. Migraine and muscle contraction headaches: a continuum. Headache 1985; 25:194-8
Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders, 2nd edn. Cephalalgia 2004; 24(suppl.1):1-151
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
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
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
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
Marcus DA. Migraine and tension-type headaches: the questionable validity of current classification systems. Clin J Pain 1992; 8:28-36
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
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
Nelson CF. The tension headache, migraine headache continuum: A hypothesis J Manipulative Physiol Ther 1994; 17:156-167
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
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)
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Anaesthetising Neck Structures Cease the Hemiplegic Aura of Migraine
July 17, 2009 by dean · Leave a Comment
Selected neck structures were anaesthetised
In a recent report anaesthetising selected neck structures ceased the hemiplegic aura in a two migraine patients.
This patients’ auras comprised slight weakness, tingling and or numbness involving one side of the body, and face. Within 5 minutes of injecting a local anaesthetic the auras ceased and were not followed by their usual pain states.
I have on two occasions prevented auras from developing, in fact they ceased within 5 minutes after mobilising the upper cervical spine – and furthermore the usual pain did not occur. My experience and what is reported in this case study suggests that abnormal information from a neck disorder could be sensitising the brainstem and suppressing it, preventing the migraine occurring.
I have mentioned temporary reproduction of familiar pain as a key diagnostic sign for cervicogenic headache; in a significant proportion of patients suffering migraine with aura it is also possible to temporarily reproduce their auras with subsequent lessening (as the examination technique is sustained) when examining the upper neck – once again this is a good sign and confirms cervicogenic factors as the source of sensitisation.
It is not necessary for confirmation to have invasive (nerve block) procedures …
Cheers
Dean
(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
Rozen T. Cessation of hemiplegic migraine auras with greater occipital nerve blockade. Headache 2007;47:917-928)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
‘Triptan’ Overuse Headache
July 1, 2009 by dean · Leave a Comment
Neck structures contibuting to migraine
It is interesting to note that we now have another condition (or complication) in the headache and migraine industry – ‘Triptan Overuse Headaches’! This was always going to happen as it did with ‘Medication overuse headache’.
Whilst for many of my patients, the triptans were their best friend initially, eventually over time they were finding that they were needing to take another one in decreasing intervals, i.e. their effectiveness is decreasing or ….. perhaps it is that the cause of the sensitisation process is worsening.
It is imperative that the source of the sensitisation of the brainstem be determined.
Essentially the brainstem is influenced by four systems:
- serotonin
- diffuse noxious inhibitory control system
- information from structures inside the head – blood vessels, teeth, gums, eyes, sinuses etc
- information from structures of the upper neck – muscles, ligaments, capsules, joints etc
Of the above the easiest to confirm or eliminate is information from the neck.
Can you imagine how one of my patients who was experiencing migraine daily and who was taking Imigran (a triptan) three a times day for the past 10 years, felt when her migraine eased within 30 seconds after placing her head into a retracted (i.e. the opposite to a poking chin posture) position – she burst into tears! What a moment ….she realised her neck was contributing to her migraine.
Cheers
Dean
(Créac’h C, Radat F, Mick G, Guegan-Massardier E, Giraud P, Guy N, Fabre N, Nachit-Ouinekh F, Lanteri-Minet M. One or Several Types of Triptan Overuse Headaches? Headache 2009;49(4);519-528
Limmroth V, Katsarava Z, Fritsche G, et al. Features of medication overuse headache following overuse of different acute headache drugs. Neurology 2002;59:1011-1014)
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