The Headache and Migraine Sufferers Bill of Rights (cont)

December 4, 2009 by dean · Leave a Comment 

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)

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

Migraine And Cluster Headache Are ‘First Cousins’!

September 19, 2009 by dean · Leave a Comment 

Migraine sufferers experience many symptoms

Migraine sufferers experience many symptoms

As I have mentioned in many of my previous reports, my clinical experience agrees with the research which shows that the many different forms of headache and migraine share the same ‘heritage’ or disorder i.e. a sensitised brainstem.

This recent study which surveyed 76 Cluster Headache sufferers showed that nausea, vomiting, photophobia and phonophobia were reported by 41%, 24%, 49% and 46% respectively of the patients. Aura occurred in 28% of the patients and visual symptoms were reported most frequently.

Those of you who are migraine sufferers will be familiar with the symptoms mentioned above (!)

This is further evidence supporting a common, shared mechanism for headache and migraine.

Cheers

Dean

(Wober C and Knopf A. Migrainous features in cluster headache. Cephalalgia 2009;29 (Suppl. 1):1–166)

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

Triptans, Migraine and Menstrual Migraine – Further Evidence That Hormones Are Not The Cause!

August 24, 2009 by dean · Leave a Comment 

Photophobia means sensitivity to light

Photophobia means sensitivity to light

Interesting to note that a recent study when reviewing migraine-associated characteristics including aura, allodynia-associated (excessive tenderness to touch) symptoms, photophobia (sensitivity to light), phonophobia (sensitivity to noise), and nausea were similar for both menstrual migraine and non menstrual migraine sufferers.

Furthermore the triptans were equally effective for both menstrual related migraine and non menstrual migraine patients.

I have also mentioned before, research which demonstrates that the triptans desensitise the brainstem – a case for sensitised brainstems in menstrual migraine sufferers.

Cheers

Dean

(Diamond ML, Cady RK, Mao L, Biondi DM, Finlayson G, Greenberg SJ, Wright P. Characteristics of migraine attacks and responses to almotriptan treatment: a comparison of menstrually related and nonmenstrually related migraines. Headache 2008 Feb;48(2):248-58)

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

Migraine In 1888 – The Same As In 2009!

August 19, 2009 by dean · Leave a Comment 

Amazing! I have just come across a gentleman who in 1888 who described the migraine process in this way: “… we must not ascribe too much significance to throbbing of the increase in the pain by the cause of vascular distension; these may be due merely to the over sensitiveness of the central structures.” In other words expansion of the blood vessels is unlikely to be the cause of pain; it may be that expansion of blood vessels is misinterpreted by a sensitised central nervous system.

This information from the blood vessels has to pass through the BRAINSTEM on the way to the cortex … and what has been shown to be the disorder in headache and migraine? … a SENSITISED BRAINSTEM.

A man 120 years before his time – Bravo!

Cheers

Dean

(Gowers WR. Diseases of the brain and cranial nerves. General and functional diseases of the nervous system. A Manual of Diseases of the Nervous System, 1st Ed. Vol. 2 London: Churchill, 1888)

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

Sumatriptan Effective in a Range of Headache and Migraine

July 12, 2009 by dean · Leave a Comment 

One hundred and fourteen patients were diagnosed as migraine, 76 as tension-type headache, and 42 were not able to be classified according to the International Headache Society’s diagnostic criteria.

Ninety six per cent of migraineurs responded to sumatriptan, whilst it was effective in 97% and 95% of tension headache sufferers and unclassifiable headaches respectively .

This response clearly demonstrates that there is a common underlying mechanism for a range of headache and migraine conditions – and the recent research suggests that it is a sensitised brainstem – and the action of sumatriptan? It desensitises the brainstem.

A thorough examination of the upper neck will either confirm of negate cervical disorders as the sensitising source.

Cheers

Dean

(Afridi SK, Shields KG, Bhola R, Goadsby PJ. Greater occipital nerve injection in primary headache syndromes – prolonged effects from a single injection. Pain 2006; 122:126-9) 2009

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

Hoskin KL, Kaube H, Goadsby PJ. Sumatriptan can inhibit trigeminal afferents by an exclusively neural mechanism. Brain1996; 119:1419-28

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

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

Marcus DA. Migraine and tension-type headaches: the questionable validity of current classification systems. Clin J Pain 1992; 8:28-36

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)

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

Cluster Headache, Migraine and Tension Headache are related – more evidence ….

June 25, 2009 by dean · Leave a Comment 

The brainstem sits at the bottom of the brain

The brainstem sits at the bottom of the brain

Clinical correspondence in the latest Cephalalgia journal reports the presence of ‘cutaneous allodynia’ in two cluster headache patients.

What is cutaneous allodynia? Cutaneous (relating to or affecting the skin) allodynia (is a painful response to a normally non painful stimulus) so in this case there is a heightened, painful sensitivity to touch. This increased sensitivity to touch, along with other symptoms for e.g. photo-phobia (heightened sensitivity to light) and phono-phobia (heightened sensitivity to sound) is a sign of sensitisation of the brainstem.

Research shows quite clearly that the brainstems of migraineurs and tension headache sufferers are also sensitised …. and what do the ‘triptans’ do? they desensitise the brainstem and that is why they are effective in alleviating the pain in migraine, tension and cluster headache – all three headaches originate from the same condition i.e. a sensitised brainstem.

Cheers

Dean

(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

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

Milanov I, Bogdanova D. Trigemino-cervical reflex in patients with headache. Cephalalgia 2003; 23:35-38

Riederer F, Selekler HM, Sandor PS, Wober C. Cutaneous allodynia during cluster headache attacks. Cephalalgia 2009;29:796-798

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)

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

Tension Headache, Migraine and Cluster Headache

June 22, 2009 by dean · Leave a Comment 

The research clearly shows that the brainstems in tension headache sufferers and migraineurs are sensitised. One of the signs of sensitisation of the brainstem is ‘allodynia’ and therefore is present in tension headache and migraine patients.

What is ‘allodynia’? ‘Allodynia’ refers to excessive tenderness to physical pressure or touch.

Recent, interesting and exciting research has shown that cluster headache sufferers, also present with ‘allodynia’ – suggesting that those who endure cluster headache have sensitised brainstems. This, along with the fact that the ‘triptans’ are also effective in eliminating cluster headache, supports those authorities who suggest that the various types of headache and migraine originate from one condition or disorder – a sensitised brainstem.

Cheers

Dean

(Ashkenazi A, YoungWB. Dynamic mechanical (brush) allodynia in cluster headache. Headache 2004;44:1010-1012.

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

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

Riederer F, Selekler HM, Sandor PS, Wober C. Cutaneous allodynia during cluster headache attacks. Cephalalgia 2009; 29:796–798

Rozen TD, Haynes GV, Saper JR, SheftellFD. Abrupt onset and termination of cutaneous allodynia (central sensitization) during attacks of SUNCT. Headache 2005;45:153-155

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)

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