The Headache and Migraine Sufferers Bill of Rights (cont)

December 2, 2009 by dean · Leave a Comment 

The first ‘bill’ is that the headache sufferer has the right to know his/her headache diagnosis as precisely as possible, and to know the nature of the headache disorder, its prognosis and the possible types of treatment.

I have discussed the first point regarding diagnosis; now

to know the nature of the headache disorder

Clearly there is a substantial body of research which shows that the brainstems of Migraine, Tension Headache and Menstrual Migraine sufferers are sensitised.

We know that the ‘triptans’ desensitise the brainstem and are effective in preventing Migraine, Tension Headache, Cluster Headache, Hemicrania Continua, Menstrual Migraine, Cervicogenic (neck-related) Headache (which shows that cervicogenic disorders can sensitise the brainstem) ……

The underlying disorder is sensitisation of the brainstem; optimal management therefore is identifying the reason for the sensitisation ….

Stay tuned,

Cheers

Dean

(Members’ Handbook. International Headache Society 2000 Scandinavian University Press)

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

Post-traumatic Headache

November 21, 2009 by dean · Leave a Comment 

Neck disorders can be responsible for headache

Neck disorders can be responsible for headache

Whiplash or post-traumatic headache for some reason seems to be a controversial headache – perhaps because the only explanation for it might be that it results from a neck injury – and there is reluctance by some authorities to accept that neck disorders can be responsible for headache (especially given that post-traumatic or whiplash associated headache presents just like a migraine or tension-type headache?)

To review my previous posts on post-traumatic or whiplash associated headache. Please go to the ‘Home Page’ and key in either ‘Post-Traumatic Headache’ or ‘Whiplash Headache’.

Cheers  Dean

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

Cluster Headache – Another Headache or Migraine

November 16, 2009 by dean · Leave a Comment 

Tension Headache and Migraine are recognised as the most common forms of headache.

Cluster headache is one of the third ‘group’ of headaches – the other headache types in this group are Hemicrania Continua, Chronic Paroxysmal Hemicrania, and SUNCT.

All of the headache types in this third group share similar symptoms with Cluster Headache and either blocking or modifying information from the neck has a beneficial effect on Cluster Headache suggesting that neck disorders not only play a significant role in Cluster headache but perhaps the others(?)

To review the posts on Cluster Headache key in ‘Cluster Headache’ on the ‘Home Page’ and all associated posts will be listed for you to review.

Cheers

Dean

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

Tension Headache and Cervicogenic Headache

November 14, 2009 by dean · Leave a Comment 

I have just been asked to review a book:

“Tension-Type and Cervicogenic Headache. Pathophysiology, Diagnosis and Management.”

for the Physiotherapy Journal, published in the United Kingdom.

Whilst I am just getting started, I can’t help but be a little excited, because combining Tension Headache and Cervicogenic headache in the same title suggests that the authors may be implying that there is significant overlap between the two headache types. My clinical experience suggests that tension headache is an unrecognised cervicogenic headache.

Cheers

Dean

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

Cluster Headache – Another Headache or Migraine

November 12, 2009 by dean · Leave a Comment 

Tension Headache and Migraine are recognised as the most common forms of headache.

Cluster headache is one of the third ‘group’ of headaches – the other headache types in this group are Hemicrania Continua, Chronic Paroxysmal Hemicrania, and SUNCT.

All of the headache types in this third group share similar symptoms with Cluster Headache and either blocking or modifying information from the neck has a beneficial effect on Cluster Headache suggesting that neck disorders not only play a significant role in Cluster headache but perhaps the others(?)

To review the posts on Cluster Headache return to the ‘Home Page’ and key in the search term ‘Cluster Headache’.

Cheers

Dean

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

Post-traumatic Headache and Migraine or Tension Headache – What’s The Difference?

November 3, 2009 by dean · Leave a Comment 

It was shown that headache sufferers had neck disorders after concussion

Research showed post concussion headache sufferers had neck disorders

In a recent study of 348 patients who had experienced concussion it was found that ongoing headache after 3 months was not caused by head or brain injury – but resembled Tension Headache or migraine possibly brought on by stress.1

Other research has shown sufferers of headache following concussion have significant disorders of their upper necks.2

These studies along with surveys which show that post-traumatic headache can be classified as either migraine or tension-type headache3-5 suggest that the underlying mechanism of migraine or tension headache is a neck disorder/injury.

Just more evidence indicating that neck disorders are likely to be the source of not only post-traumatic headache but also migraine and tension-type headache.

Cheers

Dean

(5. De Benedittis G, De Santis A. Chronic post-traumatic headache: clinical, psychopathological features and outcome determinants. J Neurosug Sci 1983;27(3):177-186

3. Haas DC. Chronic post-traumatic headaches classified and compared with natural headaches. Cephalalgia 1996;16:486-93

1. Stovnera L, Schradera L, Mickeviciene D, Surkienec D, Sand T. Headache after concussion. Eur J Neurol. 2009;16:112-120.

2. Treleaven J, Jull G, Atkinson L. Cervical musculoskeletal dysfunction in post-concussional headache. Cephalalgia 1994;14:273-9

4. Weiss HD, Stern BJ, Goldberg J. Post-traumatic migraine: chronic migraine precipitated by minor head or neck trauma. Headache 1991;31(7):451-456)

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

Migraine, Tension Headache and Stress

October 24, 2009 by dean · Leave a Comment 

Managing stress helps headache and migraine

Managing stress helps headache and migraine

Why is it that when stress and migraine and tension headache are discussed studies all sorts of unproven mechanisms are discussed at length – despite all of the research and billions of dollars there is no proven causal mechanism – ‘it may be this …. or ‘it may be that‘ etc.

Muscle tension is evident in the necks of ‘tension headache‘ sufferers and migraineurs – it is tensed, shortened musculature acting on joint stiffness which leads to head pain.1

Research has shown that stress management approaches, including Relaxation Therapy and cognitive behavioural therapy consistently improve migraine 2 – if you are less stressed then stiff spinal segments sit quietly without any significant movement expected of them. Biofeedback is also helpful in managing migraine 2 for the same reason.

It can be very difficult to manage stress in our lives (for a whole lot of reasons including heart disease, depression, and other mental health disorders) and whilst is is important to take measures to do this, from a headache and migraine point of view, identifying and eliminating relevant neck disorders is crucial.

Cheers

Dean

(1. Bakal DA, Kaganov JA. Muscle Contraction and Migraine Headache: Psychophysiologic Comparison. Headache 1977;17(5):208215

2. Rains JC, Penzien DB, McCrory DC, Gray RN. Behavioral headache treatment: History, review of the empirical literature, and methodological critique. Headache. 2005;45(Suppl. 2): S92-S109.)

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

Cervicogenic Headache is Rare – You Have Got to be Kidding (?)

October 7, 2009 by dean · Leave a Comment 

In a study coming out of Norway the incidence of cervicogenic (neck) headache was found to be rare – only 0.17% of the population.

It is interesting to note that the diagnosis was made based only on the features of headache. It is widely accepted that features of headache alone are not sensitive enough to differentiate cervicogenic headache from migraine and from tension headache.

To diagnose cervicogenic headache, a thorough and skilled examination of the upper neck needs to be performed for temporary reproduction (and resolution) of familiar headache.

A physical examination was performed on only those headache sufferers selected on the basis of their headache features (and did include the above!). If it had it would have confirmed cervicogenic headache. However this is not the point, the physical examination was performed on only a select few!

Similarly, greater occipital nerve (GON) blocks blocks were performed only on those selected from their headache features – the blocks were effective in over 90% – I am not surprised. As with the physical examination, the blocks needed to be performed before a diagnosis of cervicogenic headache was made.

I have written before of the numerous studies demonstrating that headaches with a diagnosis of migraine are relieved by blocking the GON (greater occipital nerve) – who knows how many of the headache sufferers were excluded based on features and who had cervicogenic headache (?)

Previous research has shown that cervicogenic (neck) headache is as common as migraine.

Cheers

Dean

(Knackstedt H. Cervicogenic headache in the general population. the Akershus study of chronic headache. Cephalalgia 2009;29 (Suppl. 1):1–166

Nilsson N. The prevalence of cervicogenic headache in a random population sample of 20-59 year olds. Spine 1995;20:1884-1888

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

Yi X et al Cervicogenic headache in patients with presumed migraine: missed diagnosis or misdiagnosis? J Pain. 2005 Oct;6(10):700-3

Young WB, Marmura M, Ashkenazi A, Evans RW. Expert opinion: 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.

Are Whiplash Associated Headache, Cervicogenic Headache and Tension-Type Headache the same? Yes!

September 24, 2009 by dean · Leave a Comment 

A motor vehicle injury can result in allodynia

A motor vehicle injury can result in allodynia

Five patients who had developed headaches following a head and neck injury after a motor vehicle injury – the headaches had the same characteristics of tension-type headache.

Furthermore on examination it was found that they were all experiencing ‘allodynia’ (excessive tenderness to normal pressure). Allodynia is considered to be a sign of sensitisation of the brainstem. The area of allodynia suggested that it was as result of abnormal information from injuries sustained by structures in the neck.

This study further confirms that disorders of the neck are responsible for so-called ‘tension-type’ headache and that abnormal information from injured neck structures can sensitise the brainstem – a phenomenon which is evident not only in tension headache but also migraine, menstrual migraine and cluster headache ….. and that whiplash associated  headache exists!

Cheers

Dean

(Baruah JK and Baruah GR. Post traumatic headache and allodynia. Cephalalgia, 2009; 29(Suppl. 1):1–166

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 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

Varlibas A, Erdemoglu Ak. Altered trigeminal system excitability in menstrual migraine patients. The Journal of Headache and Pain 2009; 10(4):277-282)

© 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.