Migraine and Headache After Trauma – Post Traumatic Headache (PTH)

August 30, 2009 by dean · Leave a Comment 

MRI results are used to reveal abnormalities after trauma

MRI results are used to reveal abnormalities after trauma

Headache is the most common symptom after a head injury. Post traumatic headaches, like non traumatic migraine and tension headache for some reason pose a significant challenge for clinicians and are surrounded by controversy. Because the neurological examination after mild head injury is normal and standard tests as well as imaging studies (such as MRI or CT of the head) fail to reveal abnormalities, it is often thought that the symptoms following mild head injury are psychological.

Why is it then that in the presence of any abnormal findings the focus on the head continues?

It is important that after a blow to the head an intracranial (within the head) cause of headache or migraine be ruled out. However once an intracranial cause has been eliminated, why then does the source of the headache or migraine become such a mystery?

If the head hits the windscreen for example, the body keeps moving; it is the neck which connects the head to a moving body and absorbs a significant amount of stress.

It is very important then that a skilled examination of the upper three spinal segments be performed and that prior to examination of the upper neck, assessment of crucial ligaments be undertaken – this is mandatory.

An examination of this nature may prevent years of frustration and unnecessary medication.



(Packard RC. Chronic Post-traumatic headache: Associations with mild traumatic brain injury, concussion, and post-concussive disorder. Current Pain and Headache Reports 2008; (12)1:67-73

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

© 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.



(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.

Avoiding Chocolate to Prevent Migraine is Not Necessary

August 18, 2009 by dean · Leave a Comment 

Chocolate can be eaten without a migraine

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).



(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.



( 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.

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.



(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.

Headache, Migraine and Facial Surgery

July 28, 2009 by dean · Leave a Comment 

In survey of 75 patients who had undergone surgery for facial pain all had ongoing symptoms. The researchers concluded that the causes of symptoms were migraine, cluster headache, paroxysmal hemicrania and tension headache, and that sinus surgery in the large majority of patients presenting with facial pain should avoid surgery; that all surgeons when assessing facial pain should be aware of non-sinuonasal diagnoses.

An enlightened ENT Specialist refers patients to me to determine if facial pain is referred from disorders of the upper neck – and more often it is! Temporary reproduction and easing of familiar facial pain when upper neck structures are gently stressed confirms this in the large majority of patients with facial pain.



(Jones NS, Cooney TR. Facial pain and sinonasal surgery. Rhinology 2003 Dec;41(4):193-200)

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

Tension and Headache

July 27, 2009 by Dean Watson · Leave a Comment 

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

Headache and the Sinuses

July 26, 2009 by dean · Leave a Comment 

Sinusitis is over-diagnosed as the cause of headache and migraine.

Frontal pain more likely results from migraine or tension headache.

Furthermore, according to an internationally recognised authority, just because symptoms do not respond to headache and migraine treatments it should not be assumed that sinus disease is the cause.



(Silberstein SD. Headaches due to nasal and paranasal sinus disease. Neurol Clin 2004 Feb;22(1):1-19)

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

Triggers of Tension Headache and Migraine Are No Different

July 14, 2009 by dean · Leave a Comment 

After comparing the triggers of migraine, tension headache and combined tension-type headache/migraine, no differences were found. In this research, patients, irrespective of their diagnosis, reported that emotional, dietary, physical, environmental, and hormonal factors were equally likely to trigger their headache or migraine … more evidence of a single headache and migraine process.

Can you imagine the delight of my patients when, having for years avoided chocolate or red wine (fancy living a life without chocolate or a glass of red wine!), and after treatment, chocolate, red wine, cheese etc no longer triggered headache or migraine. Clearly, neck disorders were sensitising their brainstem.

One authority suggests that dietary factors alone are not sufficient to trigger headache or migraine – that they probably act on a pre-existing condition.



(Amery WK, Van den Bergh V. What can precipitating factors teach us about the pathogenesis of migraine? Headache. 1987;27:146-150

Scharff L, Tirk DC, Marcus DA. Triggers of headache episodes and coping responses of headache diagnostic groups. Headache 1995;35(7):397-403)

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

Migraine Without Aura and Migraine With Aura

July 10, 2009 by dean · Leave a Comment 

Migraine without aura and migraine with aura - different expressions of the same condition?

Not only is there debate as to whether tension headache and migraine are different expressions of the same disorder or totally different conditions, but also … are migraine with and without aura different conditions or the same disease with differing presentations.

After assessing 45 migraineurs, 70% of patients had significantly overlapping features and responses; the researchers were unable to demonstrate any significant difference in clinical characteristics and concluded that migraine with aura and migraine without aura are different manifestations of the same condition … more evidence for headache and migraine originating from a common underlying condition.



(Centonze V, Polito BM, Valerio A, Cassiano MA, Amato R, Ricchetti G, Bassi A, Valente A, Albano O. Migraine with and without aura in the same patient: expression of a single clinical entity? Cephalalgia 1997;17(5):585-587)

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