Post Traumatic Headache, Cervicogenic (Neck) Headache and Migraine or Tension Headache
July 8, 2009 by dean · Leave a Comment
Is there any difference between post traumatic headache, cervicogenic (neck) headache and migraine or tension headache?
Several studies have shown that symptoms of whiplash-induced headache are often similar to those of spontaneous, natural headaches.
In one study of 48 patients experiencing chronic post-traumatic headaches, 36 patients (75%) were diagnosed with chronic tension-type headaches, 10 (21%) were classified as migraine without aura, and 2 (4%) were undiagnosed. The symptoms of the headaches within each diagnostic group were then compared to those in a control group with naturally occurring, non traumatic headaches of the same type. No appreciable differences between the post-traumatic and control groups were found. Hence, post-traumatic headaches are symptomatically identical to either tension-type headache or migraine.
This result supports the role of cervicogenic (neck) mechanism in not only causing post-traumatic headache but also involvement in other (non traumatic) headaches – tension headache and migraine.
Cheers
Dean
(De Benedittis G, De Santis A. Chronic post-traumatic headache: clinical, psychopathological features and outcome determinants. J Neurosug Sci 1983;27(3):177-186
Haas DC. Chronic post-traumatic headaches classified and compared with natural headaches. Cephalalgia 1996;16:486-93
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.
Are Cervicogenic Disorders the Common Cause of Headache and Migraine?
July 7, 2009 by dean · Leave a Comment
The Upper Cervical Segments
A study of tension headache and migraine sufferers has demonstrated significant abnormalities of the neck – including a loss of normal lordosis (the natural inward curve of the neck) and restricted movement of the upper two spinal segments. These findings suggest that both migraine and tension headache share a common cause – disorders of the cervical spine – supporting the premise that the neck plays an important, but largely ignored role in causing headache and migraine.
Meanwhile this debate doesn’t help you as a headache or migraine sufferer!
Temporary reproduction of familiar headache or migraine pain when gently stressing movements of the upper cervical spine can confirm cervicogenic dysfunction as the source of your headache or migraine.
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
Pavese N, Bibbiani F, Nuti A, Bonuccelli U. Sumatriptan in cervicogenic headache. Proceedings European Headache Federation 2nd International Conference 1994; Abstract 131
Sjaastad O, Fredricksen TA, Pfaffenrath V. Cervicogenic headache: diagnostic criteria. Headache 1998; 38:442-5
Vernon H, Steimann I, Hagino C. Cervicogenic dysfunction in muscle contraction headache and migraine: a descriptive study. J Manip Physiol Ther 1992 15:7: 418-29)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
How to Avoid Unnecessary Sinus Surgery for Your Headache or Migraine
July 6, 2009 by dean · Leave a Comment
True sinus headache is rare.
Clinical studies have demonstrated that nearly 90 per cent of patients with a diagnosis of ‘sinus’ headache have migraine or tension headache and therefore it is not surprising that recent research has shown that the ‘triptans’, medication developed specifically for migraine and which has been shown to be effective in tension headache, also relieved ‘sinus’ headache – if this happens then clearly it is not a sinus headache!
However we also know that Cervicogenic (neck-related) headache is often misdiagnosed as migraine or tension headache and that the ‘triptans’ are effective in cervicogenic headache (that is why there is a misdiagnosis!). This suggests that the mechanisms of migraine, tension headache and neck-related headache are similar and that a neck disorder is capable of referring pain into the facial region, raising the possibility that ‘sinus’ headache may actually be referred pain from a neck disorder.
Indeed my experience is (and a significant body of research demonstrates) that facial pain and pressure is often a referred pain from a neck disorder. A very aware Ear, Nose and Throat surgeon sends me patients with ‘sinus’ headache to determine if it is referred from the neck before embarking on surgery, thus avoiding unnecessary and the not insignificant surgery!
Cheers
Dean
(Cady RK, Schreiber CP. Sinus headache: a clinical conundrum. Otolaryngol Clin North Am 2004 Apr;37(2):267-88
Kari E, DelGaudio JM. treatment of sinus headache as migraine: the diagnostic utility of triptans. Larygoscope 2008 Dec;118(12) :2235-9
Pavese N, Bibbiani F, Nuti A, Bonuccelli U. Sumatriptan in cervicogenic headache. Proceedings European Headache Federation 2nd International Conference 1994; Abstract 131
Tepper SJ. New thoughts on sinus headache. Allergy Asthma Proc 2004 Mar-Apr;25(2):95-96 ;
Yi X et al Cervicogenic headache in patients with presumed migraine: missed diagnosis or misdiagnosis? J Pain. 2005 Oct;6(10):700-3)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Posture is a Problem in Headache and Migraine Sufferers
July 5, 2009 by dean · Leave a Comment
Headache and migraine sufferers have postural abnormalities
Headache and migraine sufferers are twice more likely to have postural problems.
Twenty four migraineurs, 24 tension headache patients and 24 with both migraine and tension-type headache were assessed. Postural abnormalities were identified in 90% of the headache and migraine patients, compared to 46% of controls. A forward head or poking chin posture has been linked to cervicogenic (neck), suggesting that cervicogenic (neck) dysfunction is also common to migraine and tension headache.
Furthermore 75% of the headache and migraine patients presented with trigger points in the neck compared to 46% of controls. Joint abnormalities are a common finding in cervicogenic headache; interestingly, they are also prevalent in migraineurs and tension headache sufferers.
These two findings support my clinical experience which indicates that cervicogenic disorders are part of the migraine and tension headache process and that examination of the neck should be mandatory for headache and migraine sufferers.
Cheers
Dean
(Marcus DA, Scharff L,Mercer S,Turk DC. Abnormalities in Chronic Headache: A Controlled Comparison of Headache Diagnostic Groups. Headache 1999;39(1);21-27
Watson DH, Trott PH. Cervical headache: an investigation of natural head posture and upper cervical flexor muscle performance. Cephalalgia 1993;13:272-284)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Headache and Migraine Treatment and the ‘Watson Headache Approach’
June 28, 2009 by dean · Leave a Comment
Further to the article in ‘Frontline’ and in reference to the approach I have developed it is important to clarify that whilst my approach does include a series of techniques which restore movement and maintain natural posture of the upper cervical spine, and whilst they are powerful, they are a small part of what I have developed.
My clinical experience of over 21000 hours with headache and migraine sufferers has demonstrated that neck disorders, as the cause of sensitisation, are significantly underestimated in migraine, tension and cluster headache, menstrual migraine…. sufferers.
There are many ways to treating headache and migraine. My approach is a powerful treatment tool if chosen by Practitioners. What I am primarily passionate about is that many of you are suffering unnecessarily because your necks have not been examined comprehensively and this is the main thrust of my approach.
It is about identifying whether your neck is the source of your headache or migraine before you commence treatment.
How much longer are we to accept the explanation that … “whilst we don’t know where migraine comes from it can’t come from neck disorders” … it is irresponsible, after other investigations have ruled out other causes, for the neck not to be examined. Information from the neck is one of four systems that has the potential to potential to sensitise the brainstem – the feature (sensitisation) that is evident in the common forms of headache and migraine.
Cheers
Dean
(Hunt L. When headache is a pain in the neck. Frontline 2009 17 June; 22-25)
© 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
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.
Tension Headache and Migraine – are they the same condition?
June 19, 2009 by dean · Leave a Comment
Tension Headache
The debate as to whether tension headache and migraine are separate conditions or just different expressions of the same condition has gone on for decades and continues. Why (?), when a significant body of research has demonstrated that the brainstems of both tension headache and migraine sufferers are sensitised, that is, both tension headache and migraine come from the same abnormality – tension headache is a less severe expression of a common, shared (with migraine) disorder.
The question remains – what is causing the sensitisation?
Cheers
Dean
(Brennum J, Kjeldsen M, Olesen J. The 5-HT1-like agonist sumatriptan has a significant effect in chronic tension-type headache. Cephalalgia 1992;12(6):375-379
Cady RK, Gutterman D, Saiers JA, Beach ME. Responsiveness of non-IHS migraine and tension-type headache to sumatriptan. Cephalalgia 1997;17(5):588-590
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
Lipton RB, Walter FS, Cady R, Hall C, O’Quinn S, Kuhn T, Gutterman D. Sumatriptan for the Range of Headaches in Migraine Sufferers: Results of the Spectrum Study. Headache 2000;40(10);783-791
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)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Tension Headache and Tension
June 18, 2009 by dean · Leave a Comment
The medical model of headache and migraine recognises two conditions – migraine and tension-type headache. Recently the International Headache Society introduced a third ‘group’ of headaches; this group comprises Cluster Headache, Chronic Paroxysmal Hemicrania, SUNCT, and Hemicrania Continua.
In this model, the assumption has been the pain of tension headache arises from increased tension in the muscles of the scalp and forehead. However research has shown:
- that tension in muscles of the scalp and forehead in tension headache sufferers during a headache is no different to controls
- increased tension in the muscles of the neck in tension headache sufferers when compared to controls
- improved performance of the muscles of the upper neck reduced the severity and frequency of tension headache significantly
Perhaps then tension headache is an unrecognised cervicogenic (neck) headache?
Cheers
Dean
(Bakal DA, Kaganov JA. Muscle Contraction and Migraine Headache: Psychophysiologic Comparison. Headache 1977;17(5):208215
Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders, 2nd edn. Cephalalgia 2004; 24(suppl.1):1-151
van Ettekoven H, Lucas C. Efficacy of physiotherapy including a craniocervical training programme for tension-type headache; a randomized clinical trial. Cephalalgia 2006; 26(8):983-91)
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.
Welcome Headache and Migraine Sufferers
June 9, 2009 by dean · Leave a Comment
In 1991 I embarked on a path that was to become the greatest challenge of my life, establishing The Headache Clinic, www.headacheclinic.com.au, in Adelaide, South Australia, in 1991. The fundamental purpose of The Headache Clinic was and is determining whether or not a neck (cervicogenic) disorder is the cause of or a significant contributing factor to headache or migraine.
We are the sum of our experiences — and my unparalleled clinical experience (having consulted over 7000 headache and migraine patients – in excess of 28000 treatments – with a range of diagnoses) suggests that neck (cervicogenic) dysfunction is significantly underestimated and can be the cause of various forms of headache and migraine. I believe therefore, that, in the presence of negative medical tests, the necks of all (primary) headache and migraine sufferers should be examined, irrespective of the diagnosis. Whilst this challenges traditionally held medical beliefs, it is incumbent to not only pass on this experience to my colleagues and headache and migraine sufferers, but to support this experience with rigorous scientific research (I am currently a PhD Candidate investigating the role of cervicogenic dysfunction in the mechanism of migraine at Murdoch University, Western Australia).
It is irresponsible to treat irrelevant cervicogenic (neck) dysfunction in migraine and headache conditions. However given that the causes of migraine and tension headache are not clear, the advances in our knowledge of pain mechanisms and the not insignificant body research supporting cervicogenic factors as key players in the headache and migraine processes, it is also irresponsible not to examine the necks of headache sufferers irrespective of the diagnosis. How much longer do we accept the notion that ‘whilst we do not know what causes migraine it can’t come from the neck’?
Over the past 15 years I have developed a series of techniques, which, by way of temporary reproduction of headache and easing of the headache as a technique is sustained, confirm that a neck disorder is the cause of or a significant factor in the mechanism of the headache or migraine – this a key diagnostic criterion for cervicogenic or neck involvement in headache according to the International Headache Society – importantly for the disorder to be related to the headache or migraine process the headache has to ease as the technique is maintained. If both reproduction and lessening are not possible then the neck may not be the source of the headache or migraine. Furthermore my experience has shown that if the techniques are performed in a specific manner it is possible to determine which spinal segment is the cause of or contributing significantly to headache and migraine. Having determined which spinal segment (or segments — there may be more than one) is involved then this significantly increases the chance of the treatment being successful because treatment can be directed at specific, relevant spinal segments.
The application of these techniques in Europe, United Kingdom and Australia has become known as the ‘Watson Headache Approach’ and forms the basis of courses I present for physiotherapists, chiropractors and osteopaths in Australia, New Zealand, Hong Kong, Singapore, United Kingdom, Northern Ireland, Belgium, The Netherlands, Switzerland, Germany, Norway and Spain — refer www.headacheeducation.com and www.headacheandmigraine.com for International Practioner Directory.
The Watson Headache Institute was established to increase the awareness of cervicogenic (neck) disorders in headache and migraine by:
imparting my (and that of others) clinical experience and knowledge
and,
undertaking and supporting rigorous clinical and scientific research in this specialty.
Dean Watson
Consultant Headache and Migraine Physiotherapist; Adjunct Lecturer, Masters Program, School of Physiotherapy, University of South Australia; PhD Candidate, Murdoch University, Western Australia
© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.