The Uncertainty of Treating Migraine

August 21, 2009 by dean · Leave a Comment 

“ … little does it concern the patient that there is an underlying cause … if the practitioner is unable to relieve his pain.” (Persian Avicienna – Critchley 1967)

This statement was made 2000 years ago and remains true today – patients are seeking treatment, but since the cause of migraine remains unclear, treatment is provided on a less than solid scientific foundation, on a ‘we’ll try this and see what affect it has’ basis.

However what is becoming increasingly clear (except to those who continue to support the notion that headache and migraine are separate entities) is that headache and migraine arise from the same (sensitised brainstem) disorder – the evidence is there – this is the underlying cause. Not only can we confirm relevant neck disorders as the source but we can offer a way of addressing it, based not on guesswork but on sound scientific evidence.

Cheers

Dean

(Anderson CD, Franks RA. Migraine and tension headache: is there a physiological difference? Headache 1981; 21:63-71

Critchley M. Migraine from cappadocia to queens square. In: Smith R, ed. Background to Migraine. London: Heinemann;1967:28

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

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

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

Nelson CF. The tension headache, migraine headache continuum: A hypothesis J Manipulative Physiol Ther 1994; 17:156-167

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)

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

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.

What Does Blocking The Greater Occipital Nerve Do?

August 3, 2009 by dean · Leave a Comment 

I have been mentioning the research which shows that by injecting and anaesthetising the greater occipital nerve the migraine process can be halted … so what does this do?

Anaesthetising the greater occipital nerve prevents information from (neck) structures supplied by the nerve from entering into the spinal cord (and the brainstem). The effect of this on migraine and headache symptoms suggests that this information being carried by the nerve was sensitising the brainstem and that by preventing it from reaching the brainstem, the brainstem is no longer sensitised.

This then is considered a diagnostic tool to confirm cervicogenic (neck) disorders in headache and migraine.

Cheers

Dean

(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

Peres MF. et al Greater occipital nerve blockade for cluster headache. Cephalalgia 2002;22:520-522

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

Tobin J,Stephen Flitman S. Nerve Blocks: When and What to Inject? Headache 2009

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.

A Treatment Technique for Migraine Sufferers

July 22, 2009 by dean · Leave a Comment 

How Clinical Research Physiotherapist, Dr Ian Davidson at Manchester University, is leading a clinical trial testing the effectiveness of fellow Physiotherapist Dean Watson’s treatment technique for migraine sufferers.

The study, which began recruiting in April 2007, is being carried out in three private physiotherapy practices in the northwest (two in Lancashire and one in Cheshire). The study was awarded £95,000 by Physio First through its charitable trust, the Private Physiotherapy Educational Foundation.

Patients have been recruited through the Migraine Action Association, local universities and GPs. Dr Davidson says around 90 are needed to complete the trial and 76 have been recruited so far, adding that a high attrition rate has made progress difficult. ‘We are about a year and a half away from completing,’ he says.

Patients are screened and asked to complete a diary before being referred for six physiotherapy sessions based on Mr Watson’s technique. ‘I hope the study does help towards developing an evidence base for headache physiotherapy,’ says Dr Davidson, adding: ‘I would hope from this trial I would be able to put in a proposal for a larger national trial.’

Quoted in Frontline Magazine, Issue 17th June 2009, the official journal of the Chartered Society of Physiotherapy in the United Kingdom, Titled “When Headache is a Pain the Neck” by Louise Hunt.

© 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.

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.

Headache and Migraine Education

June 3, 2009 by dean · Leave a Comment 

Up to date knowledge is self empowering

Appropriate up to date knowledge is self empowering

Appropriate and up-to-date knowledge is self-empowering; I believe that every headache and migraine sufferer has the right to know their headache and migraine diagnosis as precisely as possible (and what it means), to know the nature of their headache disorder, its outcome and possible types of treatment. What has yet to gain acceptance is my belief, supported by my unparalleled clinical experience and a significant body of international research, that it is incorrect to consider headache and migraine types as totally different entities. ‘Headache and Migraine Education’ is one of the aims of Watson Headache Institute – it is here that relevant, past and present research will be summarised and discussed…

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)

Anderson CD, Franks RA. Migraine and tension headache: is there a physiological difference? Headache 1981; 21:63-71

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

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

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

Nelson CF. The tension headache, migraine headache continuum: A hypothesis J Manipulative Physiol Ther 1994; 17:156-167

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.