Identifying Headache and Migraine

July 29, 2009 by Dean Watson · Leave a Comment 

© 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.

Blood Vessels and Migraine

July 25, 2009 by Dean Watson · Leave a Comment 

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

‘Triptan’ Overuse Headache

July 1, 2009 by dean · Leave a Comment 

Neck structures contibuting to migraine

Neck structures contibuting to migraine

It is interesting to note that we now have another condition (or complication) in the headache and migraine industry – ‘Triptan Overuse Headaches’! This was always going to happen as it did with ‘Medication overuse headache’.

Whilst for many of my patients, the triptans were their best friend initially, eventually over time they were finding that they were needing to take another one in decreasing intervals, i.e. their effectiveness is decreasing or ….. perhaps it is that the cause of the sensitisation process is worsening.

It is imperative that the source of the sensitisation of the brainstem be determined.

Essentially the brainstem is influenced by four systems:

  • serotonin
  • diffuse noxious inhibitory control system
  • information from structures inside the head – blood vessels, teeth, gums, eyes, sinuses etc
  • information from structures of the upper neck – muscles, ligaments, capsules, joints etc

Of the above the easiest to confirm or eliminate is information from the neck.

Can you imagine how one of my patients who was experiencing migraine daily and who was taking Imigran (a triptan) three a times day for the past 10 years, felt when her migraine eased within 30 seconds after placing her head into a retracted (i.e. the opposite to a poking chin posture) position – she burst into tears! What a moment ….she realised her neck was contributing to her migraine.

Cheers

Dean

(Créac’h C, Radat F, Mick G, Guegan-Massardier E, Giraud P, Guy N, Fabre N, Nachit-Ouinekh F, Lanteri-Minet M. One or Several Types of Triptan Overuse Headaches? Headache 2009;49(4);519-528

Limmroth V, Katsarava Z, Fritsche G, et al. Features of medication overuse headache following overuse of different acute headache drugs. Neurology 2002;59:1011-1014)

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

‘Triptans’, Hormones, and Menstrual Migraine.

June 21, 2009 by dean · Leave a Comment 

The ‘triptans’ are effective in relieving menstrual migraine

The ‘triptans’ are effective in relieving menstrual migraine

The ‘triptans’ are effective in relieving menstrual migraine – how (?) – isn’t menstrual migraine caused by hormones – specifically a drop in oestrogen? Research showing that hormonal patterns and fluctuations are no different in women suffering menstrual migraine from those who don’t, suggests that this is not the case, and has prompted some authorities to suggest that there is an underlying disorder in the central nervous system. Managing menstrual migraine by artificially controlling normal hormonal fluctuations, therefore, whilst helping to ease symptoms in some women, is not addressing the underlying problem.

Could it be that the underlying problem is a sensitised brainstem (?) – after all the ‘triptans’ desensitise the brainstem.

Cheers

Dean

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

Loder E. Menstrual migraine. Curr Treat Options Neurol 2001 Mar;3(2):189-200

Mannix LK, Files JA. The use of triptans in the management of menstrual migraine. CNS Drugs 2005;19(11): 951-72

Martin VT, Behbehani M. Ovarian hormones and migraine headache: understanding mechanisms and patohogenesis – part 2. Headache 2006;46:365-386

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.

The ‘Triptans’, Tension Headache, Blood Vessels and Migraine

June 20, 2009 by dean · Leave a Comment 

The ‘triptans’ are a group of medications developed specifically to prevent migraine attacks. Just how they do this has been debated for some time. Initially it was thought that the ‘triptans’ constricted the blood vessels, but research has shown clearly that dilatation of blood vessels is not consistently present during a migraine attack.

It has been demonstrated the ‘triptans’ desensitise the brainstem – perhaps it is this which prevents a migraine attack. This is supported by research which shows that the ‘triptans’ are effective in relieving tension headache and that the brainstems in tension headache are sensitised …. as they are in migraine.

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

Hoskin KL, Kaube H, Goadsby PJ. Sumatriptan can inhibit trigeminal afferents by an exclusively neural mechanism. Brain 1996; 119:1419-28

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, Tezzon F. The trigemino-cervical reflex in tension-type headache. European Journal of Neurology 2003; 10(3):307-312

Tegeler CH, Davidai G, Gengo FM, Knappertz VA,Troost BT, Gabriel H, Davis RL. Middle cerebral artery velocity correlates with nitroglcerin-induced headache onset. J Neuroimaging 1996; 6(2): 81-6

Thomsen LL, Iverson HK, Olesen J. Cerebral bloodflow velocities are reduced during attacks of unilateral migraine without aura. Cephalalgia 1995; 15(2): 109-116)

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