Headache, Migraine and Depression

November 30, 2009 by dean · Leave a Comment 

It is of no surprise to me that a recent survey showed that headache sufferers were almost 3 times as likely to be depressed than non headache sufferers but who had other issues in their lives.

Let’s consider the lot of a headache sufferer:

little is known about what causes headache or migraine

headache sufferers either experience constant or near constant pain or severe pain

the only management appears to be medication which at best relieves the pain, but doesn’t change the cause (because the cause is unknown)

the doctor is despairing (because he or she doesn’t know what to do next)

Arguably the aforementioned points are more significant than some other issues(?) ….. not much hope is there?

Actually there is … it is amazing that, when after examination of the upper neck reveals the source of headache or migraine symptoms, ‘depression’ lifts – just knowing where the headache comes from leads to significant improvement in one’s outlook.

Cheers

Dean

(Marlow RA, Kegowicz CL, Starkey KN. Prevalence of depression symptoms in outpatients with a complaint of headache. J Am Board Fam Med 2009 Nov-Dec(6):602-3)

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

The Brainstem

November 27, 2009 by dean · Leave a Comment 

Blood Vessels - The Arteries and Veins of the Brain and Neck

Blood Vessels - The Arteries and Veins of the Brain and Neck

I have mentioned the brainstem on a number of occasions.

But what is the brainstem?

The brainstem is an area at the top of the spinal cord, which receives input from (activity of) structures inside the head (including blood vessels) and also from structures of the upper neck (ligaments, joints and the capsules, and muscles) which are supplied by the top three spinal nerves.

The brainstem is also influenced by serotonin and a system known as the Diffuse Noxious Inhibitory Control system . Now all information or activity in relation to headache, head pain and migraine, passes through the brainstem to the higher brain centres where it is interpreted, where the decisions are made!

The Brainstem is the final common pathway for all headache and migraine information.  It is to headache what the black box is to the airplane.

Cheers

Dean

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

Examining The Neck of a Cluster Headache Sufferer

November 8, 2009 by dean · Leave a Comment 

I was talking to a neurologist when in the UK recently and he mentioned that he was writing a case study of a cluster headache sufferer who has been free of cluster headache since his neck was treated. This is not a surprise to me as cluster headache frequently responds to treatment of relevant neck disorders.

This discussion reminded me of patient I saw when in The Netherlands about 5 years ago. This gentleman was 55 years of age and had suffered cluster headache since he was 25 years of age. His episodes lasted 6 months and occurred every 5 years.

I have mentioned that a key diagnostic finding when examining the upper neck structures is the temporary reproduction of headache and for headache to lessen as the technique is sustained. I examined this man when he was not experiencing an attack. Not only was I able to reproduce his head pain, but his eye started to water and his nose started to run, just as if he was in the middle of an attack – those of you who are cluster headache sufferers will identify with this!

Unfortunately I lost touch with this gentleman so I am not sure of the outcome or if in fact he sought treatment ….. but I would be confident of a successful outcome in experienced hands.

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.

Depression, Migraine and Tension Headache

October 28, 2009 by dean · Leave a Comment 

Depression may be the result of headache and migraine experience

Depression may be the result of headache and migraine's isolating experience

Every time I hear that depression is causing migraine or headache I get really frustrated – I would be depressed if I went through what my patients were experiencing!

Migraine and other forms of headache are significant stressors in themselves. However, it is more than coping with the pain, nausea, and vomiting etc. It is also about one’s inability to participate in life – to be able to plan a social life.

Depression is not the cause of headache or migraine … it results from it! It is amazing the change in a person’s demeanor once their headache or migraine has not necessarily resolved, but just improved!

Have you considered that your (upper) neck may be the cause of your depression?

Cheers

Dean

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

Migraine and Stress

October 22, 2009 by dean · Leave a Comment 

When stressed, muscles shorten, joints move abnormally, pain is referred to the head

When stressed, muscles shorten, joints move abnormally, pain is referred to the head

One of the most common triggers reported by individuals with migraine is stress.1-5 Approximately 76% of migraine suffers report identifiable triggers and of those 80% report stress as a common trigger.6

When we get stressed our muscles shorten ‘asking’ the vertebra to which they are attached, to move. If however the joint is stiff, messages from shortened structures for example capsules, ligaments and muscles, which are there to prevent the joint from moving too much, are not allowing the joints to move normally and pain is referred to your head – stress without a neck disorder does not result in headache.

A skilled examination of the movements of the upper neck can confirm this for you.

Cheers

Dean

(2. Chabriat H, Danchot J, Michel P, Joire JE, Henry P. Precipitating factors of headache. A prospective study in a national control-matched survey in migraineurs and nonmigraineurs. Headache. 1999;39:335-338.

1. Hung CI, Liu CY, Wang SJ. Precipitating or aggravating factors for headache in patients with major depressive disorder. J Psychosom Res. 2008;64:231-235.

4. Karli N, Zarifoglu M, Calisir N, Akgoz S. Comparison of pre-headache phases and trigger factors of migraine and episodic tension-type headache: Do they share similar clinical pathophysiology? Cephalalgia. 2005;25:444-451.

6. Kelman L. The triggers or precipitants of the acute migraine attack. Cephalalgia. 2007;27:394-402.

5. Martin PR, Milech D, Nathan PR. Towards a functional model of chronic headaches: Investigation of antecedents and consequences. Headache. 1993;33:461-470

3. Rasmussen BK. Migraine and tension-type headache in a general population: Psychosocial factors. Int J Epidemiol. 1992;21:1138-1143)

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

Cluster Headache After Mild Head Trauma

October 18, 2009 by dean · Leave a Comment 

Horrible day

Cluster Headache after mild head trauma

In this case study a 48 year old woman developed signs and symptoms of cluster headache after hitting her head on an iron ladder.

The authors consider various possibilities as to the cause, but all related to intra cranial, i.e. inside the head, factors … this pre occupation with intra cranial causes is frustrating on two counts.

Firstly, this woman is still suffering 19 years (Yes – 19!) later, and secondly, that a neck injury has not been considered. Research has shown that symptoms of cluster headache are treated successfully by blocking information from the upper neck indicating that neck disorders can be the source of symptoms.

In instances such as this when there is a blow to the head by a stationary object, clearly the head stops (suddenly and momentarily), and the body continues to move, leaving the neck to absorb the strain, effectively to put the brakes on! This patient has experienced a neck injury and even a minor incident can be much than what it seems especially when the blow is unexpected.

Cheers

Dean

(Lambru G, Castellini P, Manzoni GC, Torelli P. Traumatic Cluster Headache: From the Periphery to the Central Nervous System? Headache 2009;49:1059-1072

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

Solomon S, Lipton RB, Newman LC. Nuchal features of cluster headache. Headache 1990;30:347-9

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

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.

‘Tension Headache’ or ‘Migraine Without Aura’ or ‘Mixed’ Headache?

October 12, 2009 by dean · Leave a Comment 

Diagnosis cannot be done from symptoms alone

Diagnosis cannot be done from symptoms alone

This study from Spain demonstrates that diagnosing headache and migraine cannot be done from symptoms alone.

One hundred and five GPs were asked to examine and treat a patient who was considered (according to the International Headache Society’s diagnostic criteria) to be suffering migraine without aura.

Forty six diagnosed migraine correctly, 41 diagnosed the patient as tension-type headache, whilst 17 concluded ‘mixed’ headache and one GP was unable to diagnose the patient. One hundred and three recommended anti inflammatory medication as symptomatic treatment. Triptans were recommended by 67 GPs (including 15 of the 41 who had diagnosed the patient as tension-type headache). Preventive treatment was not considered by 30 GPs. A total of 66 GPs would prescribe beta-blockers (13 of the 41 who diagnosed tension-type headache), 35 amitriptyline (of whom 23 diagnosed tension-type headache) and the remaining 9, other treatments.

I have always maintained that a ‘diagnosis’ is not particularly useful – this study supports my clinical experience – what is the point of a diagnosis. The key to successful management is finding the source of the sensitisation; whilst the triptans may decrease the sensitisation they do not remove the source.

A skilled examination of the structures of the upper neck can identify relevant disorders – this involves temporary reproduction (and easing as the technique is sustained) of familiar head pain.

Cheers

Dean

(Pascual J, Sanchez A, Castillo J Dif?culties for diagnosing and treating migraine among general practitioners Cephalalgia 2009;29(Suppl. 1):1–166)

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

Cluster Headache and Migraine Are Just Different Expressions of the Same Condition

October 9, 2009 by dean · Leave a Comment 

After examining six clinical trials in which cluster headache sufferers were treated with various ‘triptan’ medications it was concluded that the ‘triptans’ were effective in preventing the debilitating pain of cluster headache – just further evidence to support that cluster headache and migraine share a common underlying disorder.

This disorder has been demonstrated to be a sensitised brainstem and of course the ‘triptans’ de-sensitise the brainstem.

Furthermore there is a significant body of research which suggests that influencing (anaesthetising/blocking) information from structures of the upper neck prevents migraine and cluster headache. This suggests that abnormal information from disorders of these structures can sensitise the brainstem and that therefore a skilled examination of the upper neck should be included in assessment of migraine and cluster headache sufferers.

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

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

Law S, Derry S, McQuay H, Moore A A systematic review of the triptan class of drugs for the treatment of cluster headache Cephalalgia 2009;29 (Suppl. 1):1–166

Nardone R et al Trigemino-Cervical Reflex Abnormalities in Patients with Migraine and Cluster Headache. Headache 2008; 48(4):578-585

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

Solomon S, Lipton RB, Newman LC. Nuchal features of cluster headache. Headache 1990;30:347-9obin 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.

Chronic Migraine and Episodic Migraine

September 27, 2009 by dean · Leave a Comment 

In the 1980s it was suggested that the migraine state was a progressive condition.1

Over recent years there has been significant research which shows that this in fact is the case – that migraine is a continuum or spectrum disorder, i.e. a process in which episodic migraine may or may not evolve into chronic migraine.2,3 Indeed, the findings of various physiological and imaging (of the brain) investigative techniques suggest that the features of the ‘mis-behaving’ brain during episodic migraine are present persistently in chronic migraine sufferers.4 Three per cent of individuals with episodic migraine progress to chronic migraine over the course of a year.3

This brain dysfunction (or mis-behaviour) has been shown to be sensitisation of the brainstem and one of the sensitising factors could be abnormal information from a neck disorder or injury. Confirmation of this is not difficult or costly – a skilled examination of the upper neck is all that is required.

Cheers

Dean

(Aurora SK. Is chronic migraine one end of a spectrum of migraine or a separate entity? Cephalalgia 2009;29:597-605

Bigal ME, Lipton RB. Concepts and mechanisms of migraine chronification. Headache 2008; 48:7–15.

Cady RK, Schreiber CP, Farmer KU. Understanding the patient with migraine: the evolution from episodic headache to chronic neurologic disease. A proposed classification of patients with headache. Headache 2004; 44:426–35.

Mathew NT, Stubits E, Nigam MP. Transformation of episodic migraine into daily headache: analysis of factors. Headache 1982; 22:66–8)

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