Commentary

for health professionals

Misconception 4 of 10

Yellow Flags Focus on yellow flags. No, achieve a positive outcome and they miraculously disappear! There is too much emphasis on Yellow Flags; perhaps we need to face an unpalatable thought … instead of blaming the patient’s ‘depression’, beliefs, social or vocational situation, stress etc. for lack of progress it is because of our lack

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Commentary - Greater Occipital Nerve

Greater Occipital Nerve

And Primary Headache Because primary headache often includes pain in the back of the head, anaesthetic blockade of the greater occipital nerve (GON) has become an increasingly common practice,1 despite denunciation of its value on the basis that it supplies only the skin, muscles and vessels of the scalp which are not established sources of

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Commentary - Misconception 3 of 10

Misconception 3 of 10

Complex Presentations That seemingly complex presentations with a multitude of (often unusual) symptoms means multiple causes requiring multidisciplinary approach – wrong! Complex presentations are often chronic and the original disorder has now been swamped by a myriad of symptoms (also known as a school of ‘red herrings’!). For example a ‘splinter’ that hasn’t been located

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Misconception 2 of 10

Chronicity That chronicity means protracted treated and unsatisfactory outcomes – wrong! The underlying disorder in headache and migraine is a sensitised brainstem and chronicity is underpinned by central sensitisation. This is how the ‘triptans’ (heavy duty anti-migraine medication) abort migraine – they desensitise the brainstem21-23 – temporarily of course because they do not change the

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Commentary - Misconception 1 of 10

Misconception 1 of 10

Upper Cervicogenic Dysfunction That (upper) cervicogenic dysfunction does not play a causal role in primary headache (i.e. migraine, tension and cluster headache, hemicrania continua, menstrual migraine etc) syndromes – wrong! Research continues to support the concept that the many and varied forms of headache and migraine1-7 – migraine, tension-type headache, cluster headache (that takes care

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Commentary -The General Practitioner

The General Practitioner

And Cervicogenic Headache A recent (and frequent) query from a colleague(s): “I wonder if general practitioners are aware of that (i.e. the natural progression of cervicogenic (neck) headache… If it is left untreated, cervicogenic headache becomes more frequent, more severe, requiring stronger and stronger medication, and eventually becomes continuous see Cervicogenic Management Decreases Migraine Progression). I

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