Summarising the Reasons Why Several authorities recently summarised the reasons why headache and migraine treatment often fails. Amongst other things, they suggested that the diagnosis is incomplete or incorrect and that this could occur for various reasons. One of the reasons is ‘misdiagnosis’. I have mentioned this research before but diagnosing headache and migraine is like
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
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
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
Cervicogenic Headache Headache is classified as either Primary or Secondary Headache.1 Primary Headaches are those headache and migraine conditions with unknown pathophysiology. Secondary Headache comprises headache arising from a recognised and accepted cause, i.e. secondary to a known source. Cervicogenic Headache (CeH) is classified as a secondary headache i.e. headache secondary to a cervical lesion.1
Role and Relevance in Headache Recently, the role and relevance of ‘Yellow Flags’ in chronic pain has been questioned.1 The average length of history of headache/migraine patients presenting to a dedicated headache clinic is 15 years;2 these people therefore often present with chronic pain and are depressed, anxious etc.; this is not unreasonable in the
