Managing Headache and Migraine

Why Treatment Often Fails

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 ‘a dog’s breakfast’; it is all over the place with many patients receiving 2 or 3 diagnoses or patients being misdiagnosed – diagnosed as migraine when in fact it was a cervicogenic (neck-related) headache.

Headache and Migraine Treatment Will Remain Unsatisfactory

The medical profession refuses to acknowledge cervicogenic factors. Why? Because relating to it does not fit the medical model and anything that does not fit into the medical model is discarded as unworthy of serious consideration. This impacts on headache or migraine treatment.

The entire diagnostic process needs to be reviewed as well as approaches to treatment. Until cervicogenic factors are considered, headache and migraine treatment will remain unsatisfactory with the only option for you, the headache sufferer, being pharmacological management.


  1. Lipton RB, Silberstein SD, Saper JR, Bigal ME, Goadsby PJ. Why headache treatment fails. Neurology 2003;60:1064-1070
  2. Yi X et al Cervicogenic headache in patients with presumed migraine: missed diagnosis or misdiagnosis? J Pain. 2005 Oct;6(10):700-3)

Until next time

If you are new to Watson Headache®, welcome to the Watson Headache® Approach, an evidence-informed practice when considering the role of the neck in Cervicogenic and Primary Headache.

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