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 (because of the lack of skill and therefore presumed to be no longer present) will lead to varying symptoms and involvement of various approaches and /or health professionals e.g. an infection (requiring an unnecessary (because it was missed) trial of antibiotics) and/or inability to concentrate and/or catastrophising (where is my pain coming from?) requiring a psychologist /psychiatrist).

Complexity arises from unsuccessful various treatments underpinned by a lack of understanding and expertise.

References:

  1. Kaube H, Katasavara Z, Przywara S, Drepper J, Ellrich J, Diener HC. Acute migraine headache. Possible sensitization of neurons in the spinal trigeminal nucleus? Neurology 2002; 58:1234-1238
  2. Katsavara Z, Lehnerdt G, Duda B, Ellrich J, Diener HC, Kaube H. Sensitization of trigeminal nociception specific for migraine but not pain of sinusitis. Neurology 2002; 59:1450-1453
  3. Katsavara Z, Giffin N, Diener HC, Kaube H. Abnormal habituation of ‘nociceptive’ blink reflex in migraine – evidence for increased excitability of trigeminal nociception. Cephalalgia 2003; 23:814-819
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  7. Varlibas A, Erdemoglu Ak. Altered trigeminal system excitability in menstrual migraine patients. The Journal of Headache and Pain 2009; 10(4):277-282
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  24. Watson DH, Drummond PD Cervical Referral of Head Pain in Migraineurs: Effects on the Nociceptive Blink Reflex. Headache 2014;54:1035-1045
  25. Rozen TD, Haynes GV, Saper JR, Sheftell FD. Abrupt onset and termination of cutaneous allodynia (central sensitization) during attacks of SUNCT. Headache 2005;45:153-155
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  29. Headache Classification Subcommittee of the International Headache Society.The International Classification of Headache Disorders, 2nd edn. Cephalalgia 2004; 24 (Suppl. 1): 1–151.!
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  33. Mercer S, Bogduk N. The ligaments and anulus fibrosus of human adult cervical intervertebral discs. Spine 1999;24: 619–626!
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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.

Watson Headache
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