At last… PhD completed!
This has been brewing for 25 years… life’s ongoing journey!
In the early nineties, the clinical phenomenon of reproducing and resolution of typical head pain when examining O-C3 spinal segmental movements intrigued me. I was sustaining techniques because I thought I needed to remodel soft tissue, but research indicates that it takes hours to remodel soft tissues – how could this explain resolution of typical head pain within 90 seconds?
A Pivotal Clinical Observation
Then a pivotal clinical observation (where would be without clinical experience?)… a patient said to me ‘Dean, I don’t have a headache at the moment but I am always tender here’ (and palpated his temple). This suggested allodynia – a manifestation of central sensitisation. As always I attempted to reproduce headache (which I did). His headache eased (as I sustained the technique) within 90 seconds and then after 3 more repetitions with less intense referral and expeditious resolution I was unable to reproduce head pain.
I then asked him to re-palpate his temple, and to his amazement, the tenderness (allodynia – central sensitisation) was no longer present. My interpretation was that reproduction and resolution of typical head pain reduced central sensitisation and therein the hypothesis for my PhD was born – investigating the (potential sensitising) role of cervical afferents in primary headache.
Reproduction and Resolution of Typical Head Pain
Research over the past 2 decades has demonstrated (beyond doubt) that primary headache – tension headache and migraine – are not separate entities with distinct pathophysiologies, but just different expressions of the one disorder – a sensitised brainstem.
The primary finding of my thesis, using the nociceptive blink reflex, was that reproduction and resolution of typical head pain in migraineurs reduced sensitisation of the brainstem. This discovery replicates the findings of studies which have confirmed that the ‘triptans’ abort migraine by DEsensitising the brainstem and is the first time a manual cervical technique has been shown to desensitise the brainstem – the underlying disorder in primary headache. Whilst further studies are needed, this result supports the perspective that the upper cervical spine in primary headache sufferers needs to be examined to determine the absence or presence of relevant cervical noxious afferents.
I would like to acknowledge my PhD supervisor and mentor Professor Peter Drummond, Murdoch University. Peter has challenged my interpretation of my clinical experience, whilst remaining receptive and providing valuable input. Peter’s influence has gone beyond the PhD experience – it has added another dimension to my professional and personal life.
My gratitude also extends to the participants who brought my studies to life.
And of course without the unconditional support, commitment and conviction of my childhood sweetheart and partner, Jane Watson, this would not have been possible. I owe you big time!
More research information at Migraines are a Pain in the Neck!