Examining Upper Cervical Segments That reproduction of headache when examining upper cervical segments confirms cervicogenic relevancy – wrong! Whilst reproduction of typical symptoms does not confirm relevancy, if this occurs, one can be very, very, suspicious of cervical involvement. However, there are situations in which reproduction is possible and the source is not the upper
Reproduction of Headache That reproduction of headache when examining the upper cervical structures is inappropriate… is to be avoided – wrong! It is crucial! Reproduction (and resolution) is exactly what is needed24 – without it you are in ‘no man’s (or woman’s) land’… the guessing game continues! References: Kaube H, Katasavara Z, Przywara S, Drepper
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
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
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
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
