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
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
CGRP Under the Magnifying Glass There is now widespread agreement that vasodilation is neither necessary nor of a magnitude to be responsible for migraine pain; migraine is a complex neuronal disorder with vascular epiphenomenon.1 Interest in calcitonin gene-related peptide (CGRP) comes from research which suggests that CGRP could play an important role of migraine pathophysiology.
