When Managing Headache and Migraine A colleague recently sought to question some of my criticism of medical diagnosis in migraine, see Commentary for Health Professionals, ‘Managing Headache and Migraine: Why Treatment Often Fails‘. My thoughts on my colleague’s comments/queries (in bold italics) follow. Yes there is no test for migraine so the diagnosis is based
Questions and Answers Question: In your view, if what appears to be a classical right C2,3 cervicogenic headache and it responds to a Triptan, is the diagnosis CxHA or migraine? Answer: My understanding of CxHA is where (secondary to) a disorder in the upper cervical spine is misinterpreted as residing in the trigeminal field and
Questions and Answers Q: Of the primary headache types are there some that are more difficult to treat than others? A: Probably the Trigeminal Autonomic Cephalalgia (TACs). The underlying disorder in the TACs is a sensitised brain stem. The way to determine the relevancy of cervical afferents in headache, Migraine or TAC presentations is reproduction
Referring to a Person with Migraine Over the past 25 years or so, I have never really been comfortable referring to a person with migraine as a ‘migraine sufferer’. I felt that this term had negative undertones, i.e. emphasising suffering. A Person with Migraine In recent times, I have used the term ‘migraineur’. As pointed
Diagnosing Vestibular Migraine Vestibular migraine is considered a migraine variant.1 Migraine is a sensory processing disorder in which ‘virtual’ exaggeration of activity of trigeminally innervated structures (passing through a sensitised brainstem) is perceived as noxious, resulting in head pain. Now let’s replace trigeminal with vestibular information2 and ‘vestibular migraine’ results i.e. normal, sub clinical activity
The Accompanying Neck Pain The findings and subsequent assumption from a recent observational Italian study,1 ‘When cervical pain is actually migraine: An observational study in 207 patients.’, challenge basic neuro/anatomical/physiological principles. This survey sought to assign a headache diagnosis to a cohort of 132 participants who had self-diagnosed their headache as being of cervical in origin.
