Edition 5 – Woah! Disharmony At The Primary Headache Dinner Party

Welcome back to the ‘dinner party’ (introduced in Edition 4), where after a harmonious start, some discord between the guests – DINCs, CPM and Serotonin – from ‘downtown’ (CNS), who are working hard to keep the peace, and Trigeminal Afferents and Cervical Afferents, the ‘out of towners’ (PNS), who can be, well… let’s say a little ‘volatile’ – has appeared.  The table – aka the trigemino cervical complex – has become a little ‘unstable’ or perhaps, ‘sensitive’… (Central Sensitisation – CS).

Unfortunately, because it is not clear why this has happened, the situation is progressing rapidly.

It just so happens, that at the next table, Dr Watson and his senior research colleague are discussing an upcoming project over a glass of 2012 Albert Bichot Cote de Nuits Villages Burgundy. The discord within the dinner party was becoming more and more boisterous, to the point where it was disturbing their planning. Therefore, they decided to investigate…

Watson’s companion quickly recognises what is happening, and in typical research mode establishes a hypothesis.  In this case, recognising the characteristics of the guests, he concludes that there are two possible reasons.

A Hypothesis

Either Trigeminal or Cervical Afferents have become aggressive, overpowering the other guests – DNICs, CPM or Serotonin (Peripherally driven Central Sensitisation – PCS), or conversely, DNICs, CPM or Serotonin have become more reserved, introverted (Centrally driven Central Sensitisation – CCS). After cursory probing, Watson’s companion concludes that the ‘out of town guests’ – Trigeminal and Cervical Afferents have behaved themselves, and that, therefore, the guilty party is one of the other guests – i.e. CCS.

However, whilst one aspect of Watson’s relationship with his colleague is to support his exceptional research skills, Watson is somewhat more circumspect, and tentatively proffers an alternative hypothesis.

An Alternative Hypothesis

Watson points out to his colleague that his hypothesis has relied heavily on the findings of the court of medical opinion (medical research), which, unfortunately has shown a notable bias, emphasizing DNICs, CPM, and Serotonin (they are the city dwellers regardless). Furthermore, the conclusions appear equivocal, suggesting a sense of pre-determination.

Watson is concerned, even puzzled, as to why the other guests – Trigeminal and Cervical Afferents, have been largely ignored as the potential cause of disharmony (Central Sensitisation) at the dinner party.  Is it because, they are misunderstood, mysterious… or just unrecognised? After-all, they are from ‘out of town’.

An Animated Discussion

Watson’s colleague was not expecting this response – an animated discussion ensues.  Watson sensing increasing uncertainty and frustration, suggests that whilst they contemplate his unconventional hypothesis, another glass of Burgundy is required.

They return to their table and another glass is poured, but… as before, rationalising this alternative hypothesis was being hampered by the escalating disturbance across the room.  Watson, keen that his hypothesis be given critical, objective scrutiny, has an idea, and quickly, because time is of the essence, he returns to the dinner party and discreetly slips a drug, eeerrr… perhaps starting with a ‘T’ into the communal jug of water.

Within 30 minutes, harmony (although less vibrant), was restored at the dinner party.  Watson’s colleague was bemused but pleased (as was Watson) that he could enjoy his Burgundy (which was now accompanied by some Brie de Meaux) and consider Dr Watson’s alternate hypothesis with his usual prowess.

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.


Scroll to Top