Migraines are now listed in the top 20 disabilities by the World Health Organisation and a survey of over 120,000 households found that four out of ten females and two out of ten males respectively will experience migraine at some stage in their lifetime – most likely before age of 35 and that the greatest frequency of attacks are likely to occur between the ages of 20 and 24 years in females and 15 to 19 in males. The authors reported that these findings were in accordance with previous studies. (Stewart WF, Wood C, Reed ML, Roy J, Lipton RB. Cumulative lifetime migraine incidence in women and men. Cephalalgia 2008;28:1170-1178)
Clearly this is a significant problem for many people!
Historically headache has been divided into two main types: Migraine (migraine with and without aura and numerous variants) and Tension-type Headache.
Because of the throbbing nature of ‘migraine’ the assumption has been that the underlying disorder involves blood vessels inside the head, whilst in Tension-type Headache, the assumption (yes – another assumption) has been that increased tension in the muscles of the scalp and forehead is responsible. Hence the presumption has been that Migraine and Tension-type Headache are two separate conditions with different causes. However recent research does not support this conclusion.
Let’s dispel some myths and replace them with what current research suggests:
- dilatation or expansion of blood vessels is not the cause of migraine
- increased tension in the muscles of the scalp and forehead is not the cause of Tension-type Headache
- most Tension-type Headache sufferers occasionally experience a more severeheadache resembling a Migraine; conversely most Migraineurs occasionally experience a lesser headache similar to a Tension-type Headache
- research has shown that Triptans (the medication developed specifically for Migraine) stop migraine by de-sensitising the brainstem
- surveys which show that the Triptans are also effective in relieving Tension-typeheadache
- research has demonstrated that both Migraine and Tension-type Headache conditions share a common disorder – a sensitised brainstem (your brainstem filters information on the way to the brain; when the brainstem is sensitised information passing through it is magnified; the brain then interprets this information as a threat, as if there is something wrong (when there isn’t), and its response is to produce (head) pain)
All this has led medical authorities to suggest that Migraine and Tension-type Headaches are not separate conditions but are different presentations of one condition. I liken it to Rheumatoid Arthritis for example: Rheumatoid Arthritis is one condition, with one diagnosis and one cause. Some afflicted by Rheumatoid Arthritis are severely crippled by the disease, i.e. a Migraine on the headache scale, whilst others have slight swelling of joints of the fingers or wrist, corresponding to Tension-type Headache.
Many of my patients report that they experience both ‘headache’ and Migraine. When they get a Migraine, the throbbing pain is accompanied by nausea, light and sound sensitivity and they need to take a Triptan to ease it. When they get a headache, it’s only an ache; the nausea, sensitivity to light and sound is absent, and a Paracetamol is all that is required. However when I ask about the area of pain, it is identical for both the Migraine and Tension type Headache, suggesting that the same mechanism is responsible but on some occasions it is much more severe i.e. a ‘migraine’.
Cervicogenic (neck) headache has been described for many years by clinicians of varying professions and specialties. What we now understand is that injury or joint disease in the upper three segments of the neck can sensitise the brainstem and cause Headaches and Migraines. However the great news is that we can effectively treat these injuries and damaged joints with specific Physiotherapy, which in many cases can rid patients of their pain.
My name is Lynne Midwinter and I am a Chartered Physiotherapist who set up Physio & Therapies based in Todmorden in 1996.
Since 2005 I have treated many patients for Migraines and Headaches. I studied The Watson Headache Approach with Dean Watson, a pioneering Australian Physiotherapist, who has 22,000 hours of experience with over 7,500 headache-migraine sufferers. It is his PhD research which has demonstrated that disorders in the upper neck can sensitise the brainstem. The effectiveness of his treatment approach has recently been demonstrated by his groundbreaking PhD research which confirms reproduction and lessening of familiar head pain in migraine sufferers desensitises the brainstem – the disorder which not only underpins the Migraine process, but other Headache syndromes. This is truly an exciting discovery because this mirrors the temporary effect of the heavy-duty anti-migraine medication.
I have also been involved in research at Manchester University into the treatment of Migraine patients by Physiotherapy using the Watson Headache Approach and the results of that research will be published next year.
I really enjoy treating people with Headaches and Migraines as I know how debilitating they can be and I have many delighted patients that can now have a glass of red wine, some cheese or a bar of chocolate without it ending up in a headache or a migraine!
The assessment of headaches and migraines is very clear cut – if I can reproduce your head pain by pressing on the joints in the top of your neck, I can probably greatly reduce or even rid you of the pain. If you would like to book a consultation with me to assess your headaches please call me on 01706 819464.
Physiotherapists have the necessary manual therapy skills to treat these joint problems.