Headaches:Migraine

Hoda has been trained in the Watson Headache ® Approach for the assessment and treatment of headaches and migraines. It utilises the only manual therapy techniques scientifically proven to target the underlying condition in headache and migraine.

Key features of the approach are:
• Diagnosing a stressor in the cervical spine that is amenable to sustained self-treatment.
• Demonstration that this mechanical stressor is responsible for referring usual symptoms by highly specific and localised stress on the upper cervical segments causing reproduction and resolution of familiar symptoms – fulfilling part of the IHS classification for cervicogenic cause of headpain.
• Evidence that the techniques improve the underlying problem in primary headache – a hyper-excited brainstem.
• Significant and sustainable change within 2 weeks of commencing treatment. If no significant change has occurred then treatment ceases (5% of cases). We do not support endless treatment regimes without a benchmark for improvement.
• Emphasis on self-management: aim to discharge in less than 10 sessions for 90% of patients. <10% requiring some degree of maintenance on a case-by-case basis.

The aim is to provide sufferers and their care providers with access to a highly skilled and specific assessment tool to fulfil criteria E of the International Headache Society (IHS) classification of primary headache. Criteria E states that the diagnosis of primary headache (TTH, Migraine, CH and their subtypes) can only be arrived at if the symptoms described cannot be attributed to another disorder.

Diagnosis cannot be based on symptoms alone therefore the neck must be excluded to fulfil criteria E. To diagnose a cervicogenic source of referred pain according to the IHS classification we require a clinical test demonstrating the neck as a source of symptoms. Watson and Drummond demonstrated that familiar headpain symptoms are elicited with highly specific palpation of the upper cervical spine in 100% of tension headache sufferers and 95% of migraine sufferers. That’s to say that in these people the neck is demonstrated to be a contributor to pain, but not necessarily the only source – but it is a treatable and manageable component.

Evidence from reflex studies, PET scans and the mechanism of effect of triptans, that the common underlying pathophysiology in primary headache and cervicogenic headache is an overactive brainstem (trigemino-cervical nucleus or TCN). Located in the caudal region of the pons extending into the upper 3 levels of the cervical spine, the TCN receives afferent input from the 3 upper cervical nerves. If dysfunction is present in the upper cervical spine and it is a constant it may therefore account for the increased excitability of the TCN.

The application of the Watson Headache® approach has been shown to normalise a key marker of this overactivity – the nociceptive blink reflex. This is what differentiates this approach from standard manual therapy. We can get relief from the current episode, but also by changing the underlying activity in the brainstem we can help prevent the next episode and see significant changes in 2 weeks in over 90% of people treated.

Please contact Hoda by phone or email if you would like to understand more about how this approach may be able to help you in the management of your headache and migraine.