Treatment Approach
Diagnosis is difficult and cannot be made from the features of a headache alone because the symptoms of many different types of headache overlap. But is diagnosis important — or clinically relevant? The traditional medical model and diagnosis is based upon a set of signs and symptoms which, whilst may be useful for scientific researchers, provides little direction for clinicians in regard to optimal management.
The challenge for us as physiotherapists and other professionals involved in managing headache is determining whether the neck is the cause of, or a significant contributing factor to a patient's headache or migraine before commencing treatment. Staff at the Headache Clinic recognise that not all headache or migraine comes from disorders of the neck and that headache may have more than one cause. The emphasis on the neck as a source of headache or migraine does not and will not blind us to the possibility of other factors as the cause of headache.
However the challenge of determining if the neck is involved has largely been overcome. Since 1991, I have developed a series of techniques by way of temporary reproduction of headache and lessening of the headache as a technique is sustained, confirms that a neck disorder is a significant factor in the cause of headache or migraine. Reproduction of headache alone is not enough to confirm that the disorder is the cause of headache. For the disorder to be related to the headache process the headache has to ease as the technique is maintained.
Temporary reproduction of headache in this manner is recognised by The International Headache Society, The International Association for the Study of Pain and The International Cervicogenic Research Group and is a key diagnostic feature of cervicogenic involvement in headache.
Furthermore our experience has shown that if the techniques are performed in a specific manner it is possible to determine which spinal segment is the cause of or contributing significantly to headache. If it is possible to determine which spinal segment (or segments — there may be more than one) is involved then this significantly increases the chance of a successful outcome because treatment can then be directed specifically at that segment.
This approach in Europe and the United Kingdom has become known as the Watson Headache Approach.
These techniques and their application form the basis of two-day courses I present for physiotherapists and other interested professionals in Australia, New Zealand, Hong Kong, United Kingdom, Belgium, The Netherlands, Singapore, Switzerland and Germany.
A skilled and responsible assessment involves taking a detailed history, mapping out the area of headache, and analysing the behaviour of symptoms. This is followed by a physical examination of your neck, which includes, but is not confined to, assessment of the movement of the upper three spinal segments or joints.
The examination techniques are applied slowly and smoothly with the aim of temporarily reproducing familiar head pain. If reproduction occurs the technique is sustained for up to 90 seconds to achieve lessening of the pain. If this occurs then not only is cervicogenic involvement confirmed but also the specific spinal segment identified.
If on examination there are no relevant disorders to be found in your neck, treatment cannot be justified and would not be recommended. In this case we would liase (with your permission) with your medical practitioner to discuss our findings.
Practitioners at headacheandmigraine.com recognise that not all headache or migraine comes from disorders of the neck and that headache may have more than one cause. The emphasis on the neck as a source of headache or migraine does not and will not blind us to the possibility of other factors as the cause of headache.
If treatment is indicated it usually comprises passive movement techniques. These are applied in a slow and smooth manner and sustained — a 'persuasive' type of treatment aimed at restoring normal movement at the offending segment thus ensuring that the segment functions optimally — importantly you are in control at all stages during treatment.
The Watson Headache Approach does not involve manipulation or 'cracking' of the neck. However practitioners skilled in this approach (and others) may choose to use high velocity thrust techniques or manipulation. Please discuss this with your practitioner. To maintain healthy function of the segment it may be that a program comprising exercises and alteration in posture will be necessary.
At The Headache Clinic we expect an appreciable improvement within five treatments and if this has not occurred then it is unlikely further treatment will be successful. To justify ongoing treatment there needs to be identifiable, positive changes in headache or migraine symptoms.
Staff at The Headache Clinic have undertaken and are committed to a 12 month formal and intensive training program in the assessment and management of headache and migraine. This along with comprehensive clinical experience provides an unparalleled option for those headache and migraine sufferers in whom relevant cervicogenic (neck-related) dysfunction has been identified … whilst technical expertise can be taught, success depends on how it is used — there is no substitute for experience.
