Headache and Migraine Sufferers 'Bill of Rights' (continued)

The Third & Fourth 'Bills' 

Conducting research into headache-migraine

“The headache sufferer has the right of access to an authorised healthcare provider and to relevant treatment, regardless of age, sex, race, state of health and economic standing and regardless of the geographical, cultural and economic circumstances of his/her community.”

and

“The headache sufferer has the right to expect society and the medical profession to conduct research in the field of headache to improve the understanding and treatment of headache in the future.”

My concern here is with 'conducting research' – if research resources investigating the role of neck disorders in the headache and migraine condition equalled those provided for the brain as the cause or headache or migraine and/or pharmaceutical management, then a more balanced and effective approach would result.

Cheers

Dean

References

1. Members’ Handbook. International Headache Society 2000 Scandinavian University Press

© 2012 & Beyond. Watson Headache Institute, All Rights Reserved.

Headache and Migraine Sufferers 'Bill of Rights' (continued)

The Second ‘Bill’

Conducting a relevant physical examination...

“The headache sufferer has the right to be taken seriously by the healthcare providers, whose duty it is to take down a relevant history, conduct a relevant physical examination, provide advice and reassurance and prescribe the treatment most advantageous and acceptable to the patient according to current knowledge.”

The issue I have here is with " ..., conduct a relevant physical examination, ...'

It is appropriate that a neurologist conduct the aspects of the physical examination which rule out serious causes of headache.  However, and with respect, the neurologist, physician, or general practitioner are not skilled in examination of the structures of the upper neck – this is where the ‘system’ fails you, your headache or migraine continues … the prognosis, treatment, advice are dependent on the examination, which is incomplete; incomplete because your neck has not been examined comprehensively.

So let’s summarise from the first 2 of the 4 ‘bills’ of rights’:

• a precise diagnosis is not possible (and besides, does it mean anything?)
• the nature of the disorder is a sensitised brainstem
• the prognosis and best treatment options are dependent on identifying the reason for the sensitisation
• the examination you will get will most likely be incomplete because your neck will not be comprehensively examined and therefore one of the most likely reasons for sensitisation (a neck disorder) will not identified …

…therefore you are likely to be destined to a lifetime of medication which at best just manages the symptoms and not the cause.

It is appropriate that your medical practitioner is consulted to exclude serious causes of headache (which are extremely rare) but once the various tests have been carried out and there is nothing to find, then a skilled examination of your neck is indicated. Research has shown that information from neck disorders can sensitise the brainstem.

Cheers

Dean

References:

1. Members’ Handbook. International Headache Society 2000 Scandinavian University Press

© 2012 & Beyond. Watson Headache Institute, All Rights Reserved.

Headache and Migraine Sufferers 'Bill of Rights' (continued)

The First 'Bill' (continued)

To know the prognosis...

The first ‘bill’ is that " ... the headache sufferer has the right to know his/her headache diagnosis as precisely as possible, and to know the nature of the headache disorder, its prognosis and the possible types of treatment."

OK, so we now need to look at 'its prognosis'.

The prognosis or the likely course or outcome of the condition clearly is dependent on identifying the cause of the condition, and despite the enormous amount of resources, financially and otherwise, the reason for the sensitisation of the brainstem in the headache and migraine condition has not been identified … so a prognosis cannot be predicted.

What next – the possible types of treatment … this depends on the examination and this is included in the second ‘bill’.

Until next time.

Cheers

Dean

References:

1. Members’ Handbook. International Headache Society 2000 Scandinavian University Press

© 2012 & Beyond. Watson Headache Institute, All Rights Reserved.

Headache and Migraine Sufferers 'Bill of Rights' (continued)

The First 'Bill' (continued)

To know the nature of the headache disorder...

The first ‘bill’ is that "... the headache sufferer has the right to know his/her headache diagnosis as precisely as possible, and to know the nature of the headache disorder, its prognosis and the possible types of treatment."

I have discussed the first point regarding 'diagnosis'; now ... the 'nature' of the headache disorder

Clearly there is a substantial body of research which shows that the brainstems of those experiencing Migraine, Tension Headache, Menstrual Migraine and Cluster conditions are sensitised.

We know that the ‘Triptans’ desensitise the brainstem and therefore are effective in preventing Migraine, Tension Headache, Cluster Headache, Hemicrania Continua, Menstrual Migraine, Cervicogenic (neck-related) Headache (which shows that cervicogenic disorders can sensitise the brainstem) ...

The underlying disorder is sensitisation of the brainstem; surely optimal management therefore is about identifying the reason for the sensitisation …. and the Watson Headache Approach can confirm or rule out the neck as the source of the sensitisation.

Stay tuned,

Cheers

Dean

References:

1. Members’ Handbook. International Headache Society 2000 Scandinavian University Press

© 2012 & Beyond. Watson Headache Institute, All Rights Reserved.

Headache and Migraine Sufferers 'Bill of Rights'

The First 'Bill'

To know headache diagnosis as precisely as possible...

In 2000, the International Headache Society, published a Headache Sufferers ‘Bill of Rights’.

The first ‘bill’ is "... that the headache sufferer has the right to know his/her headache diagnosis as precisely as possible, and to know the nature of the headache disorder, its prognosis and the possible types of treatment."

I would like to spend the next few posts looking more closely at these points:-

“the headache sufferer has the right to know his/her headache diagnosis as precisely as possible”

• diagnosis is difficult because it is based on a set of signs and symptoms, and the signs and symptoms of many different headache-migraine forms overlap – perhaps this is why many of you afflicted by headache or migraine have been given 2, 3 or even 4 different diagnoses

• not only do we have ‘Pure’ Menstrual Migraine, but now ‘MRM’ i.e. Menstrual Related Migraine, Menstrual Tension Headache, Menstrual Hemicrania Continua, Cluster Headache associated with menstruation etc and this is just headache and migraine supposedly associated with the menstrual cycle

• the ‘Triptans’, developed specifically to stop the migraine process are effective in other forms of headache e.g. Menstrual Migraine, Cluster Headache, Cervicogenic Headache, and Hemicrania Continua

• different headache and migraine forms responding to a range of cervicogenic (neck) treatments e.g. greater occipital nerve blocks, cervical spine stimulators

Is a diagnosis important? As far as I can see, and given the research, a diagnosis does not optimise the management of headache or migraine – it remains a ‘let’s try this and wait and see’ approach – clearly an unsatisfactory situation.

Cheers

Dean

References:

1. Members’ Handbook. International Headache Society 2000 Scandinavian University Press

© 2012 & Beyond. Watson Headache Institute, All Rights Reserved.