Focus on yellow flags. No, achieve a positive outcome and they miraculously disappear!
There is too much emphasis on Yellow Flags; perhaps we need to face an unpalatable thought … instead of blaming the patient’s ‘depression’, beliefs, social or vocational situation, stress etc. for lack of progress it is because of our lack of skill!
Besides what has depression, beliefs, social or vocational situations etc. got to do with a unilateral headache (depression affecting one side of the head (?) and one that alternates, i.e. a musculoskeletal event.
References:
Kaube H, Katasavara Z, Przywara S, Drepper J, Ellrich J, Diener HC. Acute migraine headache. Possible sensitization of neurons in the spinal trigeminal nucleus? Neurology 2002; 58:1234-1238
Katsavara Z, Lehnerdt G, Duda B, Ellrich J, Diener HC, Kaube H. Sensitization of trigeminal nociception specific for migraine but not pain of sinusitis. Neurology 2002; 59:1450-1453
Katsavara Z, Giffin N, Diener HC, Kaube H. Abnormal habituation of ‘nociceptive’ blink reflex in migraine – evidence for increased excitability of trigeminal nociception. Cephalalgia 2003; 23:814-819
Sandrini G, Cecchini AB, Milanov I, Tassorelli C, Buzzi MG, Nappi G. Electrophysiological evidence for trigeminal neuron sensitisation in patients with migraine. Neurosci Lett 2002; 317:135-138
Nardone R, Ausserer H, Bratti A, Covi M, Lochner P, Marth R, Florio I, Tezzon F. Trigemino-Cervical Reflex Abnormalities in Patients with Migraine and Cluster Headache. Headache 2008; 48(4):578-585
Nardone R, Tezzon F. The trigemino-cervical reflex in tension-type headache. European Journal of Neurology 2003; 10(3):307-312
Varlibas A, Erdemoglu Ak. Altered trigeminal system excitability in menstrual migraine patients. The Journal of Headache and Pain 2009; 10(4):277-282
Watson DH, Drummond PD. Head Pain Referral During Examination of the Neck in Migraine and Tension-Type Headache. Headache 2014;54:1035-1045
Rothbart P. The cervicogenic headache: A pain in the neck. Can J Diagnos 1996; 13: 64–71.
Takmaz AS, Inan N, Ucler S, Yazar MA, Inan L, Basar H. Greater occipital nerve block in migraine headache: Preliminary results of 10 patients. 2008 Jan;20(1):47-50
Yi X et al Cervicogenic headache in patients with presumed migraine missed diagnosis or misdiagnosis? J Pain. 2005 Oct;6(10):700-3
Young WB, Marmura M, Ashkenazi A, Evans RW. Expert opinion: Greater occipital nerve and other anesthetic injections for primary headache disorders. 2008;48:1122-1125
Rozen T. Cessation of hemiplegic migraine auras with greater occipital nerve blockade. Headache 2007;47:917-928
Peres MF, Stiles MA, Siow HC. Greater occipital nerve blockade for cluster headache. Cephalalgia 2002;22:520-522
Porta-Etessam J, Cuadrado ML, Galán L, Sampedro A, Valencia C. Temporal response to bupivacaine bilateral great occipital block in a patient with SUNCT syndrome. J Headache Pain 2010 Apr;11(2):179
Tobin J,Stephen Flitman S. Nerve Blocks: When and What to Inject? Headache 2009;49(10):1479-85
Pascual J. Treatment of hemicrania continua by occipital nerve stimulation with a bion device. Curr Pain Headache Rep 2009 Feb;13(1):3-4
Burns B, Watkins L, Goadsby PJ. Treatment of hemicrania continua by occipital nerve stimulation with a bion device: Long term follow-up of a crossover study. Lancet Neurol 2008;7:1001-1012
de Tommaso M, Guido M, Libro G, Sciruicchio V, Puca F. Zolmitriptan reverses blink reflex changes induced during the migraine attack in humans. Neurosci Lett 2000 Jul 28;289(1):57-60
Hoskin KL, Kaube H, Goadsby PJ. Sumatriptan can inhibit trigeminal afferents by an exclusively neural mechanism. Brain1996; 119:1419-28
Kaube H, Katasavara Z, Przywara S, Drepper J, Ellrich J, Diener HC. Acute migraine headache. Possible sensitization of neurons in the spinal trigeminal nucleus? Neurology 2002; 58:1234-1238
Watson DH, Drummond PD Cervical Referral of Head Pain in Migraineurs: Effects on the Nociceptive Blink Reflex. Headache 2014;54:1035-1045
Rozen TD, Haynes GV, Saper JR, Sheftell FD. Abrupt onset and termination of cutaneous allodynia (central sensitization) during attacks of SUNCT. Headache 2005;45:153-155
Cooper G, Bailey B, Bogduk N. Cervical zygapophysial joint pain maps. Pain Med 2007;8:344-353
Sjaastad O, Fredriksen TA, Pfaffenrath V. Cervicogenic headache: diagnostic criteria. Headache1998; 38: 442–5.!
Headache Classification Subcommittee of the International Headache Society.The International Classification of Headache Disorders, 2nd edn. Cephalalgia 2004; 24 (Suppl. 1): 1–151.!
Porter RW, Miller CG. Back pain and trunk list. Spine. 1986;11:596–600.
McKenzie RA, May S. Mechanical Diagnosis and Therapy: The Lumbar Spine. 2nd ed. Waikanae, NZ: Spinal Publications; 2003.
Suk KS, Lee HM, Moon SH, Kim NH. Lumbosacral scoliotic list by lumbar disc herniation. Spine. 2001;26: 667–671.
Mercer S, Bogduk N. The ligaments and anulus fibrosus of human adult cervical intervertebral discs. Spine 1999;24: 619–626!
Mercer SR, Jull GA. Review: morphology of the cervical intervertebral disc: implications for McKenzie’s model of the disc derangement syndrome. Manual Therapy 1996; 2: 76–81
Pfaffenrath V, Dandekar R, Mayer ETh, Hermann G, Pöllmann W. Cervicogenic Headache: Results of Computer-Based Measurements of Cervical Spine Mobility in 15 Patients Cephalalgia, March 1988; vol. 8, 1: pp. 45-48.
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Until next time
Dr Dean H Watson PhD Musculoskeletal Physiotherapist
MAppSc(Res) GradDipAdvManipTher(Hons) DipTechPhty
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.
Misconception 4 of 10
Yellow Flags
Focus on yellow flags. No, achieve a positive outcome and they miraculously disappear!
There is too much emphasis on Yellow Flags; perhaps we need to face an unpalatable thought … instead of blaming the patient’s ‘depression’, beliefs, social or vocational situation, stress etc. for lack of progress it is because of our lack of skill!
Besides what has depression, beliefs, social or vocational situations etc. got to do with a unilateral headache (depression affecting one side of the head (?) and one that alternates, i.e. a musculoskeletal event.
References:
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.
Articles
From Exploration to Assumption in Headache Care
Classification Helps Us Diagnose But It Does Not Explain Headache
Triggers: The Dogma That Shrinks Lives
The Forgotten Cervical Nucleus Pulposus in Headache
Unilateral Alternating Headache: Rethinking Unilaterality
Expertise Out of Place: Cervicogenic Headache Criteria
Definitions as Dogma: Cervical Migraine Factors
Rethinking Cervical Contributions to Migraine
Cervicogenic Headache: The Diagnosis Hiding in Plain Sight
Why Educating Manual Therapists About Migraine Matters
The Craniocervical Flexors: Weak or Inhibited?
The Complexion of Silent Migraine
Palpation: A Lost Art or an Overlooked Skill?
The Watson Headache® Approach: More Than Just a ‘Technique’
Cervical Afferents and Primary Headache: The Indefensible Perspective
Menstrual Migraine and Manual Cervical Therapy
Diagnosing ‘Migraine’: A Default Button?
Neck Pain and Migraine: Causality or a Migraine Symptom?
‘Cervicogenic Headache’: An Intellectual Straitjacket?
The ‘Dual Personality’ of Migraine