Dean Watson
I graduated as a physiotherapist from the South Australian Institute of Technology (S.A.I.T.) in 1976 and completed a Graduate Diploma in Advanced Manipulative Therapy in 1983 (S.A.I.T.) followed by a Master of Applied Science by Research at the University of South Australia in 1991.
The findings of the Masters Research Program in which natural head posture and upper cervical flexor muscle performance was investigated in cervicogenic (neck) headache sufferers was published in Cephalalgia and have influenced the management of cervicogenic headache sufferers.
In 1991 I embarked on a path that was to become the greatest challenge of my life, establishing The Headache Clinic in Adelaide in 1991 (to provide skilled and advanced assessment of the neck as a possible source of headache) — refer www.headacheclinic.com.au — and to increase the awareness of cervicogenic headache (and the role of the neck in a range of headache types including migraine) in the community and traditional medical circles. My fundamental purpose was and is determining whether or not a neck (cervicogenic) disorder is the cause of or a significant contributing factor to headache or migraine — My clinical experience suggests cervicogenic can be a keyplayer in the migraine process.
However, despite the enormous amount of research into migraine the cause remains a mystery and considerable doubt surrounds the role of muscle tension in tension headache.
Historically any headache that was of a throbbing nature was thought to involve the blood vessels within the head and was thought to be a migraine and any headache that was not of a throbbing nature was labeled a 'tension headache', despite there being no evidence of increased tension in the muscles of the scalp or forehead.
It may surprise you to learn that over 300 different types of headache have been described in the medical literature — are there 300 causes? No! There is not 12 months that goes by without another headache type being introduced... 'Chewing Gum', 'Pony-Tail' and 'Bath Tub' headaches!
This calls upon professionals to question the traditional way of looking at headache, that is, headaches are divided into two main types — migraine and tension headache.
Furthermore whilst controversy surrounds the role of the neck in headache and migraine, research has demonstrated that cervicogenic headache is at least as common as migraine and tension headache.
My clinical experience comprising consulting over 6000 headache and migraine sufferers and in excess of 15000 treatments suggests that the neck is not only a trigger but is the cause of or is a significant contributing factor to different types of headache and migraine. Importantly, and given that the role of the neck in headache is largely unrecognised and disputed by orthodox medicine, 90 percent of patients at The Headache Clinic were self referred which means I have managed various forms of benign recurring headache, headache that physiotherapists relying on medical referrals do not have the opportunity to assess, and headache in which the mechanism is unknown but in which cervicogenic dysfunction is considered irrelevant.
The challenge for us as physiotherapists and other professionals involved in managing headache is how to determine if the neck is the cause of, or a significant contributing factor to a patient's headache before embarking on treatment. However the challenge of determining if the neck is involved has largely been overcome — Read on!.
Diagnosis is difficult and cannot be made from the features of a headache or migraine alone because the symptoms of many different types of headache overlap. Furthermore, there are no medical tests available to support a diagnosis.
Whilst it is irresponsible to treat irrelevant cervicogenic dysfunction in migraine / headache conditions, in an environment of unknown pathophysiology of migraine and other forms of headache and the advances in our knowledge of pain mechanisms, it is also irresponsible not to examine the necks of benign recurring headache sufferers irrespective of the diagnosis. How much longer do we accept the notion that 'whilst we do not know what causes migraine it can't come from the neck'?
The medical model of headache describes a set of symptoms which whilst may be useful for scientific researchers, provides little direction for clinicians in regard to optimal management.
According to the medical model of headache the key diagnostic criterion of neck (cervicogenic) involvement in headache is the temporary reproduction of headache when examining cervical structure ... however this is misleading; it is important to recognise that reproduction of headache alone is not enough to confirm that the disorder is the cause of headache.
Since 1991 I have developed a series of techniques, which, by way of temporary reproduction of headache and easing of the headache as a technique is sustained, confirm that a neck disorder is the cause of or a significant factor in the mechanism of the headache or migraine. For the disorder to be related to the headache or migraine process the headache has to ease as the technique is maintained. If both reproduction and lessening are not possible then the neck may not be the source of the headache or migraine.
Furthermore my 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 the treatment being successful.
We are the sum of our experiences — and my unparalleled clinical experience suggests that cervicogenic dysfunction is significantly underestimated and can be the cause of various forms of headache and migraine — I believe that, in the presence of negative medical tests, the necks of all (primary) headache sufferers should be examined, irrespective of the diagnosis. Whilst this challenges traditionally held medical beliefs, it is incumbent to not only pass on this experience to my colleagues
and headache sufferers but to support this experience with rigorous scientific research (I am currently a PhD Candidate investigating the role of cerviocgenic dysfunction in the mechanism of migraine at Murdoch University, WA).
The application of these techniques in Europe, United Kingdom and Australia has become known as the 'Watson Headache Approach' and forms the basis of courses I present for physiotherapists and other healthcare professionals in Australia, New Zealand, Hong Kong, Singapore, United Kingdom, Belgium, The Netherlands, Switzerland, Germany and Spain — refer www.headacheandmigraine.com.
My primary role is now imparting and researching my clinical experience ...
Sincerely
Dean Watson
