Headache and Migraine Specialists

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Migraine Specialists

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Headache and Migraine – Cervico-Trigeminal Nucleus sensitivity – latest thinking

The international headache society recognises and classifies over 300 types of headache and migraine. However there is growing belief that these different types of headaches and migraines are not separate entities but just different manifestations of the same thing. In this article we discuss Primary Headaches these being; Migraine, Tension Type Headaches, Cluster headaches and other Trigeminal Autonomic Cephalalgias.  Secondary headaches as a result of trauma to the head and neck, or disease to the head and neck are not included.  For more information on this please see the International Headache Society’s Headache Classification of the Headache Disorders.

So what does a headache or migraine represent? The latest thinking is that it relates to a sensitized (over-excited) lower brainstem, in particular an area in the brainstem called the Cervico-Trigeminal Nucleus, which we shall call the TCN from here on. This area receives information from the neck, head and face you could say it was a bit like a junction box in an electrical circuit.  Information received in the TCN from the upper neck may relate to changes in muscle tone (spasm or tension), neck and head position, neck joint strain or nerve irritation. Information received in the TCN from the head and face may relate to changes in blood vessel diameter within the brain, changes in light, sound, taste and smell. If this information is sustained and uninhibited from these sources, it is possible for the TCN to become bombarded and therefore over sensitized.

There is growing substantial evidence to support this and research has shown that the TCN can be over sensitized as a result of four contributing factors:

1. Receiving continued warning messages from the nerves of the face, mouth ears and teeth (we call this the trigeminal nervous system) will over sensitize the TCN.

2. A lack of suppression/inhibition of these messages in the brain. Normally our bodies produce chemicals to suppress some of the warning messages our brain receives.  Sometimes a lack of these chemicals will allow continued messages to sensitize the TCN.

3. An imbalance of a specific chemical called serotonin – this affects TCN sensitivity.

4. Upper neck dysfunction (poor posture, stiffness, joint inflammation and strain, lack of muscle control and support) – information regarding the state of the upper neck can cause sensitization of the TCN.

Researchers have shown that patients with migraines can be relieved of their symptoms following intervention of the upper neck disorders. For example following surgery to remove constricting blood vessels which had grown around a nerve in the upper neck patients had less headache and migraine symptoms.

Patients diagnosed with neck related headaches (and not migraines) have responded to drugs which stop TCN sensitization (indicating TCN sensitization does actually occur in neck related headaches). Patients with migraines and cluster headaches and post orgasmic headaches have benefited with injections into the greater occipital nerve (a nerve in the neck) again showing patients with headaches and migraines that are presumably unrelated to neck dysfunction can benefit from neck intervention/treatment. As a result of these findings it is reasonable and logical to presume that the upper neck has the potential to sensitize the TCN due to nerve connections into this region.

To be sure that the neck is involved in brain stem sensitization it is vital to not only reproduce the headache or symptoms but for it to lessen while we sustain the assessment technique. If this does not happen it may well be that the headache or migraine is as a result of TCN sensitization through the other 3 factors. From this one could argue that it is irresponsible not to examine necks in headache and migraine sufferers as the neck has a significant role in the over sensitization of the TCN which we know is connected to the onset and sustainability of headaches and migraines .


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