Following on from my previous post about the cause of headaches and migraines...

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This post will discuss how we might go about treating persistent headaches or migraines and an understanding the Watson headache approach

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Assessment

To begin with understanding your story and symptoms is how we start your treatment. Pain is an individual experience and everyone’s story is going to be different. Listening to your story and completing a subjective assessment of your symptoms is key to delivering an individual treatment approach.

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Following a subject assessment, we will complete an objective assessment. This involves assessing the joint and muscles in the upper parts of your neck. As these can refer pain into your head.

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Ruling out red flags

A Red flag is a sign of a sinister pathology that might be causing your pain or symptoms. Many people who present to our clinic are concerned that their headache is being caused by something sinister. You can be reassured though, that the vast majority of painful conditions are musculoskeletal in nature and not being caused by anything nasty, despite how painful they can be.

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I would recommend though, if you are over 50 and have had a new onset of headache, which you have never had before, or is different from your usual headache; you see your GP prior to coming in for an assessment.

 

If you have had a very sudden onset of significant head pain – like a “thunderclap”, which you have never had before, you should present to the emergency department.

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We can rule out most red flags during your subjective assessment simply by asking the right questions and others during the physical assessment.

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The Watson Headache approach

This approach was developed by Dean Watson, an Australian Physio and researcher. It was develop after his findings in research showed people with persistent headaches has a sensitised brainstem

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The approach is twofold and is directed at treating patients whose headaches are driven by their neck.

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1. Assessing the joint of the upper neck - C0/1, C1/2, C2/3. During the assessment we are aiming to reproduce some of your headache symptoms by pushing on these joints, and with a sustained pressure, the symptoms should subside. This tells us we are treating the right area.

2. Once we have identified the right area. We will treat the problematic joint using a similar method of sustained pressure. Over time, by reproducing and reducing your symptoms, your body is able to regulate the information coming from these areas and helps desensitise your brainstem.

 

Over the course of treatment - to begin with, a few treatments close together over a few weeks; we will progressively push into areas that are more symptomatic or intense in nature. Treatment being progressive is key to getting long term changes, and is often why other treatments might help for the short term, but the pain returns.

 

Why should treatment be close together to start? Typically patients have had pain for a long time, this becomes their "normal" state. If treatment is too far apart, your brainstem reverts back to its "normal" state. Treatment that involves something done little and often can help your brainstem desensitise and figure out a new "normal".        

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How long will it take to get better?

This is a tough question to answer! Unfortunately for people who have been suffering from headaches and migraines for years, there is unlikely to be a quick fix.

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However, with some consistent treatment over a 4-6 week period, you should see significant improvement in your symptoms. You may still get your usual headache or migraine, but it might be less intense, be triggered less easily, or last for a short duration.

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If you had absolutely no change in symptoms over this time, you might need a different approach or it will at least rule out the neck as a cause of your headaches and you can focus your time elsewhere.

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For all people with headache and migraines, there should be a holistic approach to their care. There can be multiple contributing factors and they can have significant impacts on many area of your life.

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You might need other therapies such as exercise, or medication to help you beat this and we might need to involve other health professionals in your care, such as your GP or neurologist.  

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I will discuss further contributing factors and other treatment options in a future post.

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Owen is qualified in the Watson headache approach and has significant experience in treating persistent headache and migraine conditions, click here to book and appointment with Owen today.

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