Reason 5 - Our guarantee.
We have heard this story so often it makes me feel a little ill. I have been seeing my (insert one of chiro, physio, osteo, masseur, etc) once a week for 6 months - and it seems to help for a day or so.
This is not helping. It is treating the symptoms, and because it is not getting at the underlying cause it is ultimately ineffective, expensive, and treatment without an endpoint.
Our guarantee has 2 parts. The aim is to minimise the risk of treating people who either don't have a neck problem relating to their head pain, or not continuing to treat people who are getting no more than short term relief.
Firstly we don't book everyone that calls for an appointment. We conduct a phone interview lasting approximately 10-15 minutes seeking information that may save you the time and money of an initial consult. Some people from the phone interview will be referred back to their GP or specialist for further investigation or referred back to their local health professional (Physio/Chiro/Osteo) for follow up.
Those that are accepted will then book an initial assessment. Here we look for clear signs that your neck is related to your condition. By very selectively and precisely stressing the joints in the top of the neck we look to temporarily reproduce the area of your usual symptoms (i.e. push pain up into your head behind the eye). If we can reproduce these symptoms we sustain the pressure and look for the referred pain to ease after 30-40 seconds.
If this "reproduction and resolution" of familiar symptoms occurs (and it does in approx. 80% of initial assessments) we accept the person into the initial treatment block.
If we cannot reproduce familiar symptoms, or we can but they do not subside then it is unlikely the treatment we use will be effective, so rather than try and convince you to get a treatment that will ultimately provide short term or no relief and little else, we set ourselves apart from the crowd and decide not to treat you.
Secondly, if you are accepted into the initial treatment block, then we expect there to be significant changes in your condition within 2-3 weeks. That is not to say that you will be "cured" in 2 weeks. If we get to the end of the second treatment week after the initial assessment, and there is no sign of significant change we stop.This is a protection for the 10% of cases who start treatment, and their condition does not respond preventing the cycle described above of "endless" treatment programs with no goals. This number is relatively low, indicating over 90% of people respond. The reason for such a high success rate is due in part to screening out 20% from the initial assessment, but unfortunately there are some whose necks will not respond to treatment in the long term - we will not continue to treat if you are not improving.
We would love to be able to help everyone, and we would love everyone to respond well to treatment. The reality is that only 80% have treatable problems related to their neck, and approximately 90% of these will respond to treatment. The difference is we are upfront about these numbers, and open about every step of the process to minimise the risk of receiving treatment that is ultimately not effective.
The improvement in the first few weeks is why this clinic can effectively run outreach services to regional areas. Those that do respond, respond quickly and are able to manage with self treatment soon thereafter.
Reason 4: The figure 80%.
What could 80% have to do with the neck and headaches?
Now before you click the next button thinking I’ve lost the plot, let me explain.
In 2009 Headache Australia (in conjunction with pharmaceutical company MSD) ran a survey with over 500 migraine sufferers trying to assess the impact of migraine on people’s lives. The press release for the study was titled “Migraine misery spiraling out of control”.
Given the title, it’s not hard to guess the results were not particularly good, and at the same time not all that surprising.
Quite disturbingly this study found that 81% of migraineur’s were looking for a better, more effective treatment for their migraines. Even worse, 83% didn’t expect their condition to improve.
This sounds like a lot I know. It must lead to the question, with all the billions of dollars that have been poured into (largely pharmaceutical) research………are they missing something?
Professor of Anatomy at Newcastle University, and world-renowned spine anatomist, Nick Bogduk thinks it’s fairly obvious what the missing link is:
"People in control of the headache field seemingly have not, cannot, or will not recognize that this model for cervicogenic [neck based] headache is not only the best evolved of all headaches but is testable in vivo, in patients with headache complaints. No other form of headache has that facility."
Officially, headache coming from the neck (cervicogenic) is reported to represent between 0.1% and 4% of all headache cases.
Approximately 80% of the people assessed in the Melbourne Headache Centre have testable and reproducible headpain coming from the upper cervical spine. Almost all of these would not fit the diagnostic criteria for cervicogenic headache, but are mostly tension type headache (TTH) or migraine. Many of them do not believe they have specific problems with their necks.
So what you say. I could make that number up right? Sure, but we are not alone. Dr Rothbart, an Canadian anaesthesiologist and head of the Rothbart Pain Management clinic has published his findings widely:
“Approximately 800 new headache patients per year are examined at our clinic. An estimated 80% of these patients are diagnosed with cervicogenic headache. Of these patients, almost none are referred with this diagnosis. Physicians are not taught to consider or explore neck structures when investigating headaches. This results in a rarely diagnosed but common condition”. Rothbart P. The cervicogenic headache: A pain in the neck. Can J Diagnos 1996; 13: 64–71.
That number again. 80%.
Using the same techniques as the Melbourne Headache Centre, Drummond and Watson investigated tension headache and migraine sufferers, and found that ALL of the TTH sufferers had their usual headpain reproduced during assessment, and 95% of the migraine sufferers had their usual headpain reproduced with manual examination of the upper part of the neck.
Watson, D.H. and Drummond P. D. (2012) Head Pain Referral During Examination of the Neck in Migraine and Tension-Type Headache. Headache: The Journal of Head and Face Pain, Vol 52, (8), pp 1226–1235.
The anatomical links between the neck and the “headache/migraine centre” in the brainstem are obvious. The numbers are becoming overwhelming.
Over 80% are looking for something better. Is it a coincidence that almost all of them will not have had their upper neck assessed using headache specific assessment techniques?
80% of headache sufferers have necks that are causing a problem, but as a source of the problem the neck is largely ignored? I don’t think it’s any coincidence at all , that he same number are unhappy with their current treatment options.
Many will have tried treatment using general neck therapy from physiotherapists, chiropractors and osteopaths, without success.
It is time to try headache specific techniques and see if you too are in the majority of suffers who are needlessly putting up with treatable problems in the upper part of the neck causing so much misery.
Roger O'Toole is the Director and Senior Clinician of the Melbourne Headache Clinic and has over 10 years experience as a physiotherapist.