Dr Elliot Shevel, founder of the Headache Clinic in Johannesburg, South Africa has been a strong opponent to the current way we classify, and therefore diagnose and treat common headache disorders including migraines and tension-type headaches.
Interviewed in 2011, his theory (controversial at the time) was that diagnosing different headaches baswed on their presenting symptoms, rather than the source of the pain was wrong.
He argued that instead of looking a the symptoms "specialists should rather be looking at pinpointing where the pain is coming from" and treating these areas instead.
We agree whole heartedly with this point of view. When we can see s direct connection between a physical structure, such as the neck, and a patients symptoms, this should be the first line of treatment before we head down the road of medications which can, in turn start to create headaches of their own (keep an eye out for "Medication month" later this year).
Dr Shevel (a maxillo-facial surgeon) then focusses very narrowly on the arteries on the scalp and the muscles of the neck and jaw as the primary feedback mechanism. We think this is too narrow a focus, but a good start. We would prefer to broaden the scope of influence to what we can see from the science, which is that an overactive trigeminal nucleus underpins all major headache types. Any input into this area must be part of the suspect pool - not only stretch receptors in arteries, or muscle spindles in muscles, but stretch receptors in ligaments, joint capsules, mechanoreceptors, nociceptors (pain receptors) thermoreceptors........nothing can be excluded unless testes.
A good example are thermoreceptors - the nerves that tell you you feel hot or cold. In my experience it is rare that these are the primary source of 'overstimulation', however I have seen a number of patients who have described getting hot quickly (i.e. sitting in a hot car) as a trigger for a migraine, and almost instantaneously. Others will be set off with cold wind on their neck or head. To narrow the focus and rule out possible inputs is a mistake.
To focus treatment on the common area that all these inputs interact with, and indeed the area that generates the symptoms of headache and migraine is by far and away the most sensible place to start, and in many cases there is no need to look further.
The technique used at this clinic, pioneered by Australian physiotherapist Dean Watson, know as the Watson Headache® Approach, is a hands on technique that uses sustained pressures to identify 'inputs' into the trigeminal nucleus, and to desensitise, or to 'dial down' the activity that is constantly there.
As a safe, natural, drug free, non-invasive (non-surgical) approach it is the most sensible place to start the assessment and treatment process.
Roger O'Toole is the Director and Senior Clinician of the Melbourne Headache Clinic and has over 10 years experience as a physiotherapist.