The Facts about the Role of the Neck in Migraine and Primary Headache

The neck has long been ignored as a cause of primary headache. In fact the very diagnosis of migraine, tension headache or cluster headache is at the exclusion of all known causes of those symptoms, so by definition if you have those diagnosis the neck can't be involved. Yet in a large number of cases we are seeing what others around the world are seeing, that the neck is actually causing a large proportion of what has classically been considered primary headache, and one of the reasons for the medical approach having such a low success rate (20-25%) may well be the fact that the main source of symptoms has been ignored.
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The Watson Headache ® Approach

This is the approach used by Melbourne Headache Centre. Developed by Australian Physiotherapist Dean Watson this represents the pinnacle of neck based therapy for migraine, headache and related conditions. Pure 'cervicogenic headache' has officially been relegated almost non-existant status thanks to the political pressures brought to bear under the classification of headache. A number of researchers world wide have continued to work towards proving what we know and see in the clinic everyday. That rather than playing a role in less than 4% of all headache presentations, the neck is playing a role in a majority.

The first publication from Watson and Drummond quite simply demonstrated that in an overwhelming majority of migraineurs (95%) and tension-type headache sufferers (100%) that stress on the neck could reproduce familiar headpain. Issues in the neck had been written off as a 'symptom' of migraine or headache yet here we can see quite clearly that the neck can cause migraine pain.
This alone is enough to question criteria E in the diagnosis of migraine and tension headache, and that is that all other known causes of the symptoms have been excluded. If you can apply pressure to the neck and reproduce familiar headpain, how can it possibly be excluded as a cause?
It does in fact then become the most obvious place to start treatment.

Watson, D.H. and Drummond, P.D. (2012) Head Pain referral during examination of the neck in migraine and tension-type headache. Headache, Sep; 52 (8):1226-35.

If the first publication from Watson and Drummond could be considered 'significant', the second publication must be considered 'groundbreaking'. It has been understood for some time that overactivity in the trigemino-cervical nucleus is a common underlying feature across all forms of headache. This can be measure using two reflexes - trigemino-cervical and nociceptive blink reflexes. The latter - nociceptive blink reflex (NBr) was used by Watson and Drummond to measure the response of the brainstem to treatment in migraineurs using the Watson Headache ® Approach. If the current status of the neck in migraine (i.e. irrelevant) is correct then the NBr should not have changed with treatment. Instead, it changed significantly. So much so that the conclusion is that treating the upper cervical spine can in fact decrease the overstimulation of the trigemino-cervical nucleus, thus, treating the underlying condition in all forms of primary headache.
This is the key finding that has paved the way for world-first clinical trials using the Watson Headache ® Approach to treat migraine.

Watson, D.H. and Drummond, P.D. (2014) Cervical referral of head pain in migraineurs: effects on the nociceptive blink reflex. Headache, Jun; 54 (6):1035-45.