16th May 2016

Wendy Emberson

Migraine cube 

Every day, in amongst the usual load of emails in my in box, I get a daily update of what is going on in and around the world of medicine.

Yesterday I read about a study that had been carried out in California using a modified plastic surgical technique for headaches and migraines. The technique involved cutting part of the trigeminal nerve at the temple and it was carried out on just 19 people with migraines that had responded to Botox or local anaesthetic nerve blocks.

16 of the 19 subjects reported at least a 50% reduction in the headache symptoms, but it was unclear as to why the other 3 reported no improvement. (Point to remember)

I did some investigating about the doctor concerned and read, with interest, his eminent background and how he set up a clinic with the specific aim of treating migraines in this way. There is no doubt that he is doing what he considers to be right, as a trained plastic surgeon, and is happy enough with the outcomes to set up a dedicated clinic.


I have a problem and a number of issues with this report and surgical technique:

  1. The sample size was only 19.
  2. The results indicated about a 50% improvement only.
  3. There was no mention of any side effects of the surgery.
  4. There was no mention of how long the effects lasted.
  5. There was no mention of the type of headache/migraine that these patients had or even whether they were all presenting with the same symptoms.

… and that is just for starters.

Headaches and migraines are so common that unless you, or someone you know, suffer from them then you may not appreciate what it means. I listen to patients stories of how they have suffered for years and yet somehow managed to have a career and family. I listen to others who have been denied a career and family life because for at least one week out of four they are in bed in a darkened room vomiting. Patients also tell me how they have searched for answers trying all sorts of medication and practitioners of all sorts – not just their GPs or Consultant Neurologists. Most of these “treatments” only help to manage the pain. I wonder how many people realise that every headache/migraine medication lists headaches as a side effect!

Migraine has been put in the top 20 disabilities by the World Health Organisation and for very good reason.

The problem is that there are about 200 apparent causes of headaches and this has been cut down over the years from more than 500 by the International Headache Society and the medical profession still has no real idea of the cause of headaches other than the few identifiable brain tumours and diseases where headaches are a symptom of a more serious pathology.

The usual medical approach is to look for problems at cell level, problems with the biochemistry of the body and malfunctions of the body’s systems. That’s all well and good and amazing discoveries and treatments have been found and developed over the years, but what is very seldom considered is that problems with the mechanical functioning of the skeleton can and do cause pain and disability. In other words, the causes of man’s ills do not always lie with the biochemistry of the body.

As I see it, modern medicine has been researching and working in an increasingly narrow and specific area ie cell biology and pathology. It seems that modern medicine has become so intertwined with the pharmaceutical industry that it is assumed that drugs will be the answer to all illnesses.  If there is no medication that can manage the condition then the answer appears to be to cut out the offending tissue or structure. Of course, this is a vast oversimplification and modern medicine, at its best, is truly amazing and can achieve remarkable results……

But…… the knowledge of anatomy and how the body works to produce movement is now very definitely the province of the physiotherapy profession and allied disciplines. Medical students are taught basic anatomy and very little about musculo-skeletal conditions. Their treatment “toolbox” for these conditions is limited to drugs and surgery, whereas specialist musculo-skeletal physiotherapists have a detailed knowledge of how the body moves, what can go wrong and how to restore  as near normal movement as possible with a whole range of treatment techniques.

Headaches and migraines show this difference in knowledge and approach very well. The medical profession is looking for the cause in the biochemistry of the blood, brain, hormones etc with no understanding that pain in the head can be coming from a mechanical problem in the joints at the top of the spine, which in turn can sensitise the brain stem. So called “cervico-genic” headaches are considered to be less than 4% by doctors and yet there is a great deal of evidence and research that says it is more like 90%.

Perhaps it is a marketing problem!

The media will always put forward research by doctors as somehow being the “gold standard”, and yet there is a wealth of high quality research, knowledge and experience that doesn’t reach the ears of the public simply because it does not involve the medical profession.

More worryingly, there are few doctors who are aware of this work either.

Upper cervical spineThis is why people with headaches and migraines are largely unaware of the work of Dean Watson, and all of us around the world, who have trained under Dean, to be able to diagnose and treat these problems. GPs and Consultant Neurologists largely dismiss the idea that Physiotherapy treatments have any value because they do not include drugs or surgery.

Doctors do not have the manual therapy skills to be able to treat patients in this way and they therefore ignore them as ineffective. In reality, they are a proven and very powerful way to treat headaches and migraines and not just manage the problem.

The fundamental point that underpins Dean Watson’s approach is being able to temporarily reproduce the pain of the headache and then to relieve it – during the examination. This single fact discounts hormones, irritated blood vessels, alteration in brain chemistry etc as the cause.

The evidence is there and to read more use this link to Dean’s site: WatsonHeadache - evidence

After 25 years and many thousands of patients later, Dean’s results are profoundly more impressive and newsworthy than any drug or surgical technique around today. Look at the evidence yourself and make your own mind up!