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The Headache Clinic Courses

 


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This course challenges traditionally held beliefs.

There are over 300 different types of headache described in the literature — are there 300 different causes of headache? No. There is not a year that goes by when another headache type is recognized including ‘ponytail headache’ and ‘chewing gum headache’! Headache diagnosis is one of the longest lists of differential diagnosis in medicine.

This is a highly practical course based on current research and Dean’s unparalleled clinical experience (see profile) in the assessment (identification of) and management of relevant cervicogenic dysfunction in benign recurring headache.

The subjective examination of headache is arguably more important than in any other musculoskeletal condition for three reasons:

  • In other musculoskeletal conditions there are reproducible objective signs which can be reassessed but this is not the case in headache — there is an increased reliance on the subjective features;
  • Recognition of the ‘Red Flags’ — intracranial pathology; tumors (particularly in children) or a low volume slow leaking aneurysm which are misdiagnosed significantly — up to 60 per cent; and
  • Potential Instability — it has been argued that at best, it is presumptive of us, and at worst dangerous, for us as physiotherapists to be assessing the craniovertebral ligamentous structures; the ability to recognize instability before you lay your hands on is crucial.

Research has demonstrated that cervicogenic dysfunction exists in different headache forms but is it relevant? Dean has developed innovative examination techniques, which not only ascertain if cervicogenic dysfunction is relevant to headache or migraine but can also determine which of the spinal segments or combination thereof is responsible. This diagnostic accuracy underpins successful management.

Reproduction and lessening of headache (as the technique is sustained) is crucial otherwise a false impression may be gained. Reproduction with subsequent lessening of symptoms implies that the dysfunction is relevant and, combined with knowledge of the relevant biomechanics and recognition of clinical patterns; it is possible to determine at a segmental level the source of the headache during a headache free period.

Are you not confident using high velocity thrust techniques in the upper cervical spine? The treatment of relevant movement abnormalities does not involve high velocity thrust techniques. This course will demonstrate assessment and treatment on participants with headache and Dean also examines two unseen patients.

The course also reviews the standard examination techniques of craniovertebral stability (and the subjective features suggestive of potential instability). Arguably some of the tests are gross, potentially missing some of the minor instabilities we are presented with and at worst dangerous as they are stressing already vulnerable structures; alternative testing which lessens the impact on possibly already damaged structures will be demonstrated and practiced.

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