I was in contact with an eminent neurologist today, we had not previously communicated nor had any knowledge of each other. He was very generous with his time and expertise but it was his self confessed pragmatism that formed a thought that I should like to share here.

It appears that a "dysfunctional" cervical spine when manipulated properly can bring relief to many people who have been diagnosed with primary headache disorders including cluster headaches. A little research informed me that this notion has been aired on this site before with widely varying responses from members; including this from cbolony on13th March 2003 2.17pm (Re: Upper neck misalignments and the brainstem « Reply #8.

"I get the same CH every year 4 weeks of 3-4 ch aday 8-10 kip then they start to come down 1-2 lower kips until they just go away after about 8 weeks. I get 3-4 cycles a year been that way since 1996.How can a Upper neck misalignments do that to me are you fucking kidding me"

So not a new contender for consideration.

But what if a dodgy neck can cause cluster headaches, migraine, Hemicrania Continua etc.?

But a cause? No! One of a number of causes perhaps.

I think a number of factors have to come into play (probably very many). The occipital or trigeminal nerves could be impacted on away from the hypo mobile cervical spine but present the sufferer with the same symptoms that a damaged facet joint may cause.

But how does the response present as different primary headaches in the same / different people? The answer to that is probably related to why a continuous condition can hurt one moment and not the next and be unbearable the next.

But for the brain to decide if something is going to hurt, where and when then millions if not billions of permutations could come into play. The smell of paint doesn't cause migraine but it could be the last thing in a very long list before the brain decides "ok turn the pain on"

Pain is sometimes referred away from the point of cause by the brain, making it difficult for us to know where the pain is coming from and for a doctor to diagnose. So something that is wrong in the neck is able to manifest itself as pain behind the eye. And a diagnosis is rarely a description of cause but an accepted explanation of symptoms.

No I am not saying a dodgy neck causes cluster headaches but I am saying that it can (with a myriad  of complementing factors) lead to a diagnosis of cluster headache. I am no suggesting this as a possibility, it is a well documented fact.

And in many diagnosis of cluster headache the cervical spine may have nothing to with the cause. But there is an irrational leap to say that if someone diagnosed with CH has cervical manipulation and is "cured" then the original diagnosis is wrong, the correct diagnosis being a hypo mobile cervical spine headache. No the correct diagnosis is CH if all the accepted diagnostic protocols are followed.

How many on here accept they have CH but have not had several dozen nerve blocking tests done to ascertain that the pain is not partially generated in the cervical spine? And then had hundreds of negative tests done for other things originally diagnosed as CH but then diagnosed as something else.

If anyone is in any doubt over the vagaries of a certain diagnosis that is accepted by everyone, check out the disagreement that two of the world's most eminent HA experts are having over agreeing a diagnosis classification. I think what the patient wants is to be pain free and not a "pure" diagnosis that is unambiguous and unassailable, no such diagnosis is currently possible in primary HA's.

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It's too late in the day to engage your whole message. See if this helps.....
===

Link to: cluster-LIKE headache:

IN: "Medications, Treatments, Therapies --> "Important Topics" --> "Cluster-LIKE headache"

A dysfunctional cervical spine is no more fanciful a trigger than is chocolate, perfume, alcohol or exercise. It can do no harm at all to have these joints manipulated to see if it helps.

It doesn't need to be the cause, nor the cure, and I truly wish you luck.

Keep us informed.

Thanks Bob and Brian

The idea of cluster-like headaches is a good way of compartmentalising things, obviously a tumour or aneurysm impacting on a nerve is clearly a candidate for a secondary cause.

The primary headaches don't have known causes, when a previously diagnosed primary headache actually gets its cause(s) discovered they then are conveniently re-named and called a secondary HA.

Although I did read in some literature recently where the term secondary primary headache arose to describe a headache that satisfied the rigorous diagnostic classification of a primary headache but the cause became known(ish) (somewhere in the neck)

But I don't accept that something going on in the cervical spine that triggers a primary headache is in the same league as chocolate as a trigger.

I accept that chocolate and its interactions with human kind is complex (and can make your skin younger!) but the cervical spine is something else.

It's there to protect, amongst other things the brainstem (nestling between the spinal cord and the thalamus), itself a very complicated thing.

It also allows movement of the head and connect the head to the rest of the body. Movement is permitted through a complex collaberation of joints, muscles, tendons fascia, shock absorbers and other stuff.

If this protective sleeve becomes damaged (dysfunctional) it can have an impact on the brainstem and/or nerves either directly or via muscle contraction. One result, from one nerve impaction can result in a feeling of an icepick being driven through the head and out the eye; when this is identified as the cause of the pain it is called secondary, but when the same effect is created and the cause cannot be identified it is called primary.

When the same nerve is impacted above the neck, in the head, the same pain reaction may result, this is then a neuro problem and chocolate may be legitimately blamed. That's the state of current understanding.

Interesting to note that he is saying that the primary mode of action is NOT as a vasoconstrictor but on its effect on the central nervous system. Doesn't change our appreciation of this class of meds but suggests we need to change how we think about the nature of CH.
==============================
Handb Exp Pharmacol. 2007;(177):129-43.   


Serotonin receptor ligands: treatments of acute migraine and cluster headache.


Goadsby PJ.

Institute of Neurology, Queen Square, London WC1N 3BG, UK. peterg@ion.ucl.ac.uk

Fuelled by the development of the serotonin 5-HT(1B/1D) receptor agonists, the triptans, the last 15 years has seen an explosion of interest in the treatment of acute migraine and cluster headache. Sumatriptan was the first of these agonists, and it launched a wave of therapeutic advances. These medicines are effective and safe. Triptans were developed as cranial vasoconstrictors to mimic the desirable effects of serotonin, while avoiding its side-effects. IT HAS SUBSEQUENTLY BEEN SHOWN THAT THE TRIPTANS' MAJOR ACTION IS NEURONAL, WITH BOTH PERIPHERAL AND CENTRAL TRIGEMINAL INHIBITORY EFFECTS, AS WELL AS ACTIONS IN THE THALAMUS AND AT CENTRAL MODULATORY SITES, SUCH AS THE PERIAQUEDUCTAL GREY MATTER. Further refinements may be possible as the 5-HT(1D) and 5-HT(1F) receptor agonists are explored. Serotonin receptor pharmacology has contributed much to the better management of patients with primary headache disorders.

PMID: 17087122 [PubMed]
=================================================================
J Clin Neurosci. 2010 Mar 11.

What has functional neuroimaging done for primary headache ... and for the clinical neurologist?
Sprenger T, Goadsby PJ.

UCSF Headache Centre, Department of Neurology, University of California, 1701 Divisadero St, Suite 480, San Francisco, CA 94115, USA.

Our understanding of mechanisms involved in primary headache syndromes has been substantially advanced using functional neuroimaging.

THE DATA HAVE HELPED ESTABLISH THE NOW-PREVAILING VIEW OF PRIMARY HEADACHE SYNDROMES, SUCH AS MIGRAINE AND CLUSTER HEADACHE, AS BRAIN DISORDERS WITH NEUROVASCULAR MANIFESTATIONS, NOT AS DISORDERS OF BLOOD VESSELS.

PMID: 20227279 [PubMed]

I wish Goadsby would have had the strength in his convictions rather than bend to the strength of conventions.

He shone a light in 2009 as to where science could be now but accepted it wouldn't so it hasn't progressed.

And its not the advances in imaging thats causing the problem, std x-rays can move this field forward faster than functional neuroimaging if the collective parties had the will.

The people who could create the advances don't want to. Why? Because they are thick? No! Because their egos have outgrown their intellects? Possibly. Because there is no passion in solving this problem? Yes.

Goadsby had the chance once, I doubt he will get another.

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It's a wonky hypothalamus.  Let's not over think it.

    Potter

I think its a combo package. it could start with dental, or other knocks on the head. its also genes and if you stir all that together with a splash of that hypothingagiggy that potter just said, you get a nice big fat cluster.

Coach Bill

Having suffered from CH for 43yrs, and looked into the ins
and outs every which way to the cause of a typical CH, it all
comes back to the Hypothalamus, which is unfortunate
for the 1/1000 cluster heads, myself included.
Headache types that mimic CH's, well that's another
story, and yes, I've read many times about neck injury
that cause headaches that mimic CH's, So, who knows,
maybe a wonky spine fits into this category too, but
Horton's Cephalalgia is a disease that us cluster heads
have to live with throughout our lifetime.

The condition was originally named Horton's Cephalalgia after Dr. B.T Horton. His original paper describes the severity of the headaches as being able to take normal men and force them to attempt or complete suicide. From Horton's 1939 paper on cluster headache.

Hoppy.

There seems little doubt that the Hypothalamus is involved in CH and other P HA's. It works hand in hand with the Brainstem in pain processing.

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