RE: United Healthcare bulletin update

[Guest guest]

Cervicogenic

headache: practical approaches to therapy.

Martelletti P,

van Suijlekom H.

Department of Internal Medicine, 2nd School of Medicine,

Headache Centre, University La Sapienza, 00189 Rome, Italy.

Paolo.Martelletti@...

Cervicogenic headache is

a relatively common and still controversial form of headache arising from

structures in the neck. The estimated prevalence of the disorder

varies considerably, ranging from 0.7% to 13.8%. Cervicogenic headache is a

'side-locked' or unilateral fixed headache characterised by a non-throbbing

pain that starts in the neck and spreads to the ipsilateral oculo-fronto-temporal

area. In patients with this disorder, attacks or chronic fluctuating periods of

neck/head pain may be provoked/worsened by sustained neck movements or

stimulation of ipsilateral tender points. The pathophysiology of cervicogenic

headache probably depends on the effects of various local pain-producing or

eliciting factors, such as intervertebral dysfunction, cytokines and nitric

oxide. Frequent coexistence of a history of head traumas suggests these also

play an important role. A reliable diagnosis of cervicogenic headache can be

made based on the criteria established in 1998 by the Cervicogenic Headache

International Study Group. Positive response

after an appropriate nerve block is an essential diagnostic feature of the

disorder. Differential diagnoses of cervicogenic headache include

hemicrania continua, chronic paroxysmal hemicrania, occipital neuralgia,

migraine and tension headache. Various

therapies have been used in the management of cervicogenic headache. These

range from lowly invasive, drug-based therapies to highly invasive,

surgical-based therapies. This review

evaluates use of drug therapy with paracetamol and NSAIDs, infliximab and

botulinum toxin type A; manual modalities and transcutaneous electrical nerve

stimulation therapy; local injection of anaesthetic or corticosteroids; and

invasive surgical therapies for the treatment of cervicogenic headache.

A curative therapy for cervicogenic headache will not be developed until

increased knowledge of the aetiology and pathophysiology of the condition

becomes available. In the meantime, limited

evidence suggests that therapy with repeated injections of botulinum toxin type

A may be the most safe and efficacious approach. The surgical approach, which includes decompression and radiofrequency

lesions of the involved nerve structures, may also provide physicians with

further options for refractory cervicogenic headache patients.

Unfortunately, the paucity of experimental models for cervicogenic headache and

the relative lack of biomolecular markers for the condition mean much is still

unclear about cervicogenic headache and the disorder remains inadequately

treated.

PMID: 15377169 [PubMed - indexed for

MEDLINE]

So the take home is: 

·

Cervicogenic headache

exists but we don’t know why. 

·

The only true way to

diagnose is to anesthetize the suspected nerve supply and see if the pain is

abated. 

·

Current evidence

suggests injection with the “botulinum

toxin type A” may be the most safe and efficacious approach (!!!!), but

perhaps destruction of the nerve may be the cure (!!!!!!!!)

Btw, I had a 17 y/o new

patient last Thursday with ongoing headache of 4 weeks duration, but which had

been recurrent for 4 years.  The HA  appeared to be of cervical origin

(suboccipital), although apparently as a chiropractor I don’t know what

the hell I’m talking about, I treated this patient with multiple impulse

therapy (MIT) and manual adjusting to levels I found to be restricted. 

Yesterday I saw the patient and she had been pain-free since the initial tx. 

Re-assessment found some lingering restrictions and even though the headache

was gone I adjusted (gasp!)  Too bad I didn’t have some botulism handy,

that seems so much smarter and safer than a carefully controlled and

specifically delivered HVLA or treatment with MIT.  Oh, and the real cause of

this is terrible forward head posture, but of course this isn’t

important.

Seitz, DC

From:

[mailto: ] On Behalf Of Dr. J. Tomaino

Sent: Monday, October 01, 2007

3:56 PM

DC List, Oregon

Subject: United

Healthcare bulletin update

NOTE:

United Healthcare is again discriminating against DC's. Headaches and

Children " unproven " but it's ok for a Physical Therapist to see

cervicogenic headaches or treat children using the same methods we use.

http://content.4at5.net/email_domains/unr/0201/hosted/medical_3.html

Chiropractic

Services

UnitedHealthcare had previously concluded that

certain services provided as a part of chiropractic care were unproven. A

recent review of the clinical evidence in published peer-reviewed medical

literature leads us to further conclude that chiropractic services for

treatment of children and adolescents is unproven and services for treatment of

headaches is unproven.

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[Guest guest]

I was wondering how Botox helped headaches

and came across this :

http://www.womenfitness.net/news/alternative_health/botox_for_migraines.htm

s. fuchs dc

From: [mailto: ] On Behalf Of Seitz

Sent: Monday, October 01, 2007

4:29 PM

Subject: RE:

United Healthcare bulletin update

Cervicogenic headache: practical approaches to

therapy.

Martelletti P,

van Suijlekom H.

Department of Internal Medicine, 2nd School

of Medicine, Headache

Centre, University La Sapienza, 00189 Rome, Italy.

Paolo.Martellettiuniroma1 (DOT) it

Cervicogenic headache is a relatively common and

still controversial form of headache arising from structures in the neck. The estimated

prevalence of the disorder varies considerably, ranging from 0.7% to 13.8%.

Cervicogenic headache is a 'side-locked' or unilateral fixed headache

characterised by a non-throbbing pain that starts in the neck and spreads to

the ipsilateral oculo-fronto-temporal area. In patients with this

disorder, attacks or chronic fluctuating periods of neck/head pain may be

provoked/worsened by sustained neck movements or stimulation of ipsilateral

tender points. The pathophysiology of cervicogenic headache probably depends on

the effects of various local pain-producing or eliciting factors, such as

intervertebral dysfunction, cytokines and nitric oxide. Frequent coexistence of

a history of head traumas suggests these also play an important role. A

reliable diagnosis of cervicogenic headache can be made based on the criteria

established in 1998 by the Cervicogenic Headache International Study Group. Positive response after an appropriate nerve block is

an essential diagnostic feature of the disorder. Differential diagnoses

of cervicogenic headache include hemicrania continua, chronic paroxysmal

hemicrania, occipital neuralgia, migraine and tension headache. Various therapies have been used in the management of

cervicogenic headache. These range from lowly invasive, drug-based therapies to

highly invasive, surgical-based therapies. This

review evaluates use of drug therapy with paracetamol and NSAIDs, infliximab

and botulinum toxin type A; manual modalities and transcutaneous electrical

nerve stimulation therapy; local injection of anaesthetic or corticosteroids;

and invasive surgical therapies for the treatment of cervicogenic headache.

A curative therapy for cervicogenic headache will not be developed until increased

knowledge of the aetiology and pathophysiology of the condition becomes

available. In the meantime, limited evidence

suggests that therapy with repeated injections of botulinum toxin type A may be

the most safe and efficacious approach. The

surgical approach, which includes decompression and radiofrequency lesions of

the involved nerve structures, may also provide physicians with further options

for refractory cervicogenic headache patients. Unfortunately, the

paucity of experimental models for cervicogenic headache and the relative lack

of biomolecular markers for the condition mean much is still unclear about

cervicogenic headache and the disorder remains inadequately treated.

PMID: 15377169 [PubMed - indexed for MEDLINE]

So the take home is:

· Cervicogenic

headache exists but we don’t know why.

· The

only true way to diagnose is to anesthetize the suspected nerve supply and see

if the pain is abated.

· Current

evidence suggests injection with the “botulinum

toxin type A” may be the most safe and efficacious approach (!!!!), but

perhaps destruction of the nerve may be the cure (!!!!!!!!)

Btw, I had a 17 y/o new patient last Thursday

with ongoing headache of 4 weeks duration, but which had been recurrent for 4

years. The HA appeared to be of cervical origin (suboccipital),

although apparently as a chiropractor I don’t know what the hell

I’m talking about, I treated this patient with multiple impulse therapy

(MIT) and manual adjusting to levels I found to be restricted. Yesterday

I saw the patient and she had been pain-free since the initial tx.

Re-assessment found some lingering restrictions and even though the headache

was gone I adjusted (gasp!) Too bad I didn’t have some botulism

handy, that seems so much smarter and safer than a carefully controlled and

specifically delivered HVLA or treatment with MIT. Oh, and the real cause

of this is terrible forward head posture, but of course this isn’t

important.

Seitz, DC

From:

[mailto: ]

On Behalf Of Dr. J. Tomaino

Sent: Monday, October 01, 2007

3:56 PM

DC List, Oregon

Subject: United

Healthcare bulletin update

NOTE:

United Healthcare is again discriminating against DC's. Headaches and

Children " unproven " but it's ok for a Physical Therapist to see

cervicogenic headaches or treat children using the same methods we use.

http://content.4at5.net/email_domains/unr/0201/hosted/medical_3.html

Chiropractic

Services

UnitedHealthcare had previously concluded that

certain services provided as a part of chiropractic care were unproven. A

recent review of the clinical evidence in published peer-reviewed medical

literature leads us to further conclude that chiropractic services for

treatment of children and adolescents is unproven and services for treatment of

headaches is unproven.

No virus

found in this incoming message.

Checked by AVG Free Edition.

Version: 7.5.488 / Virus Database: 269.13.36/1041 - Release Date: 10/1/2007

10:20 AM

No virus

found in this outgoing message.

Checked by AVG Free Edition.

Version: 7.5.488 / Virus Database: 269.13.36/1041 - Release Date: 10/1/2007

10:20 AM