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Headaches more common in CSM

Headaches more common in CSM

​Cervical spondylosis, more than a pain in the neck?

by J.Hamilton

For some migraines is just another word for headache, but in medicine it refers to a specific type of headache characterised by severe head pain that can last from 2-72 hours, are a common disorder and can be incapacitating to people who suffer them. Migraines are common, with estimates suggesting up to one billion people are affected worldwide. Various triggers may cause migraines, causing a sequence of events that lead to head pain. It has been suggested that cervical spondylosis, the degeneration of the bones of the neck, may initiate migraines, but little research has been done on the topic.

With this in mind, a group at the China Medical University wanted to determine if there was an association between cervical spondylosis and the likelihood of suffering from migraines. 

​How was it done?

​The group used a health insurance research database in Taiwan.  From this database,  a group patients with and without cervical spondylosis were selected.  The group without spondylosis were matched, such that they had similarly ages, genders and presence of other illnesses such as diabetes.  Over the next 10 years, between 2000-2010, the patients who developed migraine were noted. At the end of the study, the group looked at the relative risk of getting migraines and compared them between the groups.

Do you suffer from headaches or pain and have CSM?
Researchers from the University of Cambridge what to hear about your experience


​What were the results? 

​The group of Spondylosis sufferers numbered at 27,000, compared to 111,000 without spondylosis. When they looked at the rate of people acquiring migraines each year, they found that out of those with Spondylosis, 5.16 people out of 1000 per year acquired migraine, compared to 2.09 per 1000 people per year in people without spondylosis. When they looked at the risk of getting migraine, using a statistical method known as “hazard ratios”, which compares the relative risk of getting a migraine between two groups, it was found that comparing patients with and without spondylosis patients gave a risk of 2.03. This means that people with Spondylosis are twice as likely to develop migraines as those without. When looking at the data more closely, the researchers found that this risk was further increased in patients with myelopathy and spondylosis as opposed to spondylosis patients with no myelopathy.  As expected, they also found that women and younger individuals were more likely to develop migraines, a well described association.

​How could this happen?

​Although headache has not been considered a ‘classical’ feature of neck disorders, it has been proposed for many decades that neck disorders can cause headaches.  This led to the creation of a condition called ‘Cervicogenic’ Headache (literally ‘neck generated headache’).  For some professionals this remains a controversial condition, as how a neck condition can cause a headache remains unclear.  The proposed mechanism is based on something called ‘sensitization’, a well described pain process by which the regular perception of pain can alter the ‘wiring’ of the brain and spinal cord, make them more sensitive: so what once felt like a tickle, could become more like a stab.  For Cervciogenic headaches, the theory is the neck pain from spondylosis is the regular pain, and because the pain pathways from the neck are shared with some of those of the head, these wires can cross and lead to headaches.  This has previously been discussed by Dr Lavin, Neurologist for Myelopathy.org, including an alternative theory related to altered blood flow.  

​What does this mean for Myelopathy sufferers? 

​This study is part of a number of recent articles helping to shine the spotlight on headaches and CSM.  Whilst it cannot show exactly why it happens, the association is becoming harder to ignore and makes it less likely to be simply a coincidence.    Hopefully these studies will help to raise the profile of headaches in CSM, to trigger the research necessary to further understanding and develop treatments – watch this space!
 
In the meantime, some small things that can minimize your risk of migraine include: remain well hydrated, reducing your caffeine intake (although some people find caffeine helpful), as well as ensuring a regular sleeping habit. 

Comments

  • Carol McClure | May 2,2019

    I have DSM. After having a diskectomy due to CSM five years ago, I have had visual migraine, i.e loss of focus/vision in one eye, usually the right eye, along with the sick, dizzy feeling that I got many years ago when contraceptive pills caused the normal, excruciating headache plus visual disturbance type of migraine.

    I am wondering if this is connected with my DSM…

  • Marianne Phillips | May 5,2019

    I have suffered from these headaches over two years. For me is it the most distressing part of CSM. I have them as soon as I wake. I cannot bear to open my eyes, my temp sores and I now have a Fan beside my bed. Then the sickness begins. This can be over 24 hours of continual vomiting. Always have to call paramedics as inevitably I dehydrate. I am unable to stand, move or do anything for myself at all. In fact I cannot even speak or string a sentance together so communicate with hand signals. My BP always rises…… 165/110 is an average. I was admitted many times to A & E, always put on a saline drip and given an anti sickness injection. As I live in South Wales the average wait on most occasions for an ambulance is 4 hours + but on one occasion it was 14 hours! Waking up is always the beginning of these.

  • Marianne Phillips | May 5,2019

    Cont….. Now I manage these best as I can with an acupuncture pen and as soon as I am able Caffeine. Increasing the caffeine is a major help.
    As this has become so routine the paramedics now put the Saline drip up at home give me the injection and the last time they were here, sat for 3 hours monitoring all.
    I was prescribed propranolol 80mg a few months ago during a paramedic call out…. so far NOT one headache.Sadly my GP is now suggesting I come off these so I am panicking.

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