[0:01]The Watson headache approach is a systematic approach to assessing and treating the upper cervical spine in relation to headache and migraine problems and other conditions.
[0:13]And the overall goal is to get people back to a state of independence and ideally to reduce their medication requirements and to give them back a sense of control over their headache or migraine condition. The Watson headache approach is not just about the techniques that we use. It's a system, so it's a way of going about the questioning process, the things that we're looking for that give us clues about whether the neck may or may not be involved, and more than that, which levels of the neck might be involved.
[0:55]Part of the issue with headache and migraine is it isn't always immediately apparent that the neck is involved. And traditionally the neck has been thought to be involved in a very small percentage of headache problems, namely cervicogenic headache, but what we know through treating thousands of people, thousands of headache and migraine problems is that there's a a huge underestimation of the contribution that the neck makes to headache and migraine problems. And I need to make that point clearly that migraine problems too, a problem that according to the traditional medical model, the neck has no role to play in. This is the key to a systematic approach to try and determine if the condition has a neck component or not. And it's not as if every headache or migraine has has got a a contribution from the neck. So it's really important to be able to distinguish which ones do and which ones don't.
[2:04]The Watson headache approach is really effective for a surprisingly wide variety of problems, many of which have not traditionally been thought to have a neck component, and many of which have never been thought to have a role for physiotherapy in its treatment or management.
[2:27]So when someone comes in for an initial consult, one of the things that I make a point of saying is we've got three real main aims of what we're looking to do. The first goal is to work out whether or not the upper cervical spine is implicated. The second part is to work out which levels are involved, and the third part is to work out if it's a problem that will respond to this treatment approach.
[2:55]If someone presents to their examination with a headache, then a large part of the examination is working out if there are factors that help to modify that headache in real time, can we reduce the intensity as the person is in the room? And if you can do, if you can, and particularly if it's using a movement or something they can do themselves, it gives a whole lot of control back to the person, and that's really, really important because a lot of people that have ongoing headache or migraine problems really feel like things are out of their control and that they're really reliant on usually medication of some description.
[3:38]If someone doesn't have a headache when they present for their initial consultation, part of the examination is seeing if there are particular levels that are capable of creating elements of the person's headache or migraine. And it's important that what you are trying to recreate or reproduce isn't just any headache. It's something that's relevant to them. It feels similar in in terms of its area or the quality of pain, it's a recreation of their headache pain. And what's really important too when we do that is that by taking the pressure off, the headache will go away, and it's important to demonstrate that to the patient, so they don't, they're not worried that you're giving them a headache, so that through that process it's not giving someone a headache. It's recreating elements of it by stressing a joint. And then when you take the pressure off the joint or the stress off the joint, the head pain will go. There are some really clear benefits to the Watson Headache Approach. One is speed. So we expect if someone has a relevant headache component that is going to respond to the Watson Headache Approach, that they will have a change in their headache condition fairly rapidly, if not after the first session, we expect to see some change early on within a small number of sessions, and that's something we talk about early on. We set an expectation that if we don't see change within a certain number of sessions, then this isn't a technique that's going to help you. And that level of accountability is good because people know exactly where they stand. We want to prove to ourselves that there's something that we can help with and the patient obviously wants to know too that there's something that we can help them with too, and it's not an unending process. Another benefit of the system is that it gives clarity. So being able to say whether the neck is a contributing factor definitely, or it's not a contributing factor that's really, really helpful for the patient. And even if it's not, so worst case scenario, someone comes in, go through the examination process and we determine that their neck isn't a player, hasn't got a role to play, it's not contributing to their headache or migraine condition, then that itself is useful because it's going to hopefully help someone them from going down a number of different paths, chasing a neck-based solution to their problem when it isn't a neck-based problem. So that's got the potential to save a lot of time and money and confusion as well. The clarity also comes from the fact that we're looking to see a change in the pain behavior within the session, so it's not something where someone has treatment or starts a medication and you're hoping to see a change over weeks or months. We're looking to see a change in the pain behavior during the session and, and secondly, we're looking to see a change in the pain behavior between sessions as well, so that speed of the result, that also brings clarity as well to what's going on. I think the third big benefit of the Watson headache approach is helping someone to regain control. Because a lot of people that come in have been through the works, they've seen specialists, they've tried different things, and oftentimes really their only sense of control is taking medication. And even then, sometimes it doesn't work. If there's something that someone can do to reduce intensity of their headache when it happens, or better still, if they can prevent the onset of the headache, if they can feel it starting and they can do something that that actually prevents it from escalating into a full-blown headache, then that's invaluable and that regaining of control is such an important thing for people that have headache and migraine problems. One thing that a lot of people are worried about is whether there's any neck cracking involved, and there isn't with the Watson Headache Approach, there's no neck cracking. The techniques are slow and sustained, and means that as the recipient, you've got plenty of control over what's going on, and I'll often check with someone repeatedly, 'if there's anything at all that you're not comfortable with, if there's anything that you're not happy with, whatever, just say so and, and we'll stop'. And it's as simple as that.
[8:25]One of the things that still surprises me about headache and migraine problems is how the neck is often undermined as a potential contributing factor to headache and migraine problems. And this is despite the fact that it's a really well-established fact that the trigeminal nucleus, which is an extension of the trigeminal nucleus, receives input from the top few levels of the neck. There's a well-established neuro anatomical reason why the top part of the neck can contribute to headache and migraine problems, and yet for some reason it's still underplayed by some. We see the evidence of that every day when we're treating people using the Watson Headache Approach and treating the upper cervical spine in people that have that upper neck contribution to their problem and they improve. The nice part about it too is that we are able to use real time information to prove to ourselves and prove to the patient that the top of the neck is indeed relevant to the headache or the migraine problem. Even if they don't have neck symptoms, even if they don't have a loss of range of movement in their neck, which is often the case, often people won't have any significant restriction to their movement. They might not have neck pain. Some people do, some people don't, but it's certainly not a prerequisite for your neck being involved in a headache or migraine problem.
[10:00]The Watson Headache Approach involves a subjective examination where the main priority is ruling out any possible sinister pathologies, any red flags. And so that's the first thing that we cover off in the subjective examination, to make sure that there's nothing that needs further investigation that's out of our field. And from there, the subjective is all about trying to find out bits of information that give us clues about which levels of the neck might be involved and the way in which the problem behaves. And one of the really important elements to the subjective examination is finding measures that we can use, KPIs I think of them as that we can use to measure if the condition is improving with treatment or not. And that's important because often there aren't really strong physical signs like range of movement. So instead we're relying on things like the frequency or the intensity or the behavior of the headache when it happens or something else like that. So we try and come up with three things that we can use to measure a change in the headache behavior.
[11:14]The objective examination is first of all geared towards safety. So it's a standard part of the objective to do upper neck ligament testing and testing of bony integrity to make sure that there are no surprises and nothing that contra indicates manual therapy. That's particularly important in people that have had trauma, whether it's whiplash, whether it's concussion, some kind of traumatic episode to the head or neck. From there, the objective examination involves identifying features that would suggest the neck involvement, and that can be done a number of ways. One of the ways is through reproducing elements of that person's headache experience or migraine experience through selective pressure on levels of the neck. At the end of the initial assessment, we'll be able to say whether we know for sure that the neck's involved or know for sure that it's not involved, or whether we suspect it is or suspect it isn't. Sometimes that initial provisional diagnosis needs to be refined over time, over a few sessions, but at the end of the first session, there'll be a pretty good idea of whether there's a neck component or not. The treatment is based on a number of elements, one of which is education. Really important that the person understands what we're trying to achieve, how we expect it's going to behave, what the things are that they can do to help themselves as well, and any other proven strategies that they can employ that will help with the headache or migraine problem. There's an exercise element to it for most people too, there are particular exercises that are helpful and often pain relieving. And the biggest component to the treatment session is the manual therapy that's directed at those levels that we identify are involved. At the end of the process, the most important thing is the idea of prevention and self-management. We want people to be able to be independent. We are not looking to create a therapist reliance where someone feels like they need to be reattending to feel like they're okay, if they don't come in, they're going to be at all kinds of strife. So our idea is to, to create independence, to teach people the skills that allow them to look after themselves and all the things that they can do also to prevent recurrence of headache and migraine problems. I hope that gives you a good overview of the Watson Headache Approach. In Adelaide, as far as I know, there are only two Watson Headache Certified Practitioners, and I happen to be one of them. As well as that, there are people that have done the the Level Two course, which gives them a level of skill and palpation, treatment and assessment. Lachlan Sutherland has done the Level Two course and he's hoping to do the Level Three certification this year. And Lisa Vernon, who's at Adelaide West as well, has done the Level One course, and we work together. We collaborate, we make sure that we are doing the best that we possibly can for our patients by working together and providing the the headache treatment that we can using the Watson Headache Approach.
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