1. The £3 Billion Headache Wendy Emberson MCSP Consultant Physiotherapist

2. Migraine is universal Julius Ceasar Gustav Mahler Sigmund Freud Richard Wagner Simon Cowell

3. What is migraine? Migraine is the “business end” of headaches. They are the same condition. 80% of migraine comes from the upper cervical spine. Doctors believe it is a neurological condition. But they have comparatively little knowledge of musculo-skeletal disorders. PHYSIOTHERAPISTS ARE THE MUSCULO-SKELETAL SPECIALISTS.

4. HEADACHE CLASSIFICATION There are more than 300 different classifications of headaches

5. Primary Headache Classification Migraines – with or without aura Aura without headache Tension-type headache – Infrequent, Frequent episodic, Chronic tension-type Cluster headache and other trigeminal autonomic cephalalgias (TACs) Cluster, Episodic cluster, Chronic cluster. Paroxysmal hemicrania SUNCT Short lasting unilateral neuralgiform headache attacks with conjuctival injection and tearing Hemicrania continua Menstrual migraine (Headache Classification Committee of the International Headache Society. The International Classification of Headache Disorders. Cephalgia 2004;24 (Suppl.1):1-160)

6. The Cost 1 in 4 women and 1 in 12 men in the UK suffer from migraines. The economic cost to the UK is between £2.25 and £4.8 billion a year. The World Health Organisation lists migraine in the top 20 disabilities worldwide. The cost to the world economy is estimated to be £140 billion. In the USA, a tenth of the cost is spent on triptans ie $1.7billion. WHAT IS THE COST TO YOUR BUSINESS?

7. Medical options Pain killers Triptans Botox injections Hospitalisation Avoidance – chocolate/wine/cheese etc etc NB Most migraine/headache medications have headaches listed as a side effect!

8. Medical model of diagnosis & treatment The brain stem is sensitised by chemical imbalances in the brain. The actual imbalances have yet to be found. Treatment is painkillers… Or triptans which are designed to desensitise the brainstem. Function of the brain stem: Main motor and sensory innervation to the face and neck via the cranial nerves. When sensitised there will be a whole range of symptoms, including headache, but dependent on which part and how much of the brainstem is sensitised. This is what is so confusing about the many and varied presentations of headache and migraine and why there has been so much debate about the causes.

9. The Watson approach Biomechanical dysfunction in the top 3 vertebrae will sensitise the brain stem.

10. The Proof Dean Watson is an Australian physiotherapist who for the past 20 years has examined and treated the upper necks of headache migraine sufferers exclusively. His experience of 21,000 hours with over 7500 headache and migraine sufferers is unique. These advanced clinical skills and knowledge form the basis of the Watson Headache approach, which Dean now teaches internationally. Stort Physio has hosted his international courses in the UK for the last 3 years. Dean Watson Diploma of Technology in Physiotherapy 1976 (South Australian Institute of Technology); Graduate Diploma in Advanced Manipulative Physiotherapy 1983 (University of South Australia); Master Applied Science (Manipulative Therapy – Research) 1991 (University of South Australia); Fulltime PhD Candidate, Murdoch University, Western Australia (current)

11. Reproduction of headache is considered by the International Headache Society to be a key diagnostic feature of neck involvement. There are situations in which reproduction can occur and the neck is not involved in headache or migraine. Reproduction alone is not enough to confirm cervicogenic involvement. What Dean demonstrates is that by treating the upper neck he can achieve reproduction AND resolution. This is clear proof that the problem lies in the neck ie it is cervicogenic in origin. His PhD thesis has shown that his manual therapy techniques will desensitise the brain stem as well as deal with the biomechanical dysfunction. HE CAN CLAIM AN 80% SUCCESS RATE.

12. Testimonial Amy Lipscombe: “Having suffered from migraines for nearly twenty years of my life I was resigned to them being a permanent feature for the remainder. I thought I had identified the various food/drink/lifestyle/sleep triggers that caused my migraines (which sometimes landed me in hospital) and I tried with limited success to manage them through a combination of strict lifestyle management and rizatriptan prescriptions.

13. I was rather sceptical, but very hopeful when the team at Stort Physio advised me that they could cure my daily headache and weekly migraine condition simply by treating my neck. I chose to give the team a chance. This was the best decision of my life. The team at Stort Physio has improved the quality of my life beyond measure and I will be forever grateful to them for the positive change they have made to my everyday existence. I now live a virtually headache free existence (completely headache free for a period of 2 years), something that seemed completely unimaginable in the past and for the very rare few minor headaches I feel coming on I have strategies and tools to deal with them that does not require any pain medication.

14. What does this mean to your business? How many of your workforce suffer with migraines? How much does this cost your company?

15. Stort Physio Stort Physio has hosted Dean Watson’s international courses for the last 3 years. All four of our physiotherapists are now fully trained under the Watson Headache Institute and are aiming to be the first Physiotherapists in the UK to achieve certification with the Institute.

16. Where are we going with this? We are moving to expand the practice to include: 1.A dedicated Headache Unit 2.Expanded treatment facilities 3.Post graduate teaching facility We need more investment please!