M.A. / In all communities studied, most people suffer from headaches sometime in their life (Blau, 1991; Selby, 1983). A small portion of this group suffer from both migraine and tension-type headache on a regular basis. Currently the main treatment modality for headache is pharmacological in nature. This type of treatment is limited in as far as it does not address the concomitant psychological variables that often accompany chronic headaches. Furthermore, it seems that most psychophysiological therapies were developed in the USA and Canada over the last 30 years, but thus far research has not been done within the South African context. The aim of this study was to determine the effectiveness of an individualized psychophysiological treatment program for individuals suffering from migraine and tension-type headache. A change in headache activity and mood states such as anxiety and depression was envisaged. Seven subjects suffering from both migraine and tension-type headache were selected to participate in the study. The A-B-A single-subject design was employed allowing three weeks before and after the intervention for baseline recordings. The intervention consisted of seven sessions of cognitive coping training and electromyographic biofeedback. All subjects kept daily records of their headache activity over the eleven week period. They completed the Psychological Assessment of Headache Questionnaire, levels of depression and anxiety were assessed by the Beck Depression Inventory and the State-Trait Anxiety Inventory which were administered three weeks prior to and after the intervention. Results indicated that subjects who exhibited a decrease in headache frequency and intensity and an increase in the number of headache-free days per week, were those who were not habituated to analgesic medication. Subjects who reported no differences at all with regard to headache activity were those who suffered from chronic daily headache. Those subjects were older and consumed analgesic and other medications daily. These findings support those found in literature (Blanchard & Andrasik, 1988). All but one subject reported lower scores at post-assessment on indicators of depression and state-anxiety. Even though there were no significant improvements regarding headache activity, for certain subjects. The overall aim of the study, namely to evaluate the effectiveness of individualized treatment strategies, were addressed and contribute to future intervention studies.

Although headaches are a very common complaint, those accompanied by paresthesia and muscle wasting indicate an underlying neurological disorder. In this review, we present the case of a 58-year-old man with chronic headaches who developed tingling and numbness in his right limbs along with right-hand muscle atrophy.

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Migraine patients often demonstrate cutaneous allodynia, defined as a hypersensitivity of the skin to touch or mechanical stimuli that is considered non-noxious under normal circumstances. The allodynia sometimes begins intracranially and spreads, via unknown mechanisms, to extracranial regions. The goal of the study was to develop and validate a model of cutaneous allodynia triggered by dural inflammation for pain associated with headaches, and to explore neuronal and glial mechanisms underlying generalized allodynia. Inflammatory mediators (IM) were applied to the dura of unanesthetized rats via previously implanted cannulas and sensory thresholds of the face and hindpaws were characterized. IM elicited robust and time-related facial and hindpaw allodynia which peaked after approximately three hours as well as FOS expression in the trigeminal nucleus caudalis (TNC), indicative of central sensitization. These effects were reminiscent of cutaneous allodynia seen in patients with migraine or other primary headache conditions, and were reversed by agents used clinically in the treatment of migraine including sumatriptan, naproxen, CGRP-antagonist, and morphine. Consistent with clinical observations, the allodynia was unaffected by an NK-1 antagonist. Having established facial and hindpaw allodynia as a useful animal surrogate of headache-associated allodynia, we next showed that blocking pain-facilitating processes from the rostral ventromedial medulla (RVM) interfered with its expression. Inactivation of the RVM with local anesthetic, destruction of putative pain-facilitation cells, and blockade of cholecystokinin receptors all prevented or significantly attenuated IM-induced allodynia. Electrophysiological studies confirmed activation of pain-facilitating "ON" cells and transient suppression of "OFF" cells in the RVM following IM. Additionally, microinjection of the RVM with a microglial inhibitor or sumatriptan also inhibited the expression of IM-induced cutaneous allodynia as well as microglial activation. Facial and hindpaw allodynia associated with dural stimulation is a useful surrogate of pain associated with primary headache including migraine and may be exploited mechanistically for the development of novel therapeutic strategies for headache pain. The data also demonstrate a requirement for activation of descending facilitation from the RVM, likely reliant on neuronal-glial interactions, for the expression of cranial and extracranial cutaneous allodynia. Consequently, the findings are consistent with a brainstem generator of allodynia associated with headache disorders.

M.Tech. / The primary aim of this investigation was to evaluate the possible effectiveness of a cervical support pillow in combination with cervical spine manipulation versus cervical spine manipulation alone, in the management of cervicogenic headache. The secondary aim of this study was to compare the efficacy of a cervical support pillow (Top Pillow) to the efficacy of the cervical support pillow used by Ross (2002) in the management of cervicogenic headache. During this study, thirty participants were recruited. The participants were divided into three groups of ten each. The three groups received the following treatments over a 3 week period: • Group one only received chiropractic cervical adjustments • Group two received a cervical support pillow and chiropractic cervical adjustments • Group three received only a cervical support pillow. After the treatment was concluded the recorded data was submitted to the staff at STATKON where the data was analysed using the Statistical Package for Social Sciences. The results of the clinical trial revealed that the group that received chiropractic manipulation and the cervical support pillow showed the most significant changes of all three the groups in all planes of cervical range of motion, with all the results being statistically significant. The group that only received chiropractic manipulation also exhibited a significant increase in all planes of cervical range of motion, with only extension not being statistically significant. The group that only received a cervical support pillow, revealed a statistically significant increase in almost all planes of cervical range of motion except for flexion where no increase was noted the increases were, however, still markedly less than those of the former two groups that received chiropractic adjustments to specific restricted motion segments. With regard to perceived pain measured on the Numerical Pain Rating Scale, the two groups that received chiropractic adjustments improved to a much greater degree than the group that only received a cervical support pillow. With regard to Vernon-Mior Neck Pain and Disability Index all three groups had a statistically significant decrease in the perception of disability although the adjustment groups once again showed a much greater decrease in disability than the pillow only group. The already proven benefits that patients with cervicogenic headache receive from chiropractic spinal manipulation, can be successfully supplemented by the use of a cervical support pillow and the top pillow performed better than the pillow used by Ross et al. (2002) in the treatment of cervicogenic headache.

Thesis (MAppSc in Physiotherapy) -- University of South Australia, 1998

Thesis (Ph.D.) - University of Queensland, 2004. / Includes bibliography.

Thesis (doctoral)--University of Göteborg, Sweden, 1981. / Includes bibliographical references (p. 29-33).