Chronic Paroxysmal Hemicrania, Hemicrania Continua and Cluster Headache – All From The Same Disorder?

In recent times the International Headache Society has added a third primary group of headache(s) to the two primary headache types – migraine and tension-type headache.

This third primary group includes Cluster headache, Chronic Paroxysmal Hemicrania, and SUNCT (Short lasting Unilateral Neuralgia form headache attack with Conjunctival injection and Tearing!) and Hemicrania Continua.

Chronic Paroxysmal Hemicrania is very similar to Cluster Headache and is often described as the female equivalent of Cluster Headache (Cluster Headache is more frequent in males).

It is interesting to note a report demonstrating that both chronic Paroxysmal Hemicrania and Hemicrania Continua (thought to be two different types of headache) respond to the same medication – Indomethacin. (Indomethacin is a non steroidal anti inflammatory drug used to reduce pain)

I have written before that Cluster Headache and Hemicrania Continua respond to blocking or injecting of the greater occipital nerve i.e. a feature of Cervicogenic (neck-related) Headache – just more evidence to support the role of neck disorders in many different headache forms …..

==== is one voice of the Watson Headache Institute.

The Watson Headache Institute was established to increase the awareness of cervicogenic (neck) disorders in headache and migraine by imparting my (and that of others) clinical experience and knowledge; to present and discuss past and present relevant research and to undertake and support rigorous clinical and scientific research in this specialty.

Appropriate and up-to-date knowledge is self-empowering; I believe that every headache sufferer has the right to know their headache diagnosis as precisely as possible (and what it means), to know the nature of their headache disorder, its outcome and possible types of treatment.

What has yet to gain acceptance is my (and that of others) belief, supported by my unparalleled clinical experience and a significant body of international research, that it is incorrect to consider headache and migraine types as totally different entities and that cervicogenic (neck) disorders can be instrumental in the headache and migraine process.

Although Physiotherapy, Chiropractic and Osteopathy are different disciplines, we are supporters of the idea that headache and migraine sufferers, no matter what their diagnoses, can be helped to live their lives more effectively through appropriate neck treatment. However, because treatment of the neck does not fit the medical model of headache and migraine, the model has demonstrated little interest in exploring this as an option. It is essential that all factors, which have the potential to sensitise the brainstem, be investigated equally.  Currently this is not the situation – the neck is largely disregarded.

So, whilst is also about Education, it is also a directory for headache and migraine sufferers to source practitioners who have a particular interest in and are skilled in examination of the neck as a source of your headache or migraine – to create a more comprehensive approach and provide an alternative, medication-free treatment.

ver the past 15 years I have developed a series of techniques, which, by way of temporary reproduction of headache and easing of the headache as a technique is sustained, confirm that a neck disorder is the cause of or a significant factor in the mechanism of the headache or migraine – this a key diagnostic criterion for cervicogenic or neck involvement in headache according to the International Headache Society – importantly for the disorder to be related to the headache or migraine process the headache has to ease as the technique is maintained. If both reproduction and lessening are not possible then the neck may not be the source of the headache or migraine. Furthermore my experience has shown that if the techniques are performed in a specific manner it is possible to determine which spinal segment is the cause of or contributing significantly to headache and migraine. Having determined which spinal segment (or segments — there may be more than one) is involved then this significantly increases the chance of the treatment being successful because treatment can be directed at specific, relevant spinal segments.

The application of these techniques in Europe, United Kingdom and Australia has become known as the ‘Watson Headache Approach’ and forms the basis of courses I present for physiotherapists, chiropractors and osteopaths in Australia, New Zealand, Hong Kong, Singapore, United Kingdom, Northern Ireland, Belgium, The Netherlands, Switzerland, Germany, Norway and Spain — refer

The Watson Headache Institute was established to increase the awareness of cervicogenic (neck) disorders in headache and migraine by:

imparting my (and that of others) clinical experience and knowledge


undertaking and supporting rigorous clinical and scientific research in this specialty.

Dean Watson

Consultant Headache and Migraine Physiotherapist; Adjunct Lecturer, Masters Program, School of Physiotherapy, University of South Australia; PhD Candidate, Murdoch University, Western Australia