International Myotherapy Society

	Cervico-brachial neuralgia
	Cluster headaches

Cluster headaches

About 7 cases treated by Brachy-Myotherapy as only treatment.

P. Ponzio, Physiotherapist, Herblay, France, Europe

J. Polak, MD, President of the International Myotherapy Society (IMS),
Member of the American Association for Orthopaedic Medicine (AAOM).

Contact: Dr Polak, 12 Rue Wilson, F- 32300 Mirande, France, Tel: (0) 562 666 700, Fax: (0) 562 66 77 88

Abstract

   Seven unselected cases of 'Cluster Headaches' were treated succesfully by Brachy-Myotherapy as only treatment.
   All seven patients included were cured (with 2 years follow-up for 4 of them, the 3 others being lost sight of).
   A vascular participation in this disease is usually accepted: it would be essentially a vasodilatation in the carotid sector, aiming to compensate a hypoxia or a possible hypoxy. Given the results and the follow-up of an only manual treatment, in this case Brachy-Myotherapy, the hypothesis of a muscular factor as cause of vascular symptoms can be considered.
   What would be the link between this localised vascular dysfunction and a muscular dysfunction?

Key-Words

Cluster Headache, muscle contractures, Brachy-Myotherapy, Myotherapy, headache, muscle, cause & reaction, hypoxia, pain.

A. Introduction

Physio-pathology of the Cluster Headache (CH)

   Cluster Headache is one of the most painfull among all recuring diseases, even more than Migraine. It has been described by the International Headache Society (IHS) in 1988 [2] as a headache having the following elements:
   >> Painfull crisises are one-sided
   >> Painfull crisises arise in salvoes (= cluster) [3]
   >> Their localisation is orbital or just above the eye
   >> A crisis lasts for 15 minutes to 3 hours
   >> CH can occur from 1 to 8 times an hour. Pain can be associated with one or more of the following symptoms: conjonctival blush; sniveling; nasal congestion; rhinorrhea; sweating of the forehead, tears, myosis, ptosis; eyelids oedema.

Crises occur by periods, that last from some weeks up to several months, separated by periods of total absence of symptoms [1].

Epidemiology

CH is considered as rather rare, 100 times less frequent than migraine. It has a prevalence of about 50 for 100.000 men, and of 8 for 100.000 women [4]. The first crisis begins at an age of 10 to 30 for 2/3 of the patients, but extremes from 1 to 73 years have been noticed [5].
There does not seem to exist neither a genetic factor nor family forms.

Clinics

   Diagnosis of CH is relatively easy to establish, because its symptoms and its evolution are typical and specific [3].
   As we said, the main elements are that pain is one-sided, almost always on the same side, and located in the orbitary region. It can remain there, but more often it radiates in a homolateral way towards the forehead, the temple, the cheekbone, the cheek, or the superior gum.
   Less frequently it extends also to the lower gum, to the lower jaw, concerning sometimes the whole hemiface or the neck, even sometimes the homolateral shoulder. In 15 to 20% of cases, maximum pain will be located in the temple [6].
   As we have mentionned pain may last from one quarter of an hour to 3 hours, it occurs usually once or twice a day, and generally at the same moment every day. Pain is always described as unbearable, and may be felt like a burn, a transfixiant pain, a destruction [3], and more rarely as pulsatile [1 & 3].

   Vasomotor signs are present during the pain: the place of the face concerned is red, whimpering, with nasal congestion or rhinorrhea [1]. It can look like a partial Claude Bernard Horner syndrome.
   Myosis and ptosis during the crisis are present in 50% of cases [7]. During the period of acute crisis, certain starting factors are quoted: alcohol, vasodilatators (e.g.: Trinitine) [1 & 3], angiography [8], nitroglycerine [9] and histamine [10]. Several authors incriminate traumas of the temporo-mandibulaire joint. Many agree on the frequency of cranio-fascial trauma [3] in the antecedents: one should thus always look for a traumatic antecedent and should examine the month and especially always the neck [1].

Evolution

   The long-term evolution of the CH is not well known, the patients consulting essentially during a painfull period [11].
   However CH is a chronic reccuring affection. It can recur whole life long. Periods of absence of crises can sometimes last for many years, for certain patients. On the contrary, for others, frequency of crises may increase. CH disapears rarely spontaneously.
   A study of Kudrow [11] observes that, 8 years after their first consultation:
   - 34% were in remission
   - 7% had worsened
   - 9% were lost signt of, or had died
   - 50% of the patients had not presented any modification of their affection, neither worse nor better.

Aetiology

CH being fortunately not a frequent disease, it is thus not perfectly known (but migraine isn't either...). Many aetiologic hypotheses have been put forewards. A vascular participation is generaly admitted, as well as a neurologic factor [1]. Pain being sometimes pulsatile, certain authors think there might be a vasodilatation in the external carotidian territory [1].
Parasympathic hyper - or hyperfunctioning have also been suggested [1].

Classical treatment

   Oral admission of medicines is very often ineffective. Only a few medicines (injectable dihydroergotamine or nasal spray of it) can shorten the duration of a crisis.
For patients whose crisises arise a previsible time, such a treatment taken before the occuring of the crisis is often effective. Anaesthesia of the Spheno-Palatine ganglion region can be considered, as well as the inhalation of oxygen, corticotherapy (in the intial period of an CH), or some drugs against migraine (like betablockers, lithium, calcic inhibitors). All this with inconstant, uncertain results [1], and unwanted effects, medicinal interactions [1] and often the necessity of increasing doses to maintain a certain efficiency. Certain CH seem to resist to all the current medicinal treatments [1].
Sometimes the use of morphine-like drugs are then the only relief.

   The preventive treatments have a difficult to appreciate effect, evolution of CH being often rather anarchic.
   Certain studies show an efficiency of drugs treatments, provoking sometimes rather important relapses and in some cases disppearance of the painful symptomatology for some years [11 & 13]. These authors conclude that CH is anyway a long disease [1].
   Let us note that a surgical treatment has been put forewards for crisises resisting medical treatment but with few or no efficiency; but sometimes heavy aftereffects have been noticed [14].
   To sum up, the proposed treatments tend to combine slight if no effects at all (except in prevention), often with important side-effects.

   The study realized and described here-under aims to show that it is possible to propose another type of treatment which (although not, until now, based on an absolutely certain aetiologic hypothesis), offers quite constant and lasting results, which can arouse the interest of the doctors, physiotherapists, and of course the patients confronted with this disease (our opinion that is better to cure without expaining how, as long as there are no side-effects, than to explain in details why we cannot treat...).

B. Method

Seven patients sent to our practice and suffering from CH (diagnosis established by the physician having established the prescription) were treated in 1998 by Brachy-Myotherapy exclusively.
Brachy-Myotherapy is a purely manual therapy that treats muscular contractions by shortening passively for a short time the concerned muscles (and sometimes muscles located further away but that are part of the pathological process). It has been treached for more than 10 years in France, about 1200 physicians and physiotherapists have been trained. Several studies have been printed in several professional magazines in France and in Switzerland (about Theory, Electromyographic controls, Hallux Valgus pain and deformation, Elbow pain, Neck pain with osteoarthrosis, thorough treatment of Migraines, Sports medicine, treatment of Ankle sprains, and manual treatment straightening lastingly Idiopathic scoliosis, treatment of Cluster headache, etc...).
It is easy to learn and to practice, can be used in chronic or acute cases, and has many indications (which are however only muscle contractures and their consequences) and is without any danger. It has been tested sucessfully by 150 medical doctors on about 60 different diseases, all linked to lasting contractures, on several thousand cases.
It seems to work by putting an end to a neurological loop (called "Beta loop") that seems to be created by traumas on certain muscles and then does not have any tendency to stop.

C. Patients and results

Seven patients suffering from CH were sent to Mr Ponzio's phisiotherapy practice (diagnosis was established by the physician who had established the prescription). All were treated in 1998 by Brachy-Myotherapy exclusively, according to the method worked out by J. Polak, MD.

Five patients out of the 7 consulted specifically for an CH, and the 2 others initially for another pathology and mentionned CH during the interrogation. All seven cases were in phase of crisis.

Case N°1

Mr R. I.
60 years, has been suffering for 30 years from CH.
Crisis arising almost every year but at different periods but always at one o'clock, lasting 1 hour for a period of 1 month.
Mr RI had multiple exams which did not show any abnormaly. No medicine had a lasting effect.
Signs associated during crisises were: whimperings, red eye, unbearable pain, tendency to isolate himself in darkness.
Examination shows very painful neck muscles (contractures). Interrogation reveals a chronic neck pain and an ancient cervical trauma.
After the first Brachy-Myotherapy session, no more crisis arose.
On the whole, 5 sessions were made over a period of 2 months, thus covering the period of crisis, and this without any relapse.
Contacted again 6 months after the end of the treatment the patient did not mention any relapse.

Case N°2

Mr L.
56 years, has been suffering for 10 years. Every year without exception by periods of 2 to 4 months, 1 or 2 crisis of 1 h 30 a day.
During the crisis, unbearable pain is felt like "an iron point that is pushed in his eye"; eye is red and snivels.
Examination shows also contractured (hard, painfull, difficult to stretch, etc.) cervical muscles.
Mr L. finds relief by absorbing Tegretol but with increasing doses.
A clear improvement is felt after the first Brachy-Myotherapy session; the dodes of the medicines could at once be decreased by half, and is fact the medicinal treatment was abandoned after the third session, because Mr L. did not feel anything any more. On the whole, 5 sessions were performed over a period of month and a half.
Contacted again 6 months after the end of the treatment the patient did not mention any relapse.

Case N°3

Mr A. F.
43 years, crises of CH evolving for 15 years (at the beginng a little time after a cervical traumatism).
Crises show themselves about every year in the same period, during 1 to 3 months.
Pains appear at a set time in the second half of the night, and last 30 to 50 minutes.
Several medical treatments were tempted in vain with the exception of Dehydroergotamine's injections which succed in easing pain.
Cervical muscular contractures are present.
Since the Brachy-Myotherapy's first session, a modification of the rythm and the intensity of the pain is obseved. The following crisis takes place at the beginning of morning (what had never occurred). It lasts onmy 10 minutes and is very fast relieved with the medical treatment.
Ahter 3 Brachy-Myotherapy sessions, one attends the complete disappearance of the painfull symptoms. The treatment will have lasted 1 month.

Case N°4

Mr T.
53 years, appear at the cabinet for a neuralgia cervico-brachal rebel.
For 1 month he has suffered from CH in this period for almost 40 years! Diagnosis of CH is confirmed.
Several years ago he suffered less but since 10 years ago crisis become more regular and more intense.
They appear during a period of about 2 months. Pain occurs every day at night-time, and persists about 1 hour and is described as "atrocious". It is accompanied with whimperings, blushes and nasal congestion. The medical treatment has an unpredictable but existing efficiency.
As in the previous cases, the presence of the cervical muscles conctractures completes the clinical picture.
4 Brachy-Myotherapy sessions eliminate completely the CH. 4 supplementary sessions are made to treat the Cervico-brachial Neuralgia which, curiously, is more difficult to treat than the CH.

Case N°5

Mr B.
40 years old, has neen suffering from CH for 2 years. Crisises return every year and appear during 4 months every day (15 in 20 mn). Sometimes, several crises (maximum 3) appear every day. Whimpering ins very important. Several unconventionnal treatments were practised unsuccessfully (ostéopathy) after the classic medical treatments had failed. Cervical pain and steepness are very important.
After the Brachy-Myotherapy's first session, daily crisises do not return. They occur only 3 days later and in a much less intense way. After the second session, only sensations of "departure of crisises without consequences" are reported.
After 4 sessions, everything having disappeared, treatment is stopped.

Case N°6

Mrs B.
51 years comes at our practice for a cervical pain, lumbar suffering and a carpal tunnel syndrom. Interrogation reveals the CH, confirmed by the consulted physician.
The CH shows itself for 20 years with a perfect regularity. There was nevertheless a period of calm during 5 years, following a medical treatment that today is uneffective.
Night-crisises last for a very wide period, during 4 to 5 months. Every crisis provokes a increase of cervical pain.
Brachy-Myotherapy's first session provokes a worsening of the daily crisis, which is longer and also more intense! After the second session and a slight change in the treatment protocol no real crisis does not arise any more. Only slignt pain continues for a week and eventually disappears.
As a whole 10 Brachy-Myotherapy's sessions have been performed for the cervical and lumbar problems, but CH's signs totally disappeared after 4 sessions.

Case N°7

Mr D. D.
47 years; has regular CH for 20 years. Crises occur about 4 in 6 weeks, but do not return certain years. But the medical treatments remain ineffective. Only intramuscular injections of Imiject's calm a crisis when it arises.
Every day during the critical period, crisis arise about at the same moment, in the second night half, and lasts about 1 hour.
Described pain is extremely acute. Eye becomes red and snivels.
Examination reveals the existence of the very tense and painful cervical muscles.
Mr D. D. suffer from lombo-sciatica for which he has been operated; the lumbar area remains nevertheless painful, as well as the knees.
yotherapy's first session aggravate the situation. From the next day 3 in 4 crises arise regulary every day. After the second session and a slight change in the treatment protocol improve the disease.
We choose to act from now on the muscles of ankles only, and this in a first time allows a return in the initial situation, and then gradually allows a sudden disappearance of daily crises (for the first time, since for 20 years the painfull period went only gradually to a stop.

On the whole, there was so no selection of cases for this forward-looking study, and the 7 patients xere only treated by Brachy-Myotherapy. This tends to show the efficiency of this treatment alone. Few sessions are necessary. The effect is lasting: 4 patients contracted after 2 years (RA, AF, T, Mrs B) had not had any crisis any more (the others could not be contacted). All the patients stopped rheir medical treatment. None of the first 6 treated patients had obtained a comparable result with whatever medical.

D. Discussion

   Although there is no proved hypothesis concerning the CH, we can only notice that only action on muscles, cervical generally but sometimes more at distance (e. g. case n°7, which shows nevertheless also that the cervical muscles are implied), brings remarkable results for the acute and thorough treatment of this difficult affection.
   One can thus suppose that the spasms of certain cervical muscles are mechanically responsible for vascular "disorders", of which most of the authors have noted the existence. Some [1] think of a neurologic factor forthe muscular difunctionnements.
Contractures of cervical muscles
   1) being on one hand a constant (in this study on 7 cases), and
   2) on the other hand their only treatment giving the results described above, is certainly a determining factor.
According to this hypothesis, factors starting the CH crisis would be factors that increase an alreally too high muscular tonus.
Of course this hypothesis should be confirmed by a more important study, that is now being done and confirms the results where the notions of recession (drop) will be taken into account, what was ont yet able to be made here as so we would wish it. The present publication realizes only a first attempt of a new and harmless therapeutics on a disease very painful and little sensitive to the classics treatments.
Nevertheless, we repeat it, only action on muscles allowing results so spectacular, we verify once more the interest of the hypothesis of the implication of muscles in number of pathologies.

E. Conclusion

   Our study does not include many cases, the disease being fortunately rare. The studies concerned essentially the periods of crisis, and showed that one could 6 times on 7 drasticly shorten them. Thurther on, one can avoid their reappeirance. As we have seen, certain patients have a recession of at least 2 years without relapse. But it might be much longer, because the treatment had been done only 2 before!
   Three other patients are currently being treated with apparently the same positive effects.

   Yhis shows the interest which there would be to investigate further on the role of the muscle contracture in the CH.

   It is likely that a comparative study between medical treatments and Brachy-Myotherapy, might allow to confirm that Brachy-Myotherapy is a good treatment. But, as we said, the disease is maybe not frequent enough for such kind of studies. Some patients could on the pther hand accept cross-over studies.

   What we can say up to now is that for Cluster headache Brachy-Myotherapy seems to be an efficient, rapid, lasting, and without side-effect treatment, easy to perform.
Treatments treating diseases not healding by themselves do not need many subjects to prove their efficiency. This is the case here.

References

1. Pradelier & Dry: La revue du praticien 69, 25/9/89

2. Tehindrazanarivelo, Massiou, Bousser: Instantanés médicaux de l'EMC 17-023-A70 se référant au Headache classification cimmitee of the International Headache Society. Céphalées, névralgies crâniennes, douleurs de la face, classification et critère de diagnstic. Revue du Praticien 1990 40-426-429

3. Tehindrazanarivelo, Massiou, Bousser: Instantanés médicaux de l'EMC 17-023-A70

4. Bousser, Baron: Migraines & Algies Vasculaires de la face. Sandoz, 1979

5. Peatfield, Gawel & Rose: The effects of infused prostacyclin in migraine & cluster headache: Headache 1981: 190-195; & Manzni, Majon: Cluster Headache in a one year infant? Headache 1981, 21: 255-256

6. Nieman, Hurwitz: ocular sympatheic palsy in periodic migrainous neuralgia. Neurol Sound Psychiatry 1961 24: 369-373

7. Mzanzoni, Terzano, Bono, Ekbom: Clinical findings,10 180 patients. Cephalalgia 1983 3-21-30

8. Ekbom, Gremtz: carotid angiography in cluster headache. Actu radial diagn. 1978 10: 177-186

9. Ekbom: Nitroglycerin as a provocative agent. In Ekbom K

10. Horton: The use of histamine in the treatment of specific types of headaches. JAMA 1941 116: 377-383

11. Pauldry, Regli: Médecine & Hygiène 46 2808-2813, 1988

12. Kudrow: Natural hystory of headache. Headache 1982: 22: 203-6

13. Bigo, Delrieu, Bousser: Traitement des Algies Vasculaires de la Face par injection de methyl-prednisolone dans la région du nerf occipital: 16 cas. Revue neurologique, Paris, 1989, 145-2-160-162

14. Morgen, Lander, Wilkins: Surgical treatment of cluster headache. J. neurosug. 1990: 72 866-871

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