This April sees the introduction of a brand new CPD course at the UCO, specifically focusing on screening, diagnosing and managing headache conditions in patients. We asked Course Leader Helena Bridge to tell us a little about her passion for this common condition, and the role osteopaths can play in the wider headache management community.
"I guess many of us have a soft spot for treating certain conditions, despite coming from a holistic perspective, and mine has always been headaches. Having developed migraines through my teens and into early adulthood, and then chronic migraines after a car crash, I could easily empathise with other sufferers, knowing the way they take over and ruin people's lives. I used to work tirelessly to help reduce people's headaches, and was encouraged by their - and also my - progress using nothing but osteopathic treatment and lots of optimism. My own post-traumatic migraines simply disappeared never to return again after a course of osteopathic treatment for an acute low back strain! I was intrigued as to why this was, but for many years found no answers.
It wasn't until I took a PGCE at the now UCO and began teaching at the ESO many years later that I realised I had no particular system at all for appraising and treating patients with headaches. My long-ago undergraduate studies had taught me about head injury and red flags, but nothing more once primary headaches had been diagnosed. Finding myself standing in front of groups of eager students in clinic needing guidance on patients with non-responding and persistent severe headaches focused my mind sharply on the inadequacies of my own knowledge.
Five years later I am about two thirds through a Masters degree in Clinical Management of Pain specialising in Headache Conditions, still learning and still fascinated. I don't know that I am technically any better at treatments than I was when I started, but I certainly am more aware of the evidence base, and feel more confident in screening for sinister headaches, assessment of headache conditions and their progress, referral criteria, important co-morbidities of chronic pain and their multidisciplinary management. I guess it's about being able to ask the best questions, to listen fully for important clues in order to better understand what a patient is saying. That way I can see emerging symptom patterns, analyse them, fillet out where my role lies and where someone else might be better able to help. Most importantly I am able to confidently explain the complexities of their situation back to the headache sufferer and help them make choices which suit them - it's their headache after all, and no one-size-fits-all approach can be used in headache management.
Many's the time I have seen someone diagnosed or self-diagnosed with one type of headache - be it tension-type, sinus or migraine, only to be able to ascertain fairly certainly that they actually have something else. This brings with it different treatment pathways, and the possibility of easing the deadlock of their pain as we work together to put the jigsaw together and see the whole picture. It also often involves looking in detail holistically at all aspects of their lives and sharing the evidence for simple natural interventions that have been shown to work. On other occasions it means writing to medical professionals on their own specialist territory, and having the "language of headaches" at our fingertips can be invaluable in gaining respect for our profession and help for our patients.
One thing that bothers me about all this is that fellow clinicians may feel that offering training in headache management appears to compartmentalise the issue. However, by the very nature of this all-encompassing body area, demanding skills in all aspects from biomechanical to psychological and neurological, scooping up sleep science and nutrition along the way, we are drawn into a truly holistic world. I have found it the reverse of compartmentalised - it spreads its long arms into all facets of human life, from the personal journeys of our patients, to the impact on their home lives, their need for advocacy at work, their ability to exercise and stay healthy, and ultimately to research funding and government policies.
To be perfectly honest, I found my in-depth studies very challenging - late night reading and early morning essay deadlines do nothing for family life, and it's not for everyone. After two years of leading the ESO student headache clinic though, I am convinced that with some solid CPD, we as a profession, (and musculoskeletal medicine professionals in general) could "up our game" considerably...the statistics on headaches in the community are staggering, and many sufferers might benefit from our help. I feel excited by the idea that we could become more skilled and more known in this rather hidden and somewhat untapped area of our work. Headaches are so often a side-conversation in our consultations, but headache specialists worldwide - even the WHO - want them to become more central to the conversation.
GOsC, with its evolving OPSs, require us to be able to lead our patients safely and collaboratively towards the best possible outcomes whatever their problems might be, with adequate knowledge, skills, excellent communication and professionalism. To this end, a team of passionate headache-skilled colleagues have met regularly and formed a non-profit special interest group in headache education called Osteopaths for Progress in Headaches and Migraines (OPHM): it is with both pride and humility that we dedicate its purpose to both the osteopathic and related professions for the benefit of our patients. Through delivering seminars and talks at the iO Convention and regional societies over the last two years, we have worked hard to create lectures and share skills that will be enjoyable to learn and immediately useful in practice. Longer term, we hope to raise funds for much-needed research for our work.
Please join us either as a learner or a teacher - preferably both! There is work to be done and our doors are open. The UCO have given us this wonderful opportunity to share our material with you, and we hope that we will fit hand in glove with the courses in C-spine risk assessment, concussion and cranial anatomy, pain science and OsteoMAP. I look forward to seeing a good turnout for our first ever UCO course."
Headache Management, 14-15 April, University College of Osteopathy, £218-£270. Book your place now.
Helena Bridge discusses the work with the ESO Headache Clinic, which she leads.