Watson Headache Institute

1st Wednesday June Q & A

It was great to see so many join us from Australia (Brisbane and Gold Coast), New Zealand and Chile for this session.

“Dean, my patient has a congenital fusion of C2-3. What’s your approach?”

This was the opening question to our Q&A. The discussion covered research showing that radiological examinations are unreliable and prone to false positives.

That aside, my approach would focus on C3-4 (± C0-C1) as the driver of the chain reaction, and then, to complicate the picture, add an anterolisthesis of C3 on C4.

Subsequently discussion turned to cognitive problems and brain fog after concussion or mild TBI, along with related rehabilitation. Thank you all for your helpful input and for continuing to support these sessions.

We also appreciate your generous feedback. Thank you.👏👏👏

Why Does Migraine Improve After Cervical Treatment?

Cervical treatment improving migraine symptoms isn't a contradiction, it's the nervous system demonstrating exactly how it works.

Have we been asking whether cervical input causes migraine, when the more important question may be whether it helps sustain neurological susceptibility?

To read more, please click on the link https://bit.ly/4wQArFh and go to OC3 in Headache Matters, Edition # 50 'Why Does Migraine Improve After Cervical Treatment?'.

Cervical Afferents: Are There Any Below C3?

This is a question that trips up a lot of clinicians and the answer matters more than you might think.

When we talk about cervical afferents and their role in headache, dizziness, and referred pain, the spotlight usually lands on C1, C2, and C3. And for good reason because the convergence of these upper cervical afferents with the trigeminal nucleus caudalis is well established.

But what about below C3?

The evidence suggests that afferent input from segments below C3 does reach the trigeminal nucleus but the clinical significance becomes less clear the further down you go.

The upper cervical spine remains the primary driver of cervicogenic symptoms, with C1–C3 being the key levels assessed and treated.

This is why assessment of the upper cervical joints is central to our clinical reasoning when patients present with:
Cervicogenic Headache
Dizziness or unsteadiness
Referred facial or head pain
Post-concussion symptoms

Understanding the anatomy and neurophysiology behind these afferents helps us ask better questions, examine more precisely, and treat more effectively.

What level do YOU find most clinically significant in your practice?

Drop it in the comments 👇

Australia ~ Connect With Our Practitioner Directory

If you are listed on the Practitioner Directory please tag below.

The Practitioner Directory is a resource to help members of the public, health professionals and past course attendees find Physiotherapists, Osteopaths and Chiropractors who have attended a Watson Headache® Institute Course having an interest in headache, migraine and associated conditions.

It is wonderful to have received feedback... "Thank you for updating the directory. I really appreciate all the support you provide for headache physios like us."

Practitioners listed have completed at least the Level 1 Foundation Online or In-Person Course and may have undertaken further training through Levels 2–4.

Visit the directory on our website, click link in the bio and go to Watson Headache® Institute Practitioner Directory to view practitioner listings and contact details.

𝘛𝘩𝘦 𝘗𝘳𝘢𝘤𝘵𝘪𝘵𝘪𝘰𝘯𝘦𝘳 𝘋𝘪𝘳𝘦𝘤𝘵𝘰𝘳𝘺 𝘪𝘴 𝘱𝘳𝘰𝘷𝘪𝘥𝘦𝘥 𝘧𝘰𝘳 𝘨𝘦𝘯𝘦𝘳𝘢𝘭 𝘪𝘯𝘧𝘰𝘳𝘮𝘢𝘵𝘪𝘰𝘯 𝘱𝘶𝘳𝘱𝘰𝘴𝘦𝘴 𝘰𝘯𝘭𝘺. 𝘐𝘯𝘤𝘭𝘶𝘴𝘪𝘰𝘯 𝘪𝘯𝘥𝘪𝘤𝘢𝘵𝘦𝘴 𝘢𝘵𝘵𝘦𝘯𝘥𝘢𝘯𝘤𝘦 𝘢𝘵 𝘢 𝘞𝘢𝘵𝘴𝘰𝘯 𝘏𝘦𝘢𝘥𝘢𝘤𝘩𝘦® 𝘐𝘯𝘴𝘵𝘪𝘵𝘶𝘵𝘦 𝘤𝘰𝘶𝘳𝘴𝘦 𝘢𝘯𝘥 𝘥𝘰𝘦𝘴 𝘯𝘰𝘵 𝘳𝘦𝘱𝘳𝘦𝘴𝘦𝘯𝘵 𝘦𝘯𝘥𝘰𝘳𝘴𝘦𝘮𝘦𝘯𝘵 𝘰𝘳 𝘨𝘶𝘢𝘳𝘢𝘯𝘵𝘦𝘦 𝘰𝘧 𝘤𝘭𝘪𝘯𝘪𝘤𝘢𝘭 𝘰𝘶𝘵𝘤𝘰𝘮𝘦𝘴.

Level 1 Foundation In-Person Course:

A huge thank you to everyone who attended our Level 1 Foundation In-Person Course: “Cervicogenic Headache and the Role of Cervical (C1–3) Afferents in Primary Headache.”

Held in Adelaide, South Australia from 29th–31st March 2026, thank you to everyone who attended for your energy, curiosity, and commitment to advancing your clinical skills.

When we asked you, "What motivated you to take this course?", the replies were:

"Exposure to a practitioner who has completed Level 3. Increase in headache and neck presentations in clinic."

"Great reviews from peers who’ve taken the course."

"To gain more insight into managing headache. To have more strategies to apply to assess, treat and educate headache clients."

"Interest in assessing/managing headache. Recommended by my clinic."

"Being able to effectively treat patients."

"Colleagues use Watson techniques and see amazing results. Highly recommended."

"Having seen patients with headache and received treatment from the approach.
To learn more about it in a structured way with clear directions as to where to go."

"Looking for a systematic approach to tackling headache and migraine."

"Feedback from colleagues and an interest in headache."

"To learn more about headache management."

"Wanting to take headache knowledge further with an increased number of patients."

We look forward to hearing how you apply new knowledge in practice!

We began the day in small groups with participants undertaking problem solving activities and collegiate conversations recapping on Day1's information.

👏 Well done to everyone for your active participation and willingness to challenge yourselves. We look forward to seeing these skills continue to develop on Day 3.

Preparing for our Level 1 Foundation In-Person Course today 29th-31st May 2026! 🌟

Excited to welcome registrants from Queensland, New South Wales, South Australia, and Hong Kong as we begin 3 days sharing in "Cervicogenic Headache and The Role of Cervical (C1-C3) Afferents in Primary Headache. 🙌

What's On in June 2026

Our 1st Wednesday of the Month Q & A will get underway at 8a.m. (ACDT) on 3rd June.

On the 4th Wednesday of the Month Q & A will be underway at 7p.m. (ACDST) 17th June.

Look out for emails straight into your inbox for the Q & A sessions with link if you are a past Level 1 Online or Level 1, Level 2 or Level 3 In-Person course participant.

Please join us if you have questions and conversations to share.

We also have a course scheduled:

Level 2 Consolidation In-Person Course 19th - 21st June 2026

'Interpreting Neck Findings In Migraine'

What if migraine pain isn’t only coming from the brain? This eye-opening perspective explores a surprising new angle that could change how we understand chronic headaches.

Could neck findings in migraine patients be more than coincidence — and are we overlooking an important part of the bigger picture?

Click the link to https://bit.ly/4v4xvmL Clinical Perspectives # 8 'Interpreting Neck Findings In Migraine' and discover the emerging clinical theory challenging traditional migraine diagnosis and opening the door to new conversations in patient care.

What is the Brainstem?

Dr Dean Watson PhD, Musculoskeletal Physiotherapist has mentioned the Brainstem many times over the years, but what exactly is it, and why is it so important in headache, migraine and co-morbid conditions?

The brainstem sits at the base of the brain, connecting the brain to the spinal cord. It acts as a major communication and processing centre, receiving information from structures inside the head, including blood vessels and pain-sensitive tissues, as well as from the upper neck.

The upper cervical spine, particularly the structures supplied by the top three spinal nerves (C1–C3), has a close neurological relationship with the head and face. Signals arising from the neck joints, ligaments, muscles, and surrounding tissues can converge with sensory information from the trigeminal nerve within the lower brainstem. This is one reason neck dysfunction and headache are often closely linked.

The brainstem also plays an important role in pain regulation. It is influenced by chemical messengers such as Serotonin and by the body’s internal pain-control systems, often referred to as descending pain modulation mechanisms. These systems help regulate how pain signals are amplified, suppressed, or interpreted.

Importantly, much of the sensory information related to headache and migraine passes through brainstem networks before reaching higher brain centres, where pain is consciously perceived and interpreted.

For this reason, the brainstem is considered one of the key processing centres in headache and migraine physiology. In many ways, it is the neurological “hub” through which headache-related information is filtered, regulated, and transmitted, not unlike the role a black box plays in helping us understand the workings of an aircraft.