Kinetic Health - Calgary: tension headaches

Showing posts with label tension headaches. Show all posts

Tuesday, June 22, 2010

Resolving Tension Headaches Part - 4

Treatment of Tension Headaches

To resolve Tension Headaches it is essential that we remove all physical restrictions throughout the body’s Kinetic Chain. This would include restrictions in your shoulders, neck, jaw, skull, and perhaps other affected areas. In other words, wherever we find restrictions that may be initiating a physical cascade of events that will eventually cause physical or biochemical changes resulting in a headache. This will include:

Soft tissue adhesions – These will be found in muscles, ligaments, tendons and connective tissue. Anywhere that a change in tissue texture, tension, movement or function is noted.
Peripheral nerve entrapments – Besides the actual tension headache, nerve entrapment symptoms include: paresthesisas or abnormal neurological sensations which include: numbness, tingling, burning, prickling, hyperesthesia (increased sensitivity) and muscle atrophy.

It is extremely important to recognize that if we are only dealing with the headache on a pharmaceutical basis we have not addressed the chronic chain of events that perpetuates the headache.

There is a considerable amount of research in the literature to support this perspective. Even a change in posture can greatly affect the prevalence of a tension headache.

Research has demonstrated that tension or weakness in any of the following areas will cause an increase in both the intensity and frequency of tension headaches.

Examples of Anterior Structures:

Examples of Posterior Structures:

Our clinical experience has shown that the majority of chronic tension headaches can be completely resolved or substantially reduced by using soft tissue therapy (Active Release Techniques, Graston Techniuqe, Massage therapy) in conjunction with the correct exercise program.

These treatments, in conjunction with appropriate exercise and life style management changes, can prevent headaches from returning. Occasionally short term pharmaceutical intervention may be necessary, but in most cases this can be avoided when dealing with tension headaches.

If you would like more information or to purchase our books please go to www.releaseyourbody.com .

If you would like information about our clinic in Calgary Alberta please go to www.kinetichealth.ca.

(COPYRIGHT KINETIC HEALTH 2012 – ALL RIGHTS RESERVED)

References:

Forward head posture and neck mobility in chronic tension-type headache: a blinded, controlled study. Fernandez-de-las-Penas C, Alonso-Blanco C, Cuadrado ML, Pareja JA. Cephalalgia. 2006 Mar;26(3):314-9. Department of Physical Therapy & Occupational Therapy, Physical Medicine and Rehabilitation of Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.
Headache in patients with neck-shoulder-arm pain of cervical radicular origin. Persson LC, Carlsson JY. Headache. 1999 Mar;39(3):218-24. From the Department of Neurosurgery, Lund University Hospital, Sweden.
Neck flexor muscle fatigue in adolescents with headache: an electromyographic study.Oksanen A, Poyhonen T, Metsahonkala L, Anttila P, Hiekkanen H, Laimi K, Salminen JJ.Eur J Pain. 2007 Oct;11(7):764-72. Epub 2007 Feb 8. Department of Physical and Rehabilitation Medicine, Turku University Central Hospital, FIN-20521, Turku, Finland.
Myofascial trigger points and their relationship to headache clinical parameters in chronic tension-type headache. Fernandez-de-Las-Penas C, Alonso-Blanco C, Cuadrado ML, Gerwin RD, Pareja JA. Headache. 2006 Sep;46(8):1264-72. Universidad Rey Juan Carlos, Physical Therapy, Alcorcon, Madrid, Spain.
Referred pain from trapezius muscle trigger points shares similar characteristics with chronic tension type headache. Fernandez-de-Las-Penas C, Ge HY, Arendt-Nielsen L, Cuadrado ML, Pareja JA. Eur J Pain. 2007 May;11(4):475-82. Epub 2006 Aug 21. Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation of Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.
Trigger points in the suboccipital muscles and forward head posture in tension-type headache. Fernandez-de-las-Penas C, Alonso-Blanco C, Cuadrado ML, Gerwin RD, Pareja JA. Headache. 2006 Mar;46(3):454-60. Department of Physical Therapy, University Rey Juan Carlos, Madrid, Spain.

Resolving Tension Headaches Part - 3

Biochemical Changes

If we review the literature on tension headaches there is no doubt that tension headaches are associated with changes in the levels of certain brain chemicals such as serotonin, bradykinins, and substance P.

Serotonin acts as a chemical messenger that transmits nerve signals between nerve cells. It also causes blood vessels to narrow.
Bradykinins mediates the inflammatory response, increases vasodilatation (expansion of arteries and veins), and causes contraction of smooth muscle.
Substance P functions as a neurotransmitter, especially in the transmission of pain impulses from peripheral receptors to the central nervous system.

The question is, are these chemical the initial factor that created the headache or are they a secondary consequence of physical restrictions. In my opinion, the physical changes probably took place first; which in turn caused a cascade of events that eventually increased, or altered, the levels of these chemicals.

Support for my perspective comes from what is called central sensitization. Central sensitization has been hypothesized as one of the primary mechanisms of chronic pain conditions. Central sensitization occurs when pain receptors in your nervous system (nociceptive neurons) become sensitized by tissue damage or inflammation.

By damage, I am not just referring to some type of trauma like a motor vehicle accident. I am also referring to damage caused by:

The micro trauma of repetitive strain injuries.
Stress caused by muscle imbalances.
Long-term stress placed on your body by poor posture.
De-conditioned muscles.

All these causes can produce areas of hyper-tonicity (increased tension) in our bodies that become chronically restricted; such as that huge knot most people have in their shoulders or the one just under the base of their skull.

When these hypertonic tissues becomes irritated or inflamed it releases chemical mediators (bradykinin, serotonin, substance P), which cause a sensitization of nerve endings resulting in pain, tension, and the production of headaches. If we review the history of most patients who suffer from tension headache we will routinely find a source of initial tissue damage (accident, trauma, history of tension) and associated inflammation which causes biochemical changes that elicit headaches.

Myofascial trigger points and sensitization: an updated pain model for tension-type headache Fernandez-de-las-Penas C, Cuadrado ML, Arendt-Nielsen L, Simons DG, Pareja JA. Cephalalgia. 2007 May;27(5):383-93. Epub 2007 Mar 14. inDepartment of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Madrid, Spain.

Stress-induced pain and muscle activity in patients with migraine and tension-type headache. Leistad RB, Sand T, Westgaard RH, Nilsen KB, Stovner LJ. Cephalalgia. 2006 Jan;26(1):64-73. Department of Neuroscience, Norwegian University of Technology and Science and Department of Neurology and Clinical Neurophysiology, St Olavs Hospital, Trondheim, Norway.

In part four of “Resolving Tension Headaches” we will cover some viable treatment options.

Monday, June 21, 2010

Resolving Tension Headaches Part - 2

Nerve Compression

Nerve compression is a major factor in the initiation and perpetuation of tension headaches. If we look at the pathway of different peripheral nerves that transect, or pass under, musculoskeletal structures (muscles, ligaments, tendons, connective tissue) it is easy to see how nerve compression can create a tension headache.

o Superior obliques

o The Suboccipital nerve supplies input to the muscles of the suboccipital triangle. Compression of this nerve can occur at the superior oblique.

o A trigger point in the superior oblique muscle itself will also refer pain to various regions of the head.

Referred pain from the trochlear region in tension-type headache: a myofascial trigger point from the superior oblique muscle. Headache 2005 Jun;45(6):731-7. Fernandez de las Peñas C, Cuadrado ML, Gerwin RD, Pareja JA.

o Semispinalis (capitis, cervicis)

· The greater occipital nerve is located directly under the semispinalis capitis. Compression of this nerve is one of the causes of cervicogenic headaches. The symptoms from these headaches are called occipital neuralgias.

· Occipital neuralgia is a medical condition characterized by chronic pain in the upper neck, back of the head and behind the eyes. This is sometimes known as C2 neuralgia or Arnold’s neuralgia.

o SCM (Sternocleidomastoid )

§ The lesser occipital nerve and the greater auricular nerve both pass by the SCM. Compression of these nerves will give symptoms of occipital neuralgia.

o Trapezius (upper fibers)

· The third occipital nerve travels under the trapezius muscle until it pierces this muscle and ends up in the lower part of the head (occiput). Compression of this nerve also causes occipital neuralgias.

In Part Three of Resolving Tension Headaches we will continue with causes of tension headaches.

Resolving Tension Headaches Part 1

Approximately 90 percent of headaches originate as tension headaches. Medical experts continue to debate over the causes of tension headaches. In my opinion, 90% of tension headaches are either caused by mechanical factors or are perpetuated by them. In other words, most ongoing, chronic, tension headaches can be attributed to specific physical restrictions. These are restrictions in muscles, ligaments, tendons, and connective tissues which cause nerve impingement syndromes, vascular changes, and the output of biochemical substances that affect pain centres. Photo from BodyWorlds exhibit Edmonton Alberta (Special Permission granted).

Symptoms of Tension Headaches

Tension headaches usually last from half-an-hour to an hour but they can continue to return for weeks, and in chronic cases, last for years. People who suffer from tension headaches often describe their headache as a dull ache, or they may experience them as a band of tightness around the sides of their head. This band may even feel like a vice compressing their skull. In severe cases the pain may even feel like a hooded cape that drapes over and across the shoulders. Obviously in such severe cases more than just the head is involved in creating the pain syndrome.

The following is a list of some of the common symptoms of tension headaches:

Band like pressure around the head.
Difficulty concentrating.
Difficulty sleeping (insomnia).
Fatigue and irritability.
Loss of appetite.
Neck, jaw/TMJ, or shoulder discomfort.
Severe pain behind the eyes.
Tenderness of the scalp.

Muscle pain in the head: overlap between temporomandibular disorders and tension-type headaches. Svensson P. Curr Opin Neurol. 2007 Jun;20(3):320-5. Department of Clinical Oral Physiology, School of Dentistry, University of Aarhus, Denmark. psvensson@odont.au.dk

You can usually differentiate a tension headache from other types of headaches because there are many symptoms you will not experience. For example, tension headaches do not cause visual disturbances, nausea, vomiting, numbness on one side the body, or slurred speech.

Triggers for Tension headaches

Tension headaches are triggered by numerous causes. Some of the potential triggers include:

Anxiety (including several medications used for reducing anxiety).
Arthritis
Clenching or grinding teeth (bruxism).
Dental Work.
Depression (including medications used for depression).
Holding one position for a long time, or working in awkward positions.
Inflammation of the neck or shoulders.
Lack of sleep or insomnia.
Lack of physical activity.
Overuse of headache medication (3rd most common cause of headaches).
Poor posture.
Stress.
Trauma.
Whiplash injuries (hyper-extension hyper-flexion injury)

In Part two of Resolving Tension Headaches we will cover causes of tension headaches.