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Myofascial Trigger Points and Headaches

20 Feb

A myofascial trigger point (TP) is a hyper-irritable area in skeletal muscle that is commonly detected by palpating (feeling with the fingers). Although more sophisticated ways exist for locating TPs—ultrasound, microdialysis, electromyography, infrared thermography, and MRI—palpation remains the most utilized due to its simplicity, efficiency, and low cost. For patients with migraine and tension-type headaches, TPs are commonly found at the base of the skull/upper neck, paraspinal neck muscles, the upper trapezius, and/or the levator scapulae musculature.

In one study that included 34 headaches sufferers (20 had migraine headaches without aura and 14 had tension-type headaches) and 34 non-headache controls, researchers looked at what happened when they used a specific technique to recreate the effect of a trigger point on muscles in the upper neck and in the arm.

When the researchers stimulated the upper neck, 8 of the 14 (57%) members of the non-headache control group, all 14 TTH subjects, and 19 of the 20 migraine sufferers reported headache-related symptoms. On the other hand, when the same technique was used on the arm of each participant, none reported headache-like symptoms.

The authors concluded that the high incidence and accuracy of headache reproduction from upper neck stimulation supports the importance of evaluation and treatment of trigger points in the upper neck region in those with TTH and migraine headaches. Doctors of chiropractic commonly perform manual techniques to the upper neck region and train their headache patients in identifying and self-managing TPs located in the upper neck muscles.

Several methods can be used to self-treat TPs in the upper neck region. Perhaps the easiest approach is to reach back with your thumb to the muscle attachments along the base of the skull and apply deep (but tolerated) pressure, feeling for areas that are most sensitive and sliding the thumb up/down and across the sore TP until it becomes less tender. Work the left side with the left thumb and vice versa. Doing the same with small head movements—up/down, left/right rotations, etc. helps.

Another method is to sit in a straight-back chair, slide down so that you cradle your upper neck over the top edge of chair back and then roll your head left to right. When you find a sore TP, add a nodding type of head motion while “digging in” over the chair-back edge (within tolerance) until it loosens and hurts less. If you suffer from headaches, your doctor of chiropractic can train you in these and other effective exercises and render treatment to improve cervical function that can be highly effective at reducing both the frequency and intensity of headaches.

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Headaches May Suggest a More Severe Concussion

13 Jan

Cervical dysfunction is often a cause or contributing factor of headaches, especially those that occur following a sports injury, slip and fall, or motor vehicle collision. The results of a 2019 study suggest that headaches may also indicate when a patient has a severe traumatic brain injury (TBI).

In the study, researchers asked 121 children with a history of TBI to fill out a questionnaire called the Sports Concussion Assessment Tool (SCAT). A higher score on the SCAT is indicative of a more severe TBI. Among the participants, the SCAT revealed that a third (40) reported headaches following their injury. When the researchers compared the SCAT scores of the kids with post-TBI headaches and those without headaches, they found that the participants who experienced headaches scored five times higher (median score 45.5 vs. 9). These children also performed worse on cognitive assessments involving color naming, matrix reasoning, letter sequencing, and letter switching.

The authors concluded that when headaches are associated with TBI, higher symptom scores (i.e. more severe symptoms) for ALL other symptom categories (sleep, mood, sensory, and cognitive domains) can be expected. In addition, those with headaches also tested worse on neurocognitive examinations.

Interestingly, a study that included a wider age range reported that headache “is consistently the most common symptom following concussion and occurs in over 90% of athletes with sport-related concussion,” which is much higher than the 33% found in the above- mentioned study.

Another study that analyzed information from two large databases found that patients who are hospitalized for headache symptoms associated with TBI are two times more likely to experience more frequent or worse headache symptoms over the following decade. Thus, the worse the initial TBI, the more likely headaches will persist or worsen.

These studies suggest that when an individual suffers a TBI from a sports injury, slip and fall, or car accident AND they have headaches, their condition may be more severe and may require more specialized care or intensive treatment to achieve a successful outcome. These injuries can also affect the cervical region, which may explain why patients with TBI benefit from many of the same treatment approaches doctors of chiropractic use to treat whiplash associated disorder patients.

 

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Spinal Manipulation and Headaches

19 Dec

Cervicogenic headache (CGH) refers to headaches caused by dysfunction in the neck, and experts estimate that 18% of chronic headache patients have cervicogenic headaches. Spinal manipulative therapy (SMT) is a form of treatment most commonly provided by doctors of chiropractic, and several studies have demonstrated that SMT is highly effective for patients suffering musculoskeletal disorders of the neck, including those with cervicogenic headaches. However, there remains little consensus on the appropriate number of SMT treatments to achieve maximum benefits for CGH.

In a 2018 study, a team of researchers conducted a large-scale study involving 256 chronic CGH patients to determine how many treatments are needed to achieve optimum results using SMT for CGH. The investigators randomly assigned participants to one of four dose levels (0, 6, 12, or 18 visits) of SMT for six weeks. The type of SMT consisted of a manual high-velocity, low-amplitude (HVLA) thrust manipulation in the cervical and upper thoracic regions. The location of the spinal adjustment was determined by a brief, standard spinal palpatory examination from the occiput to T3 to assess for pain and restricted motion. For older patients and/or those in acute pain, the manual therapy was modified to a low-velocity, low-amplitude mobilization. To control for visit consistency and provider attention, patients continued to receive a light massage treatment once a patient’s assigned number of visits was satisfied, until the six-week treatment period ended.

After the conclusion of the treatment phase of the study, the participants used a headache diary to keep track of their headaches for the next year. The results showed that the patients who received the most SMT treatments had fewer headaches over the following twelve months. More specifically, the researchers calculated that six additional SMT visits resulted in about twelve fewer days with headaches over the next year.

If you suffer from headaches, consider consulting with a doctor of chiropractic to determine if cervical dysfunction is a potential cause or contributing factor and whether you are a candidate for spinal manipulative therapy.

 

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Do Cell Phones Cause Horns?

21 Oct

It’s not hard to argue that nearly everyone spends too much time on their electronic devices, especially smartphones. You may be familiar with the terms “text neck” or “forward head posture”, but have you heard that excessive cellphone use may cause your body to grow horns?

If you reach around to the back of your head, just above the top of the neck, you should feel a bump in the midline. This is NORMAL, and it’s called the external occipital protuberance (EOP). The EOP serves as an attachment point for the nuchal ligament and the trapezius muscle, which function to keep the head upright and tilted backward. The size of the EOP normally varies (averaging around 5mm), depending on race, gender, genetics, and occupation.

A 2016 study revealed that an alarming number of young people had spurs (technically called enthesophytes) extending from the EOP, an occurrence associated with the wear-and-tear of osteoarthritis that can develop later in life. In the study, researchers reviewed x-rays of 218 men and women 18 to 30 years old who either had back pain, neck pain, or headaches or no history of such conditions. The research team observed an enlarged EOP (EEOP for short) in 41% of participants, regardless of the presence or absence of musculoskeletal pain. However, the data did show that EEOP was three-times more common in men than women.

The same study authors conducted a larger study in 2018 that included 1,200 adults of all ages and found that the combination of male gender, the degree of forward head protraction (FHP), and age predicted the presence of EEOP. Their results showed that being a young male with a greater amount of FHP lead to the formation of EEOP.

The researchers suspect that the age component of their finding (after all, the frequency and severity of degenerative skeletal spur formation typically worsen with age) may be due to young adults placing a greater mechanical load on their necks due to forward head posture caused by excessive device use.

The good news is that studies have demonstrated forward head posture can be improved with specific resistance and stretching exercises, monitoring your posture while using electronic devices, and reducing electronic device use. Your doctor of chiropractic can show you exercises that you can perform at home to reduce forward head posture.

 

 

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Migraine Headaches and Nutrition Approaches

15 Jul

People with migraines know all too well about that throbbing, pulsating, and nauseated feeling that accompanies their headaches and the associated disability that often results. The underlying cause of migraine headaches is still not well understood, but genetics (family history), chemical imbalances in the brain (serotonin, in particular), environmental factors (weather, allergens), and hormonal changes appear to play a part. Because medications to manage headaches can come with potentially serious side effects, especially with prolonged use, many patients opt for non-pharmaceutical treatment approaches to reduce the frequency and intensity of their migraines…

A 2018 survey of 4,356 American adults with a history of migraines found that common symptoms associated with migraines include sensitivity to touch (32%), food cravings (28%), and hallucinations (18%), which include sound and smell. The most common foods to trigger a migraine were chocolate at 75%, cheese (especially aged cheeses) at 48%, citrus fruit at 30%, and alcohol (especially red wine) at 25%. Other foods that may be triggers include cured meats, monosodium glutamate (MSG), aspartame (and other artificial sweeteners), snack foods, fatty foods, dairy products, food dyes, coffee, tea, cola, and nuts.

According to a 2019 study, people who suffer from migraines are often deficient in magnesium (Mg), a mineral naturally found in spinach, nuts, and whole grains. Magnesium is also important in regulating blood pressure, blood sugar (glucose), and muscle and nerve function. A meta-review of previous study findings revealed that migraine patients who received a Mg supplement reported reductions in both headache frequency and intensity. Other benefits included a decrease in hospitalization during pregnancy, and at a higher dose, a lower incidence of type-2 diabetes and stroke!

Another nutritional anti-migraine option includes the use of fever few (Tanacetum parthenium) for both prevention and treatment of migraine headaches. Other benefits of fever few include fever reduction, irregular menstrual cycles, arthritis, psoriasis, allergies, asthma, tinnitus, dizziness, and nausea/vomiting. There is also research support for the use of riboflavin (vitamin B-2), melatonin and coenzyme Q10 by migraine patients.

Doctors of chiropractic often manage their migraine headache patients using a multi-modal approach that includes cervical spinal manipulation and mobilization, physical therapy modalities, home exercise training, nutritional counselling (including supplementation advice), and other conservative treatment approaches based on the patient’s specific needs.

 

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Neck-Specific Exercise for Headaches & Neck Pain

13 Jun

As screens (televisions, computers, and smartphones/tablets) become an increasingly important part of daily life, many people gradually take on a more slumped posture, which can place added strain on the neck and shoulders, raising the risk for neck pain and headaches. Luckily, it’s possible to improve forward head posture, rounded shoulder posture, and scapular instability with neck-specific exercises and chiropractic care.

In a 2018 study, patients with forward head posture performed either scapular stabilization or neck stabilization exercises for 30 minutes three times a week for four weeks. Participants in both groups experienced improvements related to their craniocervical angle and muscle activity around the upper back and neck, with greater results reported by the scapular stabilization group.

Several studies have shown similar results for improving forward head posture using both scapular and neck stabilization exercises. In another study, high schoolers with forward head posture performed scapular and neck stabilization exercises and exhibited good posture up to four months later.

A 2019 study looked at the effect of a six-week intervention featuring manual therapy and/or stabilizing exercises on 60 women with neck pain and forward head posture. Participants in both the manual therapy/stabilization exercise-combo group and the stabilization exercises-only group reported better outcomes with respect to head posture, pain reduction, and improved function, but the results were best in the combined treatment group. The authors concluded that manual therapy adds a meaningful role to a structured exercise program that addresses scapular and neck instability and forward head and rounded shoulder posture.

Doctors of chiropractic often incorporate exercise training in their treatment recommendations, especially when postural issues may contribute to the patient’s symptoms, like neck pain and headaches.

 

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.