Tension Headache Flashcards
what is Tension Headache?
- A muscle-contraction type headache
- Tension headaches are headaches with muscular origins and are associated with trigger points and other myofascial pain syndromes
- Headaches are divided into primary and secondary conditions:
+ Primary headaches are those in which the headache is the condition
+ Secondary headaches are the result of an underlying pathology, such as hypertension or head trauma
Other Headaches with Muscular Origins
- Cervicogenic headache:
Describes a headache that is unilateral and frontal, arising from structures in the neck
- Spinally mediated headache:
Describes a headache with origins in trigger points (in muscles of the neck and thorax as low as the 10th thoracic vertebra), as well as in cervical facet joints, cervical interspinous ligaments and the cervical intervertebral discs
- Chronic Daily Headache:
+ A term used to describe chronic daily or near-daily headaches that are constant but with fluctuation in pain levels
+ There are often disturbances of deep, restorative sleep
+ Chronic daily headaches may consist of several types of head pain: tension headaches, post-traumatic headaches, migraines, drug-associated headaches
Causes of Tension Headaches
Causes of tension headaches are trigger points that refer pain into the head and neck
Predisposing Factors of Tension Headaches
- Predisposing Factors:
- Trigger point stimuli and perpetuating factors including trauma, acute muscle overload, infection, fatigue, chilling of the muscle, referred pain and emotional stress
- Sleep disturbance of deep restorative sleep. This is present with myofascial pain syndromes
- Postural imbalances such as hyperkyphosis, head-forward posture
- Temporomandibular joint dysfunction
Symptom Picture
- Pain is bilateral, diffuse and constant. It may be dull or vise like. The location of the pain is often in the referral pattern of trigger points in specific muscles
- Headaches begin in early childhood
- The frequency is variable; tension headaches may be episodic and may or may not have easily identifiable times of onset or end
- The duration of the symptoms is from 30 minutes to weeks. A chronic tension headache is one that lasts more than 15 days
- The onset of tension headaches is usually later in the afternoon after latent trigger points have been activated
- Associated symptoms are muscle tenderness and stiffness, hypertonicity in the affected muscles and loss of appetite
- Aggravating factors include stress, fatigue, cold, hypoglycemia and poor posture or decrease in ROM of the head and neck
- During the headache, the person wishes to rest, there is mild disability, but the person can usually function in ADL’s
Contraindications
- Do not work deeply during a tension headache
- Avoid vigorous techniques or deep pressure when treating hyperirritable trigger points, since “kick-back” pain may result
+ Kick-back pain is an recurrence of the client’s symptoms hours or days after treatment. This is especially true if ischemic compressions are applied too quickly and deeply, released too quickly and not followed by either a passive stretch and heat or slow, full AF ROM and heat
Health History Questions
- Does the client have a headache now?
- When was the onset of the present headache? If the client has a history of headaches, at what age did they begin?
- Was there a trauma to the head, neck or spine that may indicate a post-whiplash or post-concussion headache?
- Does the client have a temperature, transient rash or stiff neck, indicating possible meningitis
- Does the client experience sleep disturbances?
- What is the location and quality of of the pain? Does it refer anywhere?
- What are other symptoms? How frequent are they?
- What is the duration of the headache?
- What was the time of onset? Is this the same for recurring headaches?
- What relieves the headache?
- What aggravates the headache?
- Does the client take medication for this condition, including prescription drugs, over-the-counter medication, herbal preparations or supplements?
- Are there any underlying pathologies such as FM, DDD, OA of the cervical spine or dental abnormalities?
- Has the client suffered a recent cold or influenza?
- Is the client using parallel therapies?
Assessment
- Observations:
A full postural assessment looking for head-forward posture, hyperkyphosis, hyperlordosis, scoliosis or pes planus
- Palpation:
- The neck, shoulder and thoracic muscles and muscles of mastication may be hypertonic and tender. The muscles of respiration are also likely to be hypertonic
- Ischemia produces areas of coolness in the skin of the neck or thorax with trigger points and with spinally mediated headaches
Testing
- AF and PR ROM are performed on the neck, thorax, shoulder and mandible
- AR strength testing may reveal the affected neck, head and shoulder girdle muscles to be weaker
Massage: During Headache
- The treatment is in the context of a relaxation massage
- Pre-treatment hydrotherapy is heat to the affected muscles
- Positioning is prone or supine, although prone may not be tolerated due to pressure on the face
- Treatment goals are to reduce SNS firing, pain, hypertonicity, TPs and joint dysfunction and to increase ROM and tissue health
Some common trigger point patterns:
- Upper trapezius refers above the eye, around the ear and down the lateral neck in the shape of a question mark
- Splenius capitis refers to the top of the head
- Splenius cervicis refers to the temporal region and back of the neck
- Occipitals sends pain to the posterior head
- Frontalis refers locally above the eye
- Suboccipitals refer pain around the ear
- SCM refer to the ociput, around the eye, into the ear and across the forehead
- The occipitofrontalis muscle refers above the eye and the back of the head
- Masseter refers above the eye and into the ear, jaw and teeth
- PIR is used to gently increase ROM at the neck
- PROM, gentle long axis traction or GTO release to the occiput
Massage: Between
Headache
- Treatment goals are to reduce SNS firing, hypertonicity, TPs and joint dysfunctions as well as to increase ROM and tissue health
- Treatment is similar to that which is performed during a headache, except that the therapist can be more vigorous
- Areas of restricted ROM are addressed using joint play and fascial techniques
Self Care
- The client should rest from activity following the treatment of trigger points
- A hot bath or other hydrotherapy application is indicated for the affected muscles after TP therapy
- Diaphragmatic breathing
- Self massage
- Repetitive slow, full, pain-free stretches or active free ROM to the affected muscles
- Strengthening exercise for weak muscles
- Perpetuating factors should be reduced or eliminated
- Sleeping in the prone position is avoided as this stresses the neck muscles and facet joints
