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In this third installment on headaches, we’ll be discussing how massage and trigger point therapy to key muscles in the neck and face can help diminish the effects of a headache.

Massage

If you consider the fact that 90% of all headaches are tension related in some way, then reducing tension levels, whether it be physical or psychological, should provide relief for a vast majority of people. Even those suffering from chronic migraines, cluster headaches, and new daily persistent type headaches are greatly affected by excessive tension in the muscles of the head and neck. It’s no secret that maintaining a healthy lifestyle with a balanced diet, plenty of exercise and sleep will go a long way in reducing stress levels. There may however be other factors at play that could be contributing to your headache. Factors such as postural imbalances, repetitive movements, strained sleeping positions, cervical arthritis, or even whiplash – all of which could be at the root of tight muscles. The one thing all these factors have in common though, are trigger points. Trigger points develop in strained or chronically tight muscles and are often the hidden and undetected cause of most headaches. There are close to 26 pairs of individual muscles in the neck and over 30 pairs of muscles in the face, all of which could be harboring trigger points! The work of Travell & Simons has shown that trigger points are the ‘operational element’ in most headaches stemming from physical trauma and emotional tension. The irony however, is that most headaches arise from trigger points found in the jaw, neck and upper back muscles! Knowing this saves a lot time and energy, but it also allows for a more focused and effective treatment plan. Now, let’s take a look at the key players.

There are four primary muscles in the head and neck that refer pain to the temples, forehead and jaw, and play a significant role in the development of headaches. The first two muscles, the trapezius and the sternocleidomasoid (SCM), are considered neck muscles (segments of the trapezius are also considered upper back and shoulder muscles). The other two, masseter and temporalis, are jaw muscles and are located on the face and head.

Trapezius:

Trapezius Trgr PtThe trapezius is a flat, broad upper back muscle that functions to move the neck and shoulders. It also helps to support the weight of the head and is therefore particularly susceptible to postural imbalances, which can put undue strain on the muscle. A trigger point in the upper part of the trapezius is one of the primary causes of temporal headaches. The referral pattern of this trigger point includes the back of the head, sides of the temple, and angle of the jaw. It’s also been known to setup up satellite trigger points in these areas, which can lead to a deep pain behind the eye, toothaches, and TMJ. Stress and emotional tension can often keep this muscle constantly contracted and elevated on some people — as can wearing a heavy backpack or purse, a forward head posture, or tight pectoral muscles. Trigger points in the middle and lower half of the traps will often refer pain to the back of the neck.

Sternocleidomastoid (SCM):

SCM Trgr PtsThe sternocleidomastoid muscle, or SCM for short, derives its name from its points of attachment. The two branches of the muscle attach on the sternum, clavicle, and mastoid process — which is located behind the ear. Although these muscles rarely hurt themselves, trigger points found in the SCMs are usually at the root of frontal headaches and pain located on the face. This muscle serves several purposes. Much like the upper traps, it functions to rotate and laterally flex the head to the side, and is an accessory breathing muscle — helping to elevate the ribcage during inhalation. Its very functions however, make it susceptible to postural imbalances such as, a forward head posture, and shallow upper respiratory breathing arising from emotional and/or psychological tension. Triggers points in the SCM can also be a leading cause of a painless, stiff neck; a deep pain behind the eye, ear, and back of the head; tongue pain when swallowing; and a contributing factor in TMJ pain. Unfortunately these muscles are rarely worked on, despite their wide and primary effects.

The other two muscles are located on the head and face. Masseter is a chewing muscle found along the angle of the jaw, which provides the jaw with most of its power. Trigger points in masseter can restrict the opening of the jaw and lead to pan in the upper and lower teeth. It’s also one of the leading factors in the development of TMJ. Its referral pattern includes many points on the face such as, the cheek, above the eyebrow, along the jaw, deep in the ear, and can on occasion mimic the symptoms of sinusitis. Pain arising from masseter trigger points can be an underlying cause of frontal headaches. Temporalis, like masseter, is a chewing muscle. This flat muscle is located on the sides of the head just above the ears. Trigger points in temporalis refer pain to the area above the eyes and upper lips. They contribute to the formation frontal and temporal headaches and can sometimes lead to hypersensitivity in the upper teeth.  

Another set of muscles worth mentioning are the suboccipitals. These two pairs of four, short, individually named muscles are located at the base of the head and the very top of the neck. Pain from trigger points in the suboccipitals can feel like a band of tightness inside the head, starting at the back of the head and leading to the eye and forehead. This type of pain is commonly associated with migraine headaches. The suboccipitals are particularly vulnerable to emotional tension, as well as the effects of satellite trigger points coming from the trapezius. Research has discovered that one of these short muscles not only attaches to the occiput, but to the dura mater – the connective tissue that covers the brain. In light of this connection, it’s speculated that increased tension in this muscle can disrupt the normal fluctuations of cerebrospinal fluid and lead to headaches.

In some cases, focused work on these key muscles alone can have the added benefit of deactivating satellite trigger points that fall in their referral patterns. However, this is not always the case, especially in the more severe and long-term cases. The cascading effects of trigger points are one of the main reasons why some of them are so persistent and easy to miss. But once they are systematically treated and deactivated, relief is usually not far behind.

In the next and final post, we’ll see how reflexology to particular reflexes found in the hands and feet can help with headaches.


joe-azevedo2Joe Azevedo is a New York State/NCBTMB Licensed Massage Therapist, ARCB Certified Reflexologist, and an Advanced Reiki Practitioner. He is a graduate of the Swedish Institute and is the owner and founder of Brooklyn Reflexology.

Now let’s take a look at cluster headaches and new daily persistent headaches. Although relatively rare by comparison, they are nevertheless considered primary headaches.

Cluster Headaches (CH):

Cluster headaches are unilateral, vascular headaches of short duration that occur over a period of time. The pain is usually centered behind one eye (although it can also be felt in the temple, ear, neck or face) and is often described as an intense, burning, or piercing (not throbbing) pain. Cluster headaches have a sudden onset and can be extremely painful, often leading to watery eyes, a runny nose, and reddening of the skin on the affected side of the face. They can last anywhere between 10 minutes to 2 hours and reoccur 2-3 times a day for a period of 5-6 weeks (cluster). Attacks can occur at the same time, every day and are very common at night leaving you feeling restless. A person may have a pain-free period of weeks, months, or even years in some cases, before the next cluster occurs.

Causes:

There are no known causes for cluster headaches, but research has speculated that they may be due to a sudden release of histamine and serotonin in the brain. Abnormalities have also been detected in the hypothalamus during a cluster headache. Some perpetuating factors may include stress, overwork, and emotional trauma. In some cases medical intervention may be necessary as a means of managing the pain and stress of these reoccurring headaches.

Incidence:

Although cluster headaches are relatively rare, affecting 1 in 1000 people, they are most prevalent in men ages 20-50. They affect men more than women at a ratio of 8:1

New Daily Persistent Headache (NDPH):

Another form of primary headache worth mentioning is the “new daily persistent headache” or NDPH for short. Although relatively rare, occurring in 1 out of every 3500 people between the ages of 30-44, it is considered a primary headache syndrome with no underlying cause. NDPHs are classified as a form of chronic daily headache which is present for more than 15 days a month and for as least 3 consecutive months. It has an acute onset and typically occurs in people with no past history of headaches. The pain can be a dull, pressure-like sensation that affects both sides of the head but can also be unilateral in its presentation — being localized to one particular area of the head. The pain can fluctuate in intensity but is usually unremittant and daily.

NDPHs can be mistaken for other forms of chronic daily headaches (CDH) such as, chronic migraines (CM) and chronic tension-type headaches (CTTH) and can share similar symptoms. There are however a few key features that set them apart. Onset is usually abrupt and acute. People who suffer from CMs and CTTHs have a history of headaches and can often tell when a headache is about to come on, NDPH sufferers cannot. NDPH sufferers however can tell you the exact day their headache started. This is a signature sign of NDPHs. The pain begins acutely and reaches its peak within 3 days. The pain is not usually aggravated by routine physical activity,  although it can get worse throughout the day.

Diagnosis of NDPHs can be difficult and must first rule out secondary causes which could mimic its symptoms. Such secondary causes may include a cerebrospinal fluid leak, cerebral venous sinus thrombosis or minor head trauma. An MRI or CAT scan can rule out these conditions.

Causes:

As previously mentioned, NDPHs have no underlying cause but have been known to coincide with viral infections (i.e. Epstein-Barr, Lyme Disease, Herpes Simplex), flu-like illnesses, sinusitis, stressful life events, or minor head traumas, just to name a few. They have also been associated with medication over-use, which often leads to an analgesic rebound and a resultant headache. NDPH sufferers are particularly vulnerable to medication over-use as they try to manage the pain of their daily headaches.

Incidence:

NDPHs occur 2.5 more times in women than they do in men.

Conclusion:

Conventional treatments such as over the counter medications (OTC) and non-steroidal anti-inflammatory drugs (NSAIDs) may include: aspirin, ibuprofen (Motrin, Advil), acetaminophen (Tylenol) and naproxen (Aleve). These are most commonly prescribed for tension-type headaches and some mild forms of migraine. Triptans and Ergots have been prescribed for those with severe, chronic forms of migraine. They constrict blood vessels and block pain pathways in the brain, but are not without their precautions and side effects. Most migraine sufferers learn to avoid triggers, such as stress, scents, loud noise, bright lights and certain foods that might set off a migraine. Cluster headaches are often treated with vasoconstrictors, oxygen inhalers and corticosteroids. NDPH sufferers have had successful treatments with Neurontin (gabapentin) and Topomax (topiramate) in cases that have lasted more than a few months.

Although these treatments may provide symptom relief and in some cases may be essential in managing the pain of a severe headache, caution should be used when using any drug or medication over a long period of time. Medication overuse headaches (MOH), commonly referred to as rebound headaches, can be a byproduct of an over-reliance on pain medication. The liver and kidneys are particularly susceptible to the effects of medication overuse. If you suffer from chronic headaches of any form, you may be well advised to consult your doctor. Keeping a ‘headache journal’ may be helpful in detecting patterns or triggers. Eliminating certain stressors, foods, or activities may go a long way in preventing your next headache.

 In the third post of this series, we’ll begin to discuss the benefits of an holistic approach to headache relief — namely massage and trigger point therapy.


joe-azevedo2Joe Azevedo is a New York State/NCBTMB Licensed Massage Therapist, ARCB Certified Reflexologist, and an Advanced Reiki Practitioner. He is a graduate of the Swedish Institute and is the owner and founder of Brooklyn Reflexology.

We’ve all suffered through a headache at some point in our lives. Some may get the occasional headache as a result of stress, illness, lack of sleep, or even caffeine withdrawal. Others may experience much more severe and episodic headaches that can be excruciating and extremely debilitating. Headache disorders are considered the most common disorder of the nervous system. Headaches are so common in fact, that the World Health Organization (WHO) has estimated that nearly half to three quarters of adults (18-65) worldwide have experienced a headache in the past year. In this four part series on headaches we’ll discuss the three main classifications of a headache, four different types of headache, and finally how massage and reflexology can help.

According to the International Headache Society, headaches are classified into three categories: primary headaches, secondary headaches, and cranial neuralgia/facial pain and other headaches.

Primary Headaches such as tension-type heaches (TTH) and migraines are among the most widely reported forms of headache. Cluster headaches (CH) and  new daily persistent headaches (NDPH) although less prevalent, are also considered primary in nature. These headaches typically exist independent of any medical condition or underlying cause.

Secondary Headaches are usually the result of some underlying cause or condition. Secondary headaches can be a symptom of things such as caffeine withdrawal, smoking, and alcohol consumption (hangover). Some common types include, sinus headaches and medication overuse headaches (MOH). They can on occasion be a symptom of a much more serious nature, such as a stroke or concussion.

Cranial neuralgia/facial pain and other headaches are the result of irritation or inflammation of one of the 12 cranial nerves that supply the head and neck. The most frequent example is trigeminal neuralgia, which affects the 5th cranial nerve.

Now that we’ve familiarized ourselves with these classifications, let’s take a closer look at  four different types of primary headache.

Tension-Type Headaches (TTH):

Also known as muscle tension or fibrositic headaches, tension-type headaches are by far the most common type of headache and account for nearly 90% of all headaches. The pain is usually bilateral, starting at the back of the head and neck then spreading to the temples and forehead. The pain can be a dull, persistent ache and feel like a band of tightness encircling the head. TTH are not usually debilitating but can be worse in the evening.

Causes:

-Chronic muscle tension

-TMJ Syndrome

-Neck/Jaw trigger points

-Psychological or physical stress

-Irritation of the cervical spine

-Sleep deprivation

-Grinding of the teeth (Bruxism)

-Injury to the coccyx or sacrum

 -Hunger

Other contributing factors:

-Mental or visual strain

-Holding your head in a fixed position

-Bright lights

-Strained sleeping position

-Noise

-Prolonged exposure to cold

Incidence:

80% of women and 67% of men are affected

Migraine Headaches:

The second most common form of headache, migraines are exceedingly painful events often accompanied by nausea, vomiting, blurred vision and hypersensitivity to light and noise. The pain is often described as a throbbing (not burning or piercing) type of pain that affects one side of the face. Some may experience pain bilaterally or behind one eye. Migraines are classified as a neurovascular disorder but their true cause is unknown. Some possible theories include, ‘leaky’ blood vessels, decreased serotonin levels, and involvement of the extra cranial nerves.

There are two main types of migraines: Classic migraines and Common migraines. They both share similar symptoms, however the classic migraine is accompanied by an aura.

There are four phases to a migraine. The first phase is known as the prodromal phase. This phase can occur hours or days before the onset of the migraine. Irritability, depression, fatigue, stiff muscles are some common precursors. The second phase, known as the aura phase (not present in common type migraines), immediately precedes the headache. Changes in vision such as flashing lights, dark spots, and double vision are often reported. The feeling of ‘pins and needles’ across the hand, arm and face followed by numbness is not uncommon. A person may experience confusion, trouble concentrating or may have difficulty communicating. In the third phase, the attack phase, the pain commences and can last anywhere from a few hours to a few days.  During this phase of the migraine, a person may be unusually sensitive to lights, sounds, and smells and for this reason may choose a quiet, dark, distraction-free environment to rest. Physical activity can often make the pain worse. The pain may be so intense as to cause light-headedness, nausea and vomiting in some. The postdromal phase is the final phase and can last a couple of days after the headache has subsided. A person may be left feeling sore, tired, weak or moody.

Causes:

Although there no known causes, there are some possible triggers for migraines:

-Hormonal or chemical triggers that occur during puberty, menses, and menopause

-Foods containing tyramine such as in wine, beer, and cheese

-Emotional and physical tension

-Allergic hypersensitivity

-Viral infections

-A family history

Incidence:

Migraines affect nearly 8 million people in the U.S.

18% of women and 6% of men are affected

In the next post we’ll discuss cluster headaches and new daily persistent headaches, as well as some conventional forms of relief.


joe-azevedo2Joe Azevedo is a New York State/NCBTMB Licensed Massage Therapist, ARCB Certified Reflexologist, and an Advanced Reiki Practitioner. He is a graduate of the Swedish Institute and is the owner and founder of Brooklyn Reflexology.

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