Constant/Reoccuring Headache Pain

• Understanding the pain
• A Caution about headaches
• The true source of the pain
• Tension-type Headaches - why do they happen?
• How to Identify a Tension-Type headache
• How can Orthopedic Massage Help?

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Do you have constant/reoccurring Headache Pain?   

        A headache  (cephalalgia in medical terminology) is a condition of pain in the head;  sometimes neck or upper back pain may also be interpreted as a headache.  It ranks amongst the most common local pain complaints.

·       An estimated 28 million people in the United States (about 12% of the population) will experience migraine headaches. (Affecting children as well as adults.)

·       As many as 90% of adults have had or will have tension headaches.

·       In 2004, the percentage of adults who experienced a severe headache or migraine during the preceding 3 months decreased with age, from 18% among persons aged 18--44 years to 6% among persons aged >75 years.

·       Combining every age group showed that the proportion of women who experienced severe headache or migraine was greater than that of men. (Over 25% women, over 10% men.)

 SOURCE: 2004 National Health Interview Survey.

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Understanding the pain of a headache: 
    Although many factors and symptoms are often involved in a headache, they are usually classified into one of two types:  Primary Headaches and Secondary Headaches.
    Primary Headaches are not caused by other diseases.  Examples include myogenic (muscle tension, tension-type), vascular (migraine, cluster), cervicogenic (disorders of the neck), etc. 
    In fact, an American Medical Association study illustrates that muscle contraction headaches, also known as tension-type headaches, comprise about 90% of all headaches.
    Secondary headaches are caused by an associated disease.  The associated disease may be minor, serious, or life threatening.  Examples include serious and life threatening conditions such as brain tumors, strokes, and meningitis to less serious but common conditions such as withdrawl from caffeine and discontinuation of analgesics. 
 

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A Caution about headaches:

While statistically headaches are most likely to be harmless and self-limiting, some specific headache syndromes may demand specific treatment or may be warning signals of more serious disorders, including particularly sudden, severe headache or sudden headache associated with a stiff neck; headaches associated with fever, convulsions, or accompanied by confusion or loss of consciousness; headaches following a blow to the head, or associated with pain in the eye or ear; persistent headache in a person with no previous history of headaches; and recurring headache in children. It is important to receive medical attention for all these types of headaches.  Also, because there is a chance that a sudden severe headache could indicate an emergency, if you ever experience head pain unlike anything you’ve experienced before, seek medical help immediately.

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 “Where does the pain of a headache really come from?”

The brain itself is not sensitive to pain, because it lacks pain-sensitive nerve fibers. Several areas of the head can hurt, though, including a network of nerves which extends over the scalp and certain nerves in the face, mouth, and throat. The meninges, blood vessels, and muscles are the areas with pain perception. Headaches often result from traction to or irritation of these meningesm, blood vessels, and muscles of the head.

Chronic headache sufferers know that many things can trigger a tension-type headache.  These multiple triggers can include diet, stress, poor posture (due to extra time at work in front of the computer, extra driving, bad lifting habits, etc.), lack of sleep, a new allergy, and/or allergy season (and the increased sinus pressure).  These triggers can result in an irritated nerve, a misaligned vertebrae, or over-stretched (hypertonic) muscles in and around the neck and shoulders.

Since multiple factors often combine to produce chronic headaches, a multifaceted approach may be the most effective treatment.  On the whole, long-term use of painkillers is discouraged as this may lead to "rebound headaches" on withdrawal.  Some forms of headache, such as migraines, stress-related headaches, and headaches due to chronic muscle tension may be amenable to preventative treatment.  Therapeutic massage (Orthopedic Massage) is one approach that has been shown to reduce and even prevent headaches, and could play a vital role in your treatment plan.

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Muscle contraction /  Tension-type  headaches :  Why do they happen? (Tension headaches, were renamed tension-type headaches by the International Headache Society in 1988.)

When neck and jaw  muscles become  dysfunctional or tight  due to sudden trauma (muscle and ligament injuries in the neck often cause referred pain to the head, which is experienced as a headache. Muscles tension and scar tissue in injured areas can limit movement, restrict blood flow and cause trigger points) or gradual onset (from repetitious activities such as long daily hours working at a computer), this compresses the occipital and trigeminal nerve - both of which radiate into the head, neck, face, jaw, and teeth.  The end result is pain and inflammation in both neck and head.  This occipital nerve is the most common nerve to cause headaches.

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So how can I tell if it is a tension-type headache?

Tension-type headache pain is often described as a constant pressure, as if the head were being squeezed in a vise. The pain is frequently present on both sides of the head at once. Tension-type headache pain is typically mild to moderate, but may be severe.  They can last from minutes to days or even months, though a typical tension headache lasts 4-6 hours.

        The pain can radiate from the neck, back, eyes, or other muscle groups in the body, and originates from tight, contracted muscles and trigger points (irritable spots that refer pain elsewhere) in the neck, head, and shoulders.

Pain arising from tension in the neck can often be identified by pressing with one's hand against the forehead (which reduces the tension placed on the muscles at the back of the neck).  If this lessens the pain, it suggests that muscular tension in the neck is the cause of the headache.

        Approximately 3% of population suffers from chronic-tension- type headaches. That is roughly 40 million men, women, and chidlren of nearly every age who suffer from recurrent head or facial pain.  In addition, 28 million people suffer with migraine headaches, and millions of others endure the debilitating pain of cluster headaches, trigeminal neuralgia, vascular disorders, or post-traumatic head pain.

       Many believe there is little or no hope of getting better.

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How can Orthopedic Massage help Tension-Type Headaches?

        The soft tissue release of Orthopedic Massage addresses the cause of the problem at its root, by normalizing the muscles of the affected area.  In truth, orthopedic massage is not a treatment for any one issue;  it is a treatment for muscular injuries and imbalances that lead to many issues.  During treatment, the area of discomfort / tension / pain can virtually be ignored in favor of releasing the muscles which are the cause (or lead to the cause) of the imbalance.
        Orthopedic Massage is a common sense, holistic approach, which views the local symptoms as part of a larger pattern of imbalance.

This approach creates a permanent relief of pain and inflammation, ending the cycle of muscle strain, over-stretch, micro-tears and re-injury.

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Do you have Neck And Shoulder Pain?

Does this sound familiar?  “I just have this one spot that always bothers me - it is just so tight all the time;  I can always find it.  There’s nothing that can be done for it, but most of the time, I can live with it.”  I don’t remember injuring it…but this neck/shoulder pain is really persistent and nothing I try seems to help for long.

Sufferers often state:

·       It feels like its always been there…

·       That spot feels like a rock…

·       Nothing can be done about it…

·       The pain is bad, but I just have to put up with it…

Quite often this doesn’t need to be the case.

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Why is it so tight?

This is the age of computers… and our bodies are paying for it.  Most frequently, shoulder and neck pain occurs in people who work in an office, spend days at a desk, and/or do a lot of driving.

Many people have what could be called Computer Slump:  a forward tilt of the head (to view the monitor) & rounding forward of the shoulders (for typing).   This posture creates an inordinate amount of over-stretch on the backside of the neck and shoulders. 

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Tell me more…What is causing this pain? 

The most frequent cause of pain is the muscles. Often, muscles become painful when they are ischemic (i.e., when they have inadequate blood flow). You can readily see an example of this when you make a fist.  Watch your knuckles go white as the blood leaves. This is what happens to a muscle that is chronically contracted or over stretched. Without the adequate blood flow, the muscle is prevented from receiving the necessary quantities of oxygen & nutrients, and there’s a perpetual build-up of lactic acid.  Pain is the result. 

        The pain usually occurs between the shoulder blades, on top of  the shoulders, or leads from the top of the shoulder blades into the neck. In many cases, it leads to headaches and migraines as well. 

        In some cases, repetitive movements or prolonged poor posture cause certain muscle groups to become strong & short while the opposing muscle groups become overstretched & weak.  This is called a “muscle imbalance”.     

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Why does nothing I try seem to help?

        Physicians:  Muscles receive little attention in modern medical school teaching and medical textbooks. Consequently, physicians tend to give a disproportionate amount of attention to nerves, joints, bursae, and bones at the expense of the largest organ in the body: skeletal muscles. Inattention to what’s happening in the musculoskeletal system often results in medical confusion over the causes of chronic pain.

        Physical Therapy:  While physical therapy is tremendously effective for many types of treatment (such as rehabilitation of an atrophied limb after a cast has come off or stabilizing a weak joint with strengthening exercises), it does not always lend itself effectively to correcting a muscular imbalance.

        Swedish Massage:  The normal response to tight, sore muscles and tension spots is to work on them directly –after all, it feels good.  However, this doesn’t address the actual problem, so the pain often returns after a few short days.

        Chiropractic:   While chiropractic care can be extremely effective in some cases; if the main discomfort is soft tissue (muscle) related, then simple chiropractic adjustments could have only limited long-term benefits.

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…So is there something that can be done?

Orthopedic massage takes a deeper look at the problem, seeking out the “muscle imbalance” - finding the shortened front muscles that are over powering, overstretching, and causing soreness in the back muscles.  When the shortened muscles are released, the over-tensioning of the opposite muscles is relieved, and muscle balance is restored.  Remove the cause and cease suffering the effects.

The soft tissue release of Orthopedic Massage addresses the cause of the problem at its root, by normalizing the muscles of the effected area.  In truth, orthopedic massage is not a treatment for any one issue; it is a treatment for muscular injuries and imbalances that lead to many issues.  During treatment, the area of discomfort/ tension / pain can be virtually ignored in favor of releasing the muscles which are the cause (or that lead to the cause) of the imbalance. 

This approach creates a permanent relief of pain and inflammation, ending the cycle of muscle strain, over-stretch, micro-tears and re-injury.

This is usually a long process, because it requires the capsule to stretch tissues that have been stuck together, and is unlikely to occur over just one or two treatments.  It usually takes more than one or two treatments to encourage muscular stretching and releasing of the adhesions that hold the muscle fibers together.

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What is Sciatica?

        The term sciatica is often used very broadly to describe any form of pain that starts in the lower back and radiates into one or both legs.

        Sciatica occurs when the sciatic nerve (the largest nerve in the body) is pinched or irritated.

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My doctor says it’s Sciatica.

        If sciatica is the diagnosis, it’s essential to create the best environment possible for the discs and related nerve structures. To do that, proper structural alignment is essential. If a disc is compressing the sciatic nerve, it’s crucial to improve alignment to remove that compression by working closely with your chiropractor.

One or more of the following sensations may occur

as a result of sciatica:

·       Pain in the rear or leg that is worse when sitting

·       Burning or tingling down the leg

·       Weakness, numbness or difficulty moving the leg or foot

·       A constant pain on one side of the rear

·       A shooting pain that makes it difficult to stand up

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Are Disc Surgery and drugs the only options?

In a high percentage of “sciatica” cases, pain felt in the buttocks and down the back of the leg is not caused by the vertebral discs, but rather by chronically tight muscles. 

Muscles receive little attention in modern medical school teaching and medical textbooks. Consequently, physicians give a disproportionate amount of attention to nerves, joints, bursae, and bones at the expense of the largest organ in the body: skeletal muscle. Inattention to what’s happening in the musculoskeletal system often results in medical confusion with respect to lower back pain and other chronic pain.

If the sciatic nerve is being entrapped by peripheral soft tissues such as muscle or fascia, it essential to release those muscles and lengthen the fascia to relieve the entrapment by working with a massage therapist trained in those advanced techniques.(i.e. Orthopedic Massage, Neuromuscular Therapy, etc.)

Muscles in the lower back and buttocks can become chronically tight and painful for a variety of reasons including inactivity, stress, and structural imbalance in the pelvis, all of which can set up a pattern of muscular compensation.

        Muscles become painful when they are ischemic, meaning when they have inadequate blood flowing to them. You can readily see an example of this when you make a fist and your knuckles go white. The blood leaves. This is what happens to a muscle that is chronically contracted. Without adequate blood flow to a muscle, there’s a perpetual build up of lactic acid and no way for that acid to clear out making room for oxygen and nutrients.

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What If I Do Have Sciatica?

Sciatica often worsens with extended bed rest. Physical therapy merely exercises the unstable joints. Surgery often involves cutting away disc tissue or removing bone to make room for the nerve, requiring a long recuperative time without guaranteed success. Pain pills or muscle relaxers are unable to correct the nerve compression caused by a bulging disc. Chiropractic care can help with nerve compression but often ignores the soft tissue aspect of the pain.

Before submitting to a procedure like surgery, more and more people are seeking the less invasive approach offered by a specially trained massage therapist.

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Treat the Condition and Cause

Most sciatica pain will get better within two weeks to a few months however, left untreated, the sciatica pain almost always returns because the true cause of the pain has not yet been addressed. Remember, pain is just a warning signal from your body telling you that you need to fix a problem... and the ONLY way you are going to be able to fix this problem is by addressing both:

the cause (muscle imbalances) and the resulting condition (which may be a back problems associated with “sciatica”):

Back Problems Associated with “sciatica”:

·       Lumbar herniated disc:  a disc bulges beyond its boundaries, placing pressure on the nerve root.  A herniated disc is sometimes referred to as a slipped disk, ruptured disk, bulging disc, protruding disc, or a pinched nerve.

·       Lumbar spinal stenosis:  a narrowing of the spinal canal, more common in adults over age 60 - often causes sciatica pain that waxes and wanes over many years

·       Degenerative disc disease:  a natural aging process, not an actual disease, that can irritate the nerve root

·       Isthmic spondylolisthesis:  a small stress fracture that only rarely causes back pain or sciatica pain

·       Sacroiliac joint dysfunction:  irritation of the sacroiliac joint at the bottom of the spine can also irritate the L5 nerve– causing pain similar to sciatica

The majority of Sciatic pain is NOT due to a lumbar disc herniation!

·       Iliopsoas muscle tension:  No other muscle has so many different functions, cause so much pain and is so difficult to palpate (touch). Prolonged sitting, particularly in the sloped seats of a car or sleeping in the fetal position causes the continual shortening of these muscles resulting in tightness and pain.

·       Piriformis syndrome:  The sciatic nerve can also get irritated as it runs under, and in some cases, through, the piriformis muscle – not considered sciatica, although it feels the same. 

One of the most common mistakes a healthcare professional will make once they encounter a patient who comes into their office with sciatica type symptoms is to assume that it is a disc problem.

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