describe the head pain they are experiencing. A detailed headache history is important for proper diagnosis. There are numerous factors to consider in regard to treatment, such as whether the cephalalgia is a new onset (primary) type or the result of a separate disease (secondary). With this in mind, the Primary headaches About 90% of adults will experience a primary headache between the ages of 20 and 40 years. It has become more prevalent in recent years for children to suffer head pain, consequently compounding the ability to establish a clear history. Primary headaches, however, remain the most common and are generally described as vice-like, throbbing, squeezing, pulsating pain on one or both sides of the head, depending on the subtype. These headaches are a direct result of inflammation of the nerves or blood vessels near or in the brain from muscular tension or altered chemical activity as seen with an excess of dopamine production (Wikipedia, 2017e). The most pertinent headache under this classification is the tension-type headache. Head pain that builds gradually and is described as broad pressure around the head is the chief Secondary headaches Perhaps the most feared underlying cause of cephalalgia, yet the rarest, is a brain tumor. The warning signs for a headache caused by a brain tumor are head pain upon waking that progressively increases in intensity throughout the day and is worsened when transitioning from lying down to a seated position. Another key feature is that this form of headache does not go away but continues from day to day (Lowth, 2015). Secondary headaches could be caused by something relatively harmless – such as dehydration, caffeine withdrawal, or medication overuse – but also can reflect a serious disorder, such as meningitis or intracerebral hemorrhage (International Headache Society, 2016). Thunderclap headache is the blanket term for a life-threatening headache characterized by its sudden onset and quick rise in severity. Hemorrhages, cerebral blood clot, and pituitary apoplexy (interrupted blood supply to the pituitary gland) are some causes for thunderclap cephalalgia (Wikipedia, 2017a). Cervicogenic headaches are secondary headaches that are not life-threatening and extremely common. Defined as a chronic headache caused by head or neck injury specifically arising from the cervical region, this dysfunction is often caused by whiplash, concussion, or occupational repetitive motion, as seen with hairdressers. Once the structural cause is successfully addressed, the headache goes away. This type of secondary headache is where massage therapy may be most beneficial in conjunction with a patient’s health care team to achieve lasting relief (Physiopedia, 2017). Secondary headaches pose a challenge in the necessity to determine the underlying cause for head pain that afflicts the sufferer. Another challenge is the increased chances of being misdiagnosed as a chronic primary headache as seen with CGH or post-traumatic headaches (International Headache Society, 2016). A health care provider familiar with the red flags indicating a dire situation could save the life of a patient. Cranial neuropathies,facial pains, and other headaches The final category of headaches includes two disorders that a massage therapist may encounter in some form. They are trigeminal neuralgia, also called tic douloureux , and occipital neuralgia. By definition, neuralgia means “nerve pain”; neuropathy is defined as “a dysfunction of a nerve marked by numbness or weakness.” Headaches under this category are caused by a block to a nerve caused by compression, inflammation, or infection. Trigeminal neuralgia symptoms present as a stabbing pain along the CN5 dermatome, which encompasses the jaw, eye, and scalp. This disorder can often be confused as temporomandibular joint dysfunction (TMJD) or other pain that can commonly result from dental work.
ICHD-3 beta lays out specific guidelines to determine when a dull, throbbing head pain experienced intermittently should be considered chronic or more serious (International Headache Society, 2016).
symptom experienced under this malady. Tension headaches are associated with stress, physical or emotional. The second most common primary headache that afflicts 28 million people in the United States alone is migraine headache. Typified as experiencing unilateral, pulsating, and sometimes debilitating pain, a migraine sufferer will seek a dark, quiet place to relieve symptoms. These may or may not present with an aura, which manifests as a disturbance that is either visual or auditory (McIntosh, 2017). Though rare, cluster headaches are the third most common form of primary headaches. A cluster headache presents as a severe, intense pain that occurs at the same time of day for several days, weeks, or even months. They are known to disappear for months or years before another onset begins (Wedro, 2017). ● New headache in someone with HIV or cancer. ● Headache with systemic symptoms (fever, stiffness). ● Sharp headache after a head injury. ● Motor weakness. ● Altered mental state (personality or consciousness). (American Headache Society, 2016; Wikipedia, 2017e) Nevertheless, it is the more common cephalalgias arising from cervical dysfunction or soft tissue compensation seen with CGH and whiplash that will cause a patient to seek relief with massage therapy. Because it is important to discriminate between primary and secondary headaches as quickly as possible to address any underlying disease, the American Headache Society has compiled five clues to indicate a secondary headache using the mnemonic SNOOP: 1. Systemic symptoms or secondary risk factors (fever, stiff neck, cancer). 2. Neurologic or atypical signs (complete or partial paralysis, altered mental status). 3. Onset that occurs rapidly. 4. Older: a new headache that presents after age 40. 5. Previous headache history (if it is a different headache than any experienced in the past or if it is a headache that presents more often than usual with or without change in severity). These clues, coupled with the diagnosis criteria laid out in the ICHD-3 beta, equips medical professionals to recognize warnings signs more efficiently (American Headache Society, 2016). Following are the warning signs: ● New headache after age 40 to 50. ● Abrupt onset. ● An increase in attacks and intensity. Trigeminal neuralgia symptoms, however, usually include a tic or painful spasm, giving it the surrogate name tic douloureux (Singh, 2016). Because the occipital nerve provides sensation to the scalp and posterior head, any interference will exhibit as cephalalgia. The symptoms of occipital neuralgia have been confused with migraine in that both present unilaterally. Even so, occipital neuralgia attacks occur suddenly and are described as a piercing pain (Gotter, 2017). Although many people tend to attribute any painful headache as a migraine, it is clear to see that primary headaches are
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