in confidently executing the pericranial tenderness assessment and possible trigger-point therapy. To better discern between the upper trapezius and splenius capitis, first find the external occipital protuberance. From there, locate the outer edge of the trapezius muscle, slide off the trapezius, and feel that the muscle fibers lead to the mastoid process. This is the splenius capitis. If the muscle fibers lead back toward the superior angle of the shoulder (under the trapezius), this indicates the levator scapula instead (Biel, 2001). Tension-type headaches are usually harmless and the reason many people seek massage therapy. More often than not, a client tries aspirin or ibuprofen before seeking manual therapy Migraine A pain that presents as throbbing and pulsating encompassing one side of the head and that creates a feeling of nausea, sometimes so intense it turns into vomiting. Eventually the room spins, noises become amplified, and lights seem brighter than ever, all adding to the pain – most notably felt behind the eye and into the temple – and more nausea. The only relief is to lie down in a dark, quiet place and sleep. This is one possible description of a migraine attack (Chawla, 2017; International Headache Society, 2016; Wikipedia, 2017b). As seen with all primary headaches, a migraine occurs unilaterally but may travel to the opposite side of the head. Simple movements, such as nodding the head or coughing, exacerbate symptoms, and a sufferer will be completely debilitated by the nausea or vomiting (International Headache Society, 2016). If an aura is present – for instance, impaired vision or motor weakness – a consuming need to seek a secluded area to sleep also arises. An attack may last between 4 and 72 hours and vary in frequency from once per week, once per year, to the more commonly seen once per month. A couple of hours or days before migraine pain is experienced, a number of things can happen alerting the sufferer of the oncoming episode. These signs could be depression, food cravings, or neck stiffness. After these signs, an aura may or may not manifest; however, when an aura accompanies a migraine attack, it slowly develops and then tapers off after 60 minutes wherein the characteristic pain and nausea set in (International Headache Society, 2016; Wikipedia, 2017b). The pain begins in one area, mainly the eye and forehead, and then expands posteriorly, taking one to two hours to reach maximum intensity. At the conclusion of an attack, the pain then subsides, leaving soreness in its place and an overwhelming feeling of extreme fatigue and in some cases, mental confusion (Chawla, 2017; International Headache Society, 2016). This recurrent headache type is usually first seen during puberty and peaks between the ages of 35 and 45, then often diminishes after age 50 (Wikipedia, 2017b). Typically afflicting women, approximately 15% of the global population is plagued by migraine headaches, although there is a vast number of sufferers who do not get the correct diagnosis because of a lack of adequate education or knowledge by health care providers (WHO, 2016). For a headache to be classified as a migraine, a patient must experience the following criteria laid out in the ICHD-3 beta (International Headache Society, 2016): 1. A minimum of five attacks with symptoms 2, 3, and 4. 2. Headache duration of 4 of 72 hours regardless of treatment attempts. 3. Attacks that contain at least two of the following features: ○ Pain on one side. ○ Pulsating pain. ○ Moderate to severe pain. ○ Pain worsened by mild physical activity (walking, head movement, coughing). 4. One or both must occur during an attack:
(McIntosh, 2017; Wedro, 2017). Being familiar with the pericranial tenderness assessment and indicated trigger points equips the massage therapist with enough information to create an effective treatment plan. Because tension headaches are commonly a result of stress, emotional or physical, having the client reassess her coping strategies, ergonomics, and recreational time will aid in the prevention of attacks. Maintaining careful documentation of the number and severity of headache episodes assists in recognizing a pattern of chronic tension cephalalgia and the possibility of something more serious as the cause (International Headache Society, 2016).
There are four phases to a migraine. Not all are required for it to be classified as migraine, but all are unique to a migraine attack. Likely two or three of the four phases will take place: 1. Prodrome phase.
2. Aura phase. 3. Pain phase. 4. Postdrome phase. (Johns Hopkins, 2017a; Wikipedia, 2017b)
The prodrome phase begins a day or two before the headache episode. This is commonly referred to as the premonition phase because the symptoms alert the patient of an oncoming attack. The symptoms experienced are exclusive to each individual and vary from a change in mood, depression, fatigue, neck stiffness, food cravings, and euphoria to gastrointestinal complications. Approximately 60% of migraine sufferers begin an episode with the prodromal phase (Chawla, 2017; Johns Hopkins, 2017a; Wikipedia, 2017b). Aside from the presence of nausea and need to be in a dark, quiet place, the aura phase indicates a migraine episode. Not all sufferers experience an aura, and those who do may not have an aura with each attack. An aura can manifest as a visual, sensory, or even motor disturbance (International Headache Society, 2016; Wikipedia, 2017b). The most common aura is visual disturbance, with nearly 99% of migraine sufferers reporting having this symptom (Wikipedia, 2017b). There are several different forms of visual disturbance. Some experience a temporary complete loss of vision. Some simply have a blind spot in their field of vision that enlarges over the course of the migraine attack (Chawla, 2017; International Headache Society, 2016; Wikipedia, 2017b). Most often what is called fortification spectrum occurs before any partial or complete visual loss takes place. Fortification spectrum involves zigzagging lines resembling the walls of a castle that begin centrally and spread out laterally leaving blurriness or vision loss in its path. Another trait of visual disturbance is that it affects both eyes simultaneously beginning on either the right or the left side of the field of vision. And once the pain phase sets in, the pain begins on the opposite side of the visual disturbance (Chawla, 2017; Wikipedia, 2017b). Sensory disturbances are the next most frequently experienced aura afflicting 30% to 40% of migraine sufferers who present with an aura (Wikipedia, 2017b). Beginning in the hand or arm, a tingling sensation slowly travels up to the face and mouth, unilaterally, and then is replaced with numbness and loss of proprioception. It is not unusual, however, for numbness to be the only sensory symptom (Chawla, 2017; Wikipedia, 2017b). Finally, some people are afflicted with a motor disturbance that manifests as speech slurring or muscle weakness (Chawla, 2017; Wikipedia, 2017b). Although the aura phase lasts one hour, if a sufferer experiences muscle weakness, this symptom lasts beyond the normal time frame. Generally, these three types of disturbances take place in succession (Wikipedia, 2017b). The third phase of a migraine attack, the pain phase, is also called the headache phase (Wikipedia, 2017b). Migraine pain begins unilaterally at the eye or forehead region and can expand to include the back of the head or travel to the opposite
○ Nausea with or without vomiting. ○ Sensitivity to lights and sounds.
Page 87
Book Code: MLA1224
EliteLearning.com/Massage-Therapists
Powered by FlippingBook