headache engulfs the entire head with fierce pain (International Headache Society, 2016; Wikipedia, 2017a). Depending on the cranial structure involved, other symptoms may accompany the headache: seizures, weakness, vomiting, temporary loss of consciousness, visual impairment, or neck pain with stiffness (International Headache Society, 2017). This cephalalgia is described as new onset, or one never before experienced. It is considered a serious warning sign of a possible stroke, brain tumor, or aneurysm. Undergoing proper diagnostic imaging and other testing to determine the underlying cause as soon as possible is extremely important (International Headache Society, 2017). Trigeminal neuralgia The more common of the two neuralgias under the classification cranial neuropathies, facial pain, and other headaches is also known as tic douloureux . Nicholaus Andre in 1756 first used this term for trigeminal neuralgia to describe the facial reaction that characteristically accompanies an attack. When translated to English, tic douloureux means “painful spasm” (Singh, 2016). As previously discussed under the anatomy section, the trigeminal nerve (CN5) is the largest of the cranial nerves, with three branches that provide sensory input to the eye, nose, and face while providing motor output to the muscles used for chewing (Singh, 2016). This is why those afflicted with this condition avoid touching the area of their face where the nerve is affected, going as far as leaving that side of the face unshaven. Another clue is a person attempting to keep that side of her face from moving to avoid an attack, even choosing to consume liquids so as not to chew (International Headache Society, 2016; Singh). Trigeminal neuralgia is defined as a compression or irritation of the nerve that in 81% of cases involves the nearby superior cerebellar artery touching the nerve. Or it may be from a brain tumor (International Headache Society 2016; Singh, 2016). But why some develops trigeminal neuralgia is still largely unknown. Regardless of the cause, because of a structure coming into contact with the nerve, the pain (albeit brief) is quite severe, much like that described with cluster headaches. Because the trigeminal nerve has an ophthalmic division, tearing and reddening of the eye on the affected side are two symptoms. The differentiating feature from cluster headache pain is the length of an attack: short in reaching full intensity and then quickly rescinding leaving a burning ache (International Headache Society, 2016; Singh, 2016). The jolting shock-like pain is not only abrupt but also extremely painful. This is the reason those afflicted react by attempting to move their head away from the pain while grimacing resembling an involuntary spasm, or tic. Attacks can be singular or in the hundreds for any given day and then go into remission anywhere from one month to several years (Singh, 2016). This anomaly is thought to occur because over time, the compression from a nearby structure on the nerve results in demyelination. Myelin is a protective coating surrounding nerve fibers. Demyelination is the reduction, or thinning of the myelin sheath, leaving the nerve exposed and Occipital neuralgia The final headache type relative to massage therapy is occipital neuralgia. This is portrayed as a sharp electrical pain at the posterior scalp that can radiate to the forehead. The onset of an attack is sudden but short in duration, much like trigeminal neuralgia, yet may occur on one or both sides of the head (International Headache Society, 2016; Johns Hopkins, 2017b). This makes any touch to the scalp quite sensitive, so that even resting the head upon a pillow can trigger an attack. Once the pain diminishes, tenderness in that area is often experienced. This condition is caused by the pinching of the greater or lesser occipital nerve by various factors. Arthritis of the upper cervical vertebrae, head or neck injury, or a poor posture where the
One specific cause for this debilitating headache type is subarachnoid hemorrhage (International Headache Society, 2016). As mentioned under the anatomy section, the subarachnoid is the space between the arachnoid and pia mater meninges of the brain. This is the passage route for all blood vessels going to and from the brain. When this is the cause for thunderclap headache, the likelihood of death before medical attention is administered is 10% to 20%; 50% of those who do survive are left crippled. The abrupt onset and intense pain covering the entire head are two key features to look for in recognizing this headache type (International Headache Society, 2016; Wikipedia, 2017a). Hemorrhage is defined as heavy bleeding from a ruptured blood vessel. vulnerable. It is unclear whether this situation is present before symptoms occur or the result of the constant erosion from a nearby structure rubbing against the nerve creating more frequent episodes. Each case is unique, yet imaging has shown arterial compression of the nerve leading to demyelination to be a more prevalent cause (Singh). The ICHD-3 beta notes a minimum of three spontaneous attacks brought about through harmless stimuli, such as touching the face, as one criterion necessary to diagnose a patient with this condition. Following is the full diagnostic criteria for trigeminal neuralgia: 1. Unilateral pain along the trigeminal dermatome experienced a minimum of three times and fulfilling Criteria 2 and 3. 2. Unilateral pain felt along the ophthalmic, maxillary, or mandibular division of the trigeminal nerve singularly or in any combination but not traveling outside the dermatome for the trigeminal nerve. 3. Pain that meets three of the four listed traits: ○ Periodic sudden attacks that last from seconds up to two minutes. ○ Severe intensity. ○ Shooting pain. ○ Brought about by harmless stimuli to the affected side of the face. (International Headache Society, 2016) The pain experienced is more commonly traced from the mouth to the corner of the jaw. It can also present as traveling from the teeth up toward the eye (Singh, 2016). This may cause an initial misdiagnosis by the patient as a dental concern, particularly gum sensitivity; the consumption of hot or cold liquids is a trigger. Over time, usually as demyelination progresses, talking, shaving, blowing the nose, even smiling or simply touching the face can trigger an attack. Trigeminal neuralgia is seen in women more than men with an average onset beginning at 60 years of age (International Headache Society, 2016; Singh, 2016). Because of the extreme sensitivity to touch, a patient with trigeminal neuralgia will likely avoid massage therapy; however, recognition of this condition in the early stages can help steer a patient toward a proper diagnosis and away from dismissing it as a gum or dental sensitivity. head is tilted toward the shoulder resulting in tight muscles compressing the nerve are some examples (Dalton, 2017; Gotter, 2017; International Headache Society, 2016). Because the greater occipital nerve exits the spinal cord between the C1 and C2 vertebrae – an area vulnerable to misalignment – then travels through the trapezius muscle which tends to be hypertonic, it is common for this branch to be affected by this condition (Dalton, 2017). This headache type occurring as a solitary condition is rare and usually happens as a side effect of a migraine where the greater occipital nerve becomes inflamed (Johns Hopkins, 2017b). To aid in differential diagnosis to be classified as true occipital
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Book Code: MLA1224
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