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). 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. 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 Table 1: A Comparison of the classification of headaches Primary
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). 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 milder in comparison to secondary headaches and cranial/facial neuropathies. In addition, primary headaches manifest episodically, whereas secondary headaches tend to be continuous, sometimes increasing in intensity with time. Cranial neuropathies, facial pain, and other headaches share the characteristic of episodic attacks with primary headaches but are extremely painful and short in duration. A full comparison of the three classifications in shown in Table 1.
Cranial Neuropathies, Facial Pain, and Other Headaches
Secondary
Cause
• Muscle tension. • Altered chemical activity in the brain. • Inflammation.
• Disease. • Structural change. • Medication overuse.
• Compressed nerve. • Nerve inflammation. • Infection of a nerve.
Pain description • Dull ache. • Throbbing. • Severe pain.
• Severe. • Unrelenting. • Sudden onset.
• Sharp. • Stabbing. • Piercing. • Short. • Episodic.
Frequency
• Intermittent. • Varies.
• Continuous. • Progressively worsens.
Source: International Headache Society, 2016
HEADACHE TYPES
with from the secondary headache category. Trigeminal neuralgia and occipital neuralgia types from the cranial neuropathies, facial pain, and other headaches category are the only two necessary with which to be knowledgeable (International Headache Society, 2016). It is not necessary for a massage therapist to be familiar with the minutiae of cephalalgia; this is not in her scope of practice to diagnose. Recognizing and understanding the major headache types under each classification is all that is essential, especially those that are positively influenced by massage. dull ache and pain concentrated at either the temples or eyebrows. Physical and emotional stress often produces an attack through excessive contraction of the muscles of the head and neck (Johns Hopkins, 2017a). Examples of emotional stress triggers are anxiety and depression. Physical stressors include fatigue, dehydration, teeth clenching, poor posture, prolonged periods staring at a computer, or sleeping in an awkward position (DeLaune, 2008). The ICHD-3 beta requires the following measures be met to qualify a headache as tension-type: 1. An average of fewer than 12 days per year of headache attacks.
Nearly 400 types of headaches are classified in the ICHD-3 beta. Most of these fall under a broader type of headache but specify symptoms. For instance, a migraine with aura is one class of migraine where motor symptoms, such as muscle weakness, remain up to 72 hours after the migraine has ended. This is further divided into another class called migraine with typical aura, which possesses all the same attributes of a migraine with aura, except once the migraine has ended, all symptoms dissipate completely. For the primary headache category, the three common types are tension-type, migraine, and cluster headaches. Cervicogenic, post- traumatic, and thunderclap headaches are the most important for massage therapists to be familiar Tension-type headaches It is almost guaranteed a massage therapist will come across cases of tension-type headache. They are the most prominent form of cephalalgia afflicting people, mostly women, at an estimate of 1.6 billion cases per year. Sometimes called pressure headaches , tension- type headaches are depicted as a constant vice-like band spanning the forehead that may include the occipital and cervical regions. This form of headache is by far the mildest of all. Most people carry on with their regular daily activities during an episode, but as the day progresses, the intensity of pain may increase from mild to moderate (Wikipedia, 2017c). Other symptoms characteristic of tension-type headaches include a gradual onset, bilateral pain, and a
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