The final muscle relevant to tension-type headaches and second most implicated for carrying emotional stress is the upper trapezius. The most superficial of the back musculature, the upper trapezius originates on the medial aspect of the occiput including the external occipital protuberance in addition to the spinous process of C7. The fibers then run downward and laterally to insert to the outer portion of the clavicle. Similar to the SCM and splenius capitis muscles, the upper trapezius laterally flexes the head toward the shoulder of the same side. It also functions to rotate the head but does so to the opposite side. Bilaterally, the upper trapezius extends the head (Biel, 2001; Stone & Stone, 2003). Two trigger points found near the insertion point to the clavicle refer pain up the side of the neck and into the temporal region closer to the eye than to the ear. Considering the splenius capitis is partially covered by the trapezius, sound palpation skills help the massage practitioner 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 (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). 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.
and assists in deep inhalation (Biel, 2001; Stone & Stone, 2003). Seven trigger points can be found between both bellies of the SCM, generally referring to the forehead, eye area, occipital region, scalp, ear, and cheek (DeLaune, 2008). Although this muscle is more than likely to contain trigger points and require manual therapy, care must be taken to avoid the external jugular vein, which passes over the SCM, yet more important, to refrain from the carotid artery, which lies medial and deep to the SCM (Biel). Much like the SCM, the splenius capitis functions to laterally flex the head and to rotate it to the same side. This muscle originates from the upper back, specifically from vertebrae C7 to T3, and inserts to the mastoid process in addition to the lateral aspect of the occiput in the same region as the SCM (Biel, 2001; Stone & Stone, 2003). Because it originates posteriorly, this muscle is antagonistic to SCM in that it extends the head bilaterally. There is only one mapped trigger point for splenius capitis, which is located at the C2 vertebra and refers pain up to the top of the head (DeLaune, 2008). Even though splenius cervicis is not included in the pericranial tenderness assessment, it is a synergist to the splenius capitis in both its bilateral action of extension and its unilateral action to laterally flex and rotate the head to the same side. The splenius cervicis and the splenius capitis differ in two ways. The first is it inserts into the cervical vertebrae and so does not attach to the head limiting its function to the neck only. The other difference is that the upper fibers (from T3 to C1) lie beneath the splenius capitis and the lower portion (T3 to T6) is deep to the trapezius making it inaccessible for palpation (Biel, 2001). Even so, it is important to note a trigger point found between the C3 and C4 vertebrae because its referred pain pattern is felt mainly behind the eye but also in the temporal region (DeLaune, 2008). Despite not being able to isolate the splenius cervicis for palpation, the massage therapist can still affect the trigger point by knowing that the muscle rests in the lamina groove of both cervical and thoracic vertebrae, C1 to T6. The lamina groove is the space between the spinous process, or bony protrusion most recognized as the spine, and the transverse process, which is a similar bony protrusion on the sides of the vertebrae (Stone & Stone, 2003). 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 Migraine A pain that presents as throbbing and pulsating 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,
Page 39
Book Code: MNJ0524
EliteLearning.com/Massage-Therapy
Powered by FlippingBook