test for suboccipital spasm causation or cervical flexion and shoulder abduction movement tests to determine the degree of muscle hypertonicity), the clinical reasoning stage is next (Fritz, 2015). When examining the compiled data during the clinical reasoning stage, the first thing that must be determined is whether the probable headache type is contraindicated. Aside from an acute attack for migraine or cluster headache, those classified under the cranial neuropathies, facial pain, and other headaches are contraindicated for massage unless a nerve block has been administered (occipital neuralgia). Thunderclap headaches are also contraindicated for massage (International Headache Society, 2016). Once the symptoms have been interpreted as safe for massage therapy, the rehabilitation protocol must be laid out. The rehabilitation protocol was originally introduced by esteemed orthopedic massage therapist Whitney Lowe. Over years of working in numerous clinical environments, he designed a model for massage therapists to use for creating a proficient treatment plan. There are four goals in the rehabilitation protocol: 1. Assimilate the musculature: This can be treating active trigger points or breaking up scar adhesions that keep the tissues from functioning properly. 2. Address chronic hypertonicity: As seen in UCS, which is explained in the earlier section on CGH, the upper trapezius, SCM, splenius capitis, and pectoral muscles all tend to be overly tight creating imbalance in the cervicothoracic region. Deep tissue massage to these muscles, along with stretching to encourage relengthening, will help bring homeostasis back to the region. 3. Encourage proper movement through ergonomics or another modality, such as Feldenkrais. 4. Introduce strengthening once all of these goals have been accomplished: Unless dually licensed, a massage therapist will need to refer the patient out for the third and fourth goals. (Lowe, 2017) The third segment of the intake process, justification, is to present these findings from the assessment with the treatment plan (created through the clinical reasoning stage) to the patient (Fritz, 2015). The intake process is extremely important to achieve success with massage. Practicing these steps will help the therapist to master the art of unstructured conversation in addition to knowing which assessment test to employ. Naturally, this will lead to a stronger treatment session overall giving patients confidence in their outlook, at the same time boosting the credibility of massage therapy. disease or injury and present with more severity than primary headaches do. Any head pain with abrupt onset is a warning sign of more serious complications. Other warning signs are new headaches experienced after age 50, a headache that increases in frequency, and headache with neck stiffness. The majority of headaches are diagnosed during the intake process. Possessing good assessment skills will aid in this process and increase the credibility of massage among physicians. A massage therapist is already at the forefront of a patient’s health care team, and being able to recognize headaches deepens the massage therapist’s role. DeLaune, V. (2008). Trigger point therapy for headaches and migraines. Retrieved from http:// triggerpointrelief.com/headache/chapter3.html Diamond, S. (2015). Headache and migraine biology and management. Waltham, MA: Elsevier. Frank, C., Lardner, R., & Page, P. (2010). Assessment and treatment of muscle imbalance: The Janda approach. Champaign, IL: Human Kinetics. Fritz, S. (2015). Mosby’s massage therapy review (4th ed.). St. Louis: Elsevier. Gotter, A. (2017). Occipital neuralgia. Retrieved from https://www.healthline.com/health/occipital- neuralgia International Headache Society. (2016). ICHD-3 beta. Retrieved from https://www.ichd-3.org/
therapist, referring the patient back to his physician equipped with the newly found information is the proper way to handle a suspected misdiagnosis. Phrasing a question is very important. Following are some examples of questions to ask a patient to gather facts while keeping the interview unstructured: 1. When was your first headache? 2. Did anything happen before your headache (stress, hormone change, injury)? 3. How frequently do you experience headaches? 4. How long does the pain last? 5. Do you take medication (aspirin/ibuprofen) for your pain? Is it effective? 6. Where do you feel your headache? 7. Does your head pain travel to the other side or remain on one side? 8. Using a scale of 1 to 10, with 1 being light intensity and 10 being extreme intensity, how would you rate your headache pain? 9. Which best describes your headache pain? Throbbing? Penetrating? A dull ache? 10. Do you see flashing lights or lose parts of your vision before a headache attack? 11. Are there any other symptoms consistently experienced with your headache, such as nausea, vomiting, light sensitivity, sensitivity to sounds, or dizziness? 12. Does your headache wake you up from sleep? 13. Describe the amount of stress you have. 14. Have you ever gone to the hospital because of your headache? 15. Are you taking any medications? 16. Have you ever had to stay home from work because of your headache? 17. Do you experience neck stiffness with your headache? 18. Were you recently in a motor vehicle accident, or have you experienced a fall? 19. Have you tried any other therapies to alleviate your headache? If so, what were they and did they help? 20. Have you received an MRI or CT scan for your headache pain? (Diamond, 2015) These questions are designed to guide a patient and not intended for all be used during a single intake session. Each case is unique, and many of the questions seek to identify a specific headache type. Questions 10 and 11, for example, specifically relate to migraine headaches and would not be asked if the patient describes patterns inconsistent with a migraine. Once a sufficient assessment has been performed (this includes any necessary testing, such as the Brügger’s Conclusion Headaches are a malady that is mostly harmless, and they respond well to basic treatments. Massage therapy has grown in acceptance as a viable treatment option, and more physicians have been increasingly suggesting it. Migraine and tension-type headaches are the most common form, both of which are positively influenced by massage. People who suffer from headaches also have trigger points that correlate in number with the frequency of attacks. Primary headaches arise from trigger points, desensitization, or a neurological disorder. These headaches are mild to moderate in severity with a throbbing quality that gradually builds in intensity. Secondary headaches are a result of
References
American Headache Society. (2016). Primary or secondary headaches. Retrieved from https:// americanheadachesociety.org/wp-content/uploads/2016/07/Primary_or_Secondary_Headache.pdf American Massage Therapy Association. (2017). Consumer views and use of massage therapy. Retrieved from https://www.amtamassage.org/research/Consumer-Survey-Fact-Sheets.html Biel, A. (2001). Trail guide to the body. Boulder, CO: Books of Discovery. Chawla, J. (2017). Migraine headache: Practice essentials, background, pathophysiology. Retrieved from https://emedicine.medscape.com/article/1142556-overview Dalton, E. (2017). Occipital neuralgia headaches. Retrieved from https://erikdalton.com/blog/occipital- neuralgia-headaches/
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