Sarah Watson OMS V, Therese Obioha OMS V June 26, 2013 Original
Presentation by: Tim Neely OMM PCA Osteopathic Approach to
Headaches 1
Slide 2
Headaches One of the most common complaints in the Family
Practice and Emergency Room.. treated with medicationsand OMM
2
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Overview of Lab Overview of headaches Causes Differential
Diagnoses Osteopathic Approach to Headaches Goals Treatments
Practice Time Wrap-Up Summer Scholars 3
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Overview of Headaches 4
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The Brain is insensitive to painso why do we get headaches? 5
Pain Sensitive Areas: Intracranially Dura (surrounding the brain)
Venous Sinuses Arteries in the pia matter and the arachnoid space
Extracranially Skin Muscles Fascia Arteries Therefore, pain
develops from dysfunction, displacement, or encroachment on one of
the above structures (Foundations, pg 437)
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Overview of Headaches - Causes Most Common Causes 1. Tension
Headache 2. Migraine Headache 3. Cluster Headache Other Causes 1.
Intracranial Bleeding 2. Brain Neoplasm 3. Sinus Headache 4.
Hypertension - Uncontrolled 6
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Tension Headaches: Most common cause of headaches Causes Muscle
hypertonicity Postural causes Emotional Stress Symptoms: Squeezing
pain Describe as a band-like pain Bilaterally No nausea or vomiting
(unless severe) 7
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Migraine Headaches Etiology ? thought to be related to
disordered control of the craniao-cerebral circulation Recurrent
and runs in families Associated with certain triggers Symptoms
Throbbing pain Associated nausea and vomiting common Aura may be
present Relieved by sleep Sensitivity to light, sounds Symptoms can
be debilitating 8
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Cluster Headaches Cause: neurogenic inflammation affecting the
vascular plexus of the cavernous sinus Symptoms: Periorbital Pain
Develop quickly and increase in pain rapidly Occurs 2-3 hours after
onset of sleep Autonomic Features: rhinorrhea, unilateral
lacrimation, ptosis More common in men 9
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Osteopathic Approach to Headaches 10
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OMM Approach to Headaches First Correct Diagnosis Use history
and physical exam and check vitals Tension vs. Migraine vs. Cluster
vs. other cause Second Correct Structural Diagnosis Screen, Scan,
Segmental Diagnosis Third Treatment OMM Medications Home Exercises
Fourth Follow-up 11
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OMM Approach to Headaches Case Example: Pt is 34 yo Female
presenting with 1 month history of headache. Pain is described
squeezing. It located at the back of head and wraps around to her
forehead. No nausea/vomiting/visual disturbances. Advil does not
help. Sleep does not help. MedHx: Advil. FamHx: None relevant
Social: Pt has a desk job and works 10 hours a day, has 3 children.
Patient does not use EtOH, tobacco, or illicit drugs. 12
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OMM Approach to Headaches What type of headache is most likely
described? Tension Headache What areas may be involved? 13
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OMM Approach to Headache Areas to consider: Cervical Spine and
Musculature Thoracic Spine and Musculature Cranial Bones and
Sinuses Also consider Sacro-pelvis Lumbar Spine Lower Extremity
14
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OMM Approach to Headaches Muscular Involvement of the Head and
Neck Frontalis Temporalis Occipital Sternocleidomastoid Scalenes
Levator Scapuli Trapezius Lets think about the attachments of these
muscles 15
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Treatments and Practice 16
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Headache Treatments 17 Suboccipital Release 1. Patient supine
2. Find the base of the skull 3. Place pads of fingers (both hands)
into the occipital sulcus 4. Rest weight of head on fingers 5. Wait
for muscles to relax 6. Re-check
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Headache Treatments 18 Cervical Muscles: Cross Arm Stretch Pt
supine Physicians forearms crossed under patients neck and hands
are placed on anterior aspect of patients shoulders Physician lifts
patients head until the muscular restrictive barrier met Force
slowly relaxed Stretching may be repeated Recheck
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Headache Treatments 19 Trapezius Inhibition 1. Patient Supine
2. Physician places thumb on anterior side of upper trapezius, and
fingers on posterior aspect of upper trapezius 3. Physician gently
adds a squeezing force between thumb and fingers 4. Continue until
trapezius relaxes
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Switch Partners 20
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Headache Treatments 21 Trapezius Release (Upper) 1. Patient
prone 2. Use the thumb and thenar eminence of the hand to contact
muscular targets 1. Upper trapezius, hands at the patients
shoulder, fingers wrapped around superior border 3. Physician
applies gentle traction on the muscle to stretch 4. Hold, Release,
Repeat 5. Recheck
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Headache Treatments 22 Trapezius Release (Lower) 1. Patient
prone 2. Use the thumb and thenar eminence of the hand to contact
muscular targets 1. Lower Trapezius, hands below the scapular,
force directed laterally 3. Physician applies gentle traction on
the muscle to stretch 4. Hold, Release, Repeat 5. Recheck
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Headache Treatments 23 Lumbo-Sacral Traction 1. Patient Prone
2. Physician uses heel of one hand on sacrum, and heel of opposite
hand on lumbar musculature 3. Physician exerts gentle force with
both hands, pushing away from each other 4. Gently, rhythmic
kneading or deep inhibitory pressure may be used 5. Recheck
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Everyone at the Same Time 24
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Headache Treatment - Stretches 25 Head up straight Deep breath
to relax muscles of head and neck Roll shoulders back
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Headache Treatments - Stretches 26 Neck Stretch: 1. Tip head to
one side, bringing the ear and shoulder together 2. Place hand on
same side on top of head, using gravity to deepen stretch 3.
Stretch should be felt on the side of the neck, it should NEVER
hurt 4. Repeat on opposite side
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Headache Treatment - Stretches 27 Thoracic Stretch: 1. Sit on
stool/chair, feet on the floor. 2. Drop arms between legs, allow
head and back to fall forward.
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OMM and Headaches Putting it All Together 28 Common Complaint
OMM as an adjunct with traditional medical therapy Remember 1.
Diagnose Correctly 2. Develop Treatment Plan 3. Follow-up treatment
DEMO Dr. Rettos headache treatments sequence
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References Foundations for Osteopathic Medicine, 436-441.
DiGiovanna, E.L. An Osteopathic Approach to Diagnosis and
Treatment, 137-142,158-168, 194-195. Nicholas, A. Atlas of
Osteopathic Technique. pg. 99, 106