Monday, February 11, 2008

Case of the Week - Tension Headache

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Case: 26 year old female complaining of headaches several times per week, always in the afternoon or at the end of the day. The pain starts at the base of the neck and slowly moves up until it is at her forehead. The movement from neck to forehead takes about a hour. The patient has tried eating more regularly and drinking more water and decreasing or increasing caffeine intake, but none of these is effective. When she has a headache, the only thing that helps is to lie down and close her eyes. The headaches seem to be worse with increased time at the computer.

The muscles of the neck, especially the sub-occipital muscle group, are very tight and tender. There are multiple trigger points in the sub-occipital muscles and in the sternocleidomastoid on the right. Pressure on the sub-occipital trigger points reproduces the headache. Range of motion is decreased in neck flexion and right rotation. Other orthopedic testing for nerve, muscle and joint involvement was negative. The temporomandibular joint (TMJ) was not contributory.

This is a classic tension headache case. As the patient works at her desk, poor posture and fatigue cause her to slump in her chair. This causes excess tension in the posterior neck muscles, especially those at the base or the skull (the sub-occipital muscle group). Treatment involves massage to release the muscle tension, adjusting of the thoracic and cervical spine (mid back and neck) to achieve good joint motion, and then training the patient on proper posture and ergonomics. The patient education is key in this case. Without good posture, her headaches will continue to develop. Our goal in the office is to ensure her spine is able to provide that posture.

The patient feels fully in control of her headaches. She continues to receive regular chiropractic check-ups to maintain her spinal health. She maintains healthly posture by exercising at her desk and taking regular breaks. Now, on the rare occassion that she does get a headache, she knows why and she knows what to do about it.

Posture pod – check out this link for a great 2 minute posture re-fresher. Once at the page, click on Posture Pod. These were designed to be done by anyone, regardless of their physical fitness. Have fun!

Remember never to engage in an exercise without first consulting your chiropractic physician to see if it is safe for you and your unique conditions.


Take a posture break! – Every hour you are at work, take 5 seconds to do the opposite of what you have been doing. If you are at a desk, stand up and walk around. If you are standing, sit down and relax. Roll your shoulders back. Stretch your neck. Get moving! Your muscles need to be reminded that they have a job to do: holding you up! Take a few seconds every hour to get refreshed.

Remember never to engage in an exercise without first consulting your chiropractic physician to see if it is safe for you and your unique conditions.

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