1. Osteopathic Approach to Headaches
Sarah Watson OMS V, Therese Obioha OMS V
June 26, 2013
Original Presentation by:
Tim Neely OMM PCA

2. treated with medications…and OMM
Headaches…
One of the most common complaints in the Family Practice and Emergency Room..
treated with medications…and OMM

3. Overview of Lab Overview of headaches Causes Differential Diagnoses
Osteopathic Approach to Headaches
Goals
Treatments
Practice Time
Wrap-Up Summer Scholars

4. Overview of Headaches

5. The Brain is insensitive to pain…so why do we get headaches?
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)

6. Overview of Headaches - Causes
Most Common Causes
Tension Headache
Migraine Headache
Cluster Headache
Other Causes
Intracranial Bleeding
Brain Neoplasm
Sinus Headache
Hypertension - Uncontrolled

7. Tension Headaches: Muscle hypertonicity Postural causes
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)

8. Migraine Headaches Recurrent and runs in families Symptoms
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

9. 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

10. Osteopathic Approach to Headaches

11. 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

12. 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.

13. OMM Approach to Headaches
What type of headache is most likely described?
Tension Headache
What areas may be involved?

14. 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

15. 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

16. Treatments and Practice

17. Headache Treatments Suboccipital Release Patient supine
Find the base of the skull
Place pads of fingers (both hands) into the occipital sulcus
Rest weight of head on fingers
Wait for muscles to relax
Re-check

18. Headache Treatments Cervical Muscles: Cross Arm Stretch Pt supine
Physician’s forearms crossed under patient’s neck and hands are placed on anterior aspect of patient’s shoulders
Physician lifts patient’s head until the muscular restrictive barrier met
Force slowly relaxed
Stretching may be repeated
Recheck

19. Headache Treatments Trapezius Inhibition Patient Supine
Physician places thumb on anterior side of upper trapezius, and fingers on posterior aspect of upper trapezius
Physician gently adds a squeezing force between thumb and fingers
Continue until trapezius relaxes

20. Switch Partners

21. Headache Treatments Trapezius Release (Upper) Patient prone
Use the thumb and thenar eminence of the hand to contact muscular targets
Upper trapezius, hands at the patient’s shoulder, fingers wrapped around superior border
Physician applies gentle traction on the muscle to stretch
Hold, Release, Repeat
Recheck

22. Headache Treatments Trapezius Release (Lower) Patient prone
Use the thumb and thenar eminence of the hand to contact muscular targets
Lower Trapezius, hands below the scapular, force directed laterally
Physician applies gentle traction on the muscle to stretch
Hold, Release, Repeat
Recheck

23. Headache Treatments Lumbo-Sacral Traction Patient Prone
Physician uses heel of one hand on sacrum, and heel of opposite hand on lumbar musculature
Physician exerts gentle force with both hands, pushing away from each other
Gently, rhythmic kneading or deep inhibitory pressure may be used
Recheck

24. Everyone at the Same Time

25. Headache Treatment - Stretches
Head up straight
Deep breath to relax muscles of head and neck
Roll shoulders back

26. Headache Treatments - Stretches
Neck Stretch:
Tip head to one side, bringing the ear and shoulder together
Place hand on same side on top of head, using gravity to deepen stretch
Stretch should be felt on the side of the neck, it should NEVER hurt
Repeat on opposite side

27. Headache Treatment - Stretches
Thoracic Stretch:
Sit on stool/chair, feet on the floor.
Drop arms between legs, allow head and back to fall forward.

28. OMM and Headaches – Putting it All Together
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

29. References Foundations for Osteopathic Medicine, 436-441.
DiGiovanna, E.L. An Osteopathic Approach to Diagnosis and Treatment, , ,
Nicholas, A. Atlas of Osteopathic Technique. pg. 99, 106