Headaches And Pain… Oh, My!

For me, the pain associated with headaches could be debilitating at times. So much so, I would sometimes just want to crawl in bed and cry like a baby until I fell asleep; however, when I first experienced PNMT, I quickly realized that there were other options out there aside from mainstream treatments. More on that later!

Before I go over the different types of headaches though, I feel it’s important that I share some RED FLAGS that I learned through becoming certified in PNMT:

  • See a physician to have other possible causes ruled out if the headaches are a new occurrence—the number of serious problems that have headaches as a side-effect is numerous.
  • See if physician immediately if you have any other global health declines.
  • See a physician if you’ve had headaches in the past but they are different in frequency, intensity, and/or location.
  • See a physician if you’ve had headaches for a long time but now they are daily; accompanied by GI symptoms, restlessness, anxiety, irritability, memory problems, difficulty in intellectual concentration, and depression. This could be considered analgesic rebound; analgesic overuse being very common.

Now, onward with different types of headaches. I will include some bullet points and reference the clinical studies, which happens to be where I got most of my information from…

TENSION HEADACHES – In the U.S., these account for 1-4% of all emergency room visits and is the 9th most common reason for doctor visits; being the most common type of chronic recurring head pain. All ages are susceptible, but most are young adults. — Michelle Blanda, MD; Tension Headache Clinical Presentation

  • These are usually associated with a stressful event, poor posture, or depression; and are not aggravated by physical activity.
  • They are of moderate intensity but can have a throbbing quality, are bilateral, and usually present in the occipitofrontal region.
  • They typically last 30-minutes up to 7-days.
  • Muscular tightness or stiffness in the neck, occipital, and frontal regions is common.
  • Cervical muscles, when palpated, may be very tender.
  • Nausea or vomiting is not present.
  • Insomnia is present.
  • Often present upon rising or shortly thereafter.

MIGRAINE HEADACHES – This disorder is one of the most common complaints in medicine. In the U.S., more than 30 million people have one or more migraines per year. — Jasvinder Chawla, MD; Migraine Headache

  • They typically throb or pulsate.
  • The pain is initially unilateral (on one side) and localized to the Temporalis and Frontalis muscles, or over the eye, but can be felt anywhere around the head or neck.
  • The pain typically builds up over a 1- to 2-hour period and then slowly diffuses towards the back of the head.
  • They typically last 4-72 hours; usually subsiding gradually within a day, and after a period of sleep.
  • Intensity is moderate to severe and intensifies with movement or physical activity.
  • Light and sound sensitivity are very common.
  • Nausea occurs in about 80% of migraines; vomiting in about 50%.
  • Other interesting symptoms include:
    – About 60% of people reported prodrome (preheadache) symptoms hours to days prior to the migraine. Postdrome symptoms may persist for 24-hours after the headache.
    – Auras—which can be visual, sensory, motor, or any combination of these—usually develop over 5-20 minutes and lasts less than 60 minutes.

CLUSTER HEADACHES – In the U.S., it is estimated that 2-9% of migraine sufferers experience these, making it relatively uncommon compared to the classic migraine. This condition is more common in males than in females. — Lori K Sargeant, MD; Headache, Cluster

  • No aura exists like they do in migraines.
  • Sudden onset peaks in 10- to 15-minutes; duration lasts 10-minutes to 3-hours per episode; frequency may occur several times a day for 1- to 4-months.
  • Typically, 1-2 cluster periods are experienced per year; each lasting 2- to 3- months.
  • The pain associated with is described as severe; as if the eye is being pushed out.
  • They are often nocturnal—active at night.
  • Triggers in some patients include stress, allergens, and seasonal changes.
  • Alcohol and smoking induce attacks during a cluster but not during remission.
  • Risk factors include: male sex; older than 30-years; small amounts of alcohol; previous head trauma or surgery (occasionally).

CERVICOGENIC HEADACHES – The presence of these headaches in the general population is estimated to be between 0.4% and 2.5%; however, the prevalence is as high as 20% in pain management clinics. This condition is four times more common in women than in men. — David Biondi, DO; Cervicogenic Headache: A Review of Diagnostic and Treatment Strategies

  • This condition is a relatively common cause of chronic headaches that is often misdiagnosed or unrecognized; clinical features may mimic those commonly associated with other headache disorders, making this headache hard to distinguish.
  • They involve head pain that is referred from bony structures or soft-tissues of the neck; TrP’s are usually found in the suboccipital, cervical, and shoulder musculature.
  • These often develop after a head or neck injury, but may also occur in the absence of trauma.
  • They are typically described as a deep—or dull—pain that radiates from the occipital to parietal, temporal, frontal, and periorbital regions.
  • Sufferers will often have restricted cervical range of motion and altered neck posture.
  • Head pain can be triggered or reproduced by active neck movement.
  • Paresthesia and numbness over the occipital scalp are usually present.
  • Many sufferers overuse or become dependent on analgesics; medication, when used alone, does not generally provide substantial pain relief.

As stated earlier in this post, I have suffered from headaches for many years, but not so much over the past five years due to the powerful effects of PNMT. In fact, many of my clients have suffered from them as well—that is until I got my hands on them. 🙂

Believe it or not, muscle involvement—which is stated in some of the above mentioned headache descriptions—can be a huge contributing factor that is definitely worth looking in to. In fact, the SCM, Longus Colli, Trapezius, and the Suboccipital muscles are just a few examples that can mimic or refer headache-related pain. Also note that muscular-skeletal alignment is a key factor as rubbing where it hurts won’t solve the problem.

If this post strikes a cord with you, consider looking for a massage therapist as an alternative option for headache related pain-relief!

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“Neutral balance alignment is key to becoming pain free!”™ ~ Me

Massage And My Facial Scar

Because of a similar accident my husband recently had, I decided to go ahead and share the following story with you; an experience that devastated me a while back. Luckily, my husband felt and continues to feel much better about his situation than I originally did mine, due to him witnessing the wonderful effects that massage had on my facial scar.

FYI – This post does not have much to do with PNMT per se, but rather massage as a whole… So I hope you don’t mind.

Back in 2008, I cracked my forehead open while we were vacationing in the Dominican Republic. Ugh! Call me vain, but I was so sick to my stomach; automatically assuming I would need plastic surgery in the near future… And of all places, on my face.

(I can’t believe I am actually including the first two pictures in this post, but it’s important for me to show you how powerful massage truly is.)

Right after the accident and with stitches. Can you tell I had some serious crocodile tears?

Check out that gash! I know it could have been worse, but I’m a female and sometimes females worry about these things. 🙂

In order to get with a Plastic Surgeon as soon as possible, we headed back to the States early. The doctor we ended up scheduling with told me—in a surprised tone—that the resort’s doctor actually did a really good job stitching me up. Thank goodness, right?! He also said that because it was vertical and perpendicular to my lovely wrinkles, I would definitely need plastic surgery down the road.

Having just graduated from massage school shortly before, I asked him if he thought massaging the scar would help, and his response was “The only way to know for sure is to massage half of it, but I don’t think it will help regardless.” Ummm… Half? Seriously? Not gonna happen! Instead, I decided to ignore his statement and addressed the whole darn thing on my own.

Goofy distorted self-portrait two months later.

After the scab was completely gone, I massaged it multiple times a day in the very beginning; paying special attention to the scar-tissue that was forming in and around it. Sometimes I used medium pressure; other times I used deep pressure, basically to a point where the area was pretty tender the next day. When that was the case, I would take a day off or lightly rub down—towards my heart—to increase blood flow. On a few occasions, I used Vitamin E oil, but most of the time I didn’t need to because my face tends to be on the oily side as it is.

About two months ago.

Well, here I am today… Four years later, and you can hardly see my scar. I did not massage my scar daily this whole time, just for the first six or so months. Even then, I probably missed a day, or two or three, here and there.

All in all, massage in general, works some serious wonders in my book. If you ever have an accident—which I hope you don’t—and worry about potential scaring like I did, try giving massage a try. It’s less invasive and has the potential to save you a ton of money.

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“Neutral balance alignment is key to becoming pain free!”™ ~ Me

Massage And Contraindications

I have found in my practice that many people are not familiar with the word contraindication, and it is an important word to know; not just when referring to massage, but when referring to any medically-related condition as well. So, taking that into account, here is some information that I would like to share.

When referring to massage, a contraindication—”contra” meaning against—is any physical, emotional, or mental condition that may cause a particular massage treatment to be unsafe or detrimental to the client’s well-being. It means that the expected treatment is inadvisable; conditions may exist in which it would not be beneficial to apply any form of massage to part of or all of the body. There are absolute contraindications and regional (or partial) contraindications; absolute meaning that massage is absolutely not appropriate and regional (or partial) meaning that massage is not appropriate in certain areas of the body.

Some examples of absolute contraindications would be:

  • Severe, uncontrolled hypertension (high blood pressure)
  • Acute pneumonia
  • Toxemia during pregnancy
  • A fever over 101°

Some examples of regional or partial contraindications would be:

  • Local contagious conditions
  • Open wounds
  • Acute neuritis or arthritis
  • Local inflamed areas

Some of those may have been obvious, but keep in mind there are many more. At the end of the day, it is the responsibility of the therapist to fully understand contraindications for massage; however, it’s a good idea for the client to have a good idea as well.

A good book that I have on-hand is Pathology A to Z: Handbook For Massage Therapists. Not only has this book helped me with conditions I’m not familiar with, but it also helped me to understand and realize that some pharmaceutical drugs can affect the outcome of massage treatments as well.

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“Neutral balance alignment is key to becoming pain free!”™ ~ Me

The Infraspinatus Muscle

In my last post, Trigger Points (TrP’s) In Detail, I briefly mentioned a TrP in the infraspinatus and thought I would go ahead and write about this muscle more thoroughly since it is a big player with shoulder issues.

THE ANATOMY (per Tortora & Derrickson, 11th edition)
Origin: Infraspinous fossa of scapula.
Insertion: Greater tubercle of humerus.
Action: Laterally rotates and adducts arm at shoulder joint.
Innervation: Suprascapular nerve.

The infraspinatus is one of the four deep muscles that join the scapula to the humerus. The four tendons merge together to form the rotator cuff. The rotator cuff strengthens and stabilizes the shoulder joint and is comprised of the supraspinatus, infraspinatus, teres minor, and subscapularis; think S-I-t-S (small “t” representing the teres minor–not major).

The prime function of the infraspinatus is to decelerate forward motion of the humerus. Repetitive movements with the arm in over-the-head positions—such as in throwing a baseball, a tennis serve, spiking a volleyball, and swimming—can result in injuries. This happens because much of the work of the infraspinatus is done in eccentric contraction. Eccentric contraction is when the muscle fibers lengthen during contraction… More on muscle contractions in my next post.

Great info, Nicole, but how does one know if the infraspinatus needs some TLC from a CPNMT (Certified Precision Neuromuscular Therapist)?

LOL! That last sentence is so ridiculous. 🙂

Well, some general indicators for treatment could include, but are not limited to:
1) Difficulty brushing or combing your hair;
2) Inability to sleep on your side at night;
3) Inability to reach behind your back and touch the opposite shoulder blade.

There are other—more medical—indicators for treatment, which is why I recommend contacting myself or another CPNMT for an evaluation if you are experiencing problems within the shoulder girdle.

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“Neutral balance alignment is key to becoming pain free!”™ ~ Me

Trigger Points (TrP’s) In Detail

You’ve heard the term “trigger point” or “knot”, but do you really know what it is? I find in my practice that many people do not have a full know-how, which is why I feel it’s important to go into detail with it here.

First and foremost, the term “myofascial trigger point” was coined by Dr. Janet Travell in 1942. If it wasn’t for her hard-work and dedication on the subject—followed by others as well (here is a brief history)—we may not have the awareness today regarding how TrP’s can cause referred musculoskeletal pain. Kudos to her and those who followed!

TrP’s are those highly sensitive areas within our muscles that hurt when touched; giving rise to specific sensations or symptoms. Technically speaking, they are hyperirritable spots in skeletal muscle that are associated with palpable nodules in taut bands of muscle fibers. At a cellular level, the individual “knot” is made up of sarcomeres that are extremely contracted, which produces heat and a local energy crisis for the tissue. Symptoms of this crisis can include referred sensations (i.e. pain, numbness, tingling, pins-and-needles, hot/cold, etc.), a local twitch response, decreased range of motion (ROM), pain on contraction against resistance, and weakness.

There are three types of TrP’s; active, latent, and satellite. How do we know which is which though? When a TrP is compressed, or pressure is applied to, certain characteristics will follow…

Active TrP’s actively refer pain locally or to another location in the body along nerve pathways. At rest, they are commonly known to radiate pain that is familiar to the original pain complaint.

Latent TrP’s may be tender when pressure is applied, but they do not cause pain at rest, and do not yet refer pain actively. They produce shortening of length and increased muscle tension.

Satellite TrP’s are active TrP’s that rely on another “key” TrP for their existence. Treating the “key” TrP will often resolve the satellite TrP by either changing it from active to latent, or get rid of it all together.

I find TrP’s to be fascinating and I wish more people were aware of them and how their referral patterns can be related to—or actually be the direct cause of—pain and dysfunction within our muscular-skeletal system. Because I have found that so many people are unaware of TrP referral patterns, I decided to include one example of more than 620 potential possibilities in human muscles. And considering so many people suffer from pain in and around the shoulder girdle, I thought I would show just one of the four TrP’s found in the Infraspinatus.


Infraspinatus - Thorax & Arm
Image copyright of Primal Pictures

NOTE: I personally added the TrP and referral pattern to this image. It is just an approximation. The “X” is where the actual TrP is and the black area is where it could hurt when pressed upon.

If you are interested in the image you see in this post, please visit Primal Pictures to check out their Award Winning software. I own the 3D Human Anatomy: Regional Version and it is awesome.

If you are interested in learning about TrP and their referral patterns, I highly recommend that you check out this flip-chart. I also own this and refer to it quite frequently in my practice.

In closing, the number of people that get misdiagnosed and/or undergo unnecessary, invasive, and expensive treatments and procedures for pain-relief—with less than stellar results—honestly amazes me. I’m not disregarding other medical professionals and treatment options out there by any means, just hoping that some day in the near future, certified Precision Neuromuscular Therapists will be one of the first lines of defense when it comes to pain and dysfunction caused by muscular-imbalances; TrP’s do play a huge role and that’s what we treat.

UPDATE as of 9/20/12: Here is another post with additional information related to TrP’s.

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“Neutral balance alignment is key to becoming pain free!”™ ~ Me