Back Clinic Headaches & Treatment Team. The most common cause of headaches can relate to neck complications. From spending excessive time looking down at a laptop, desktop, iPad, and even from constant texting, an incorrect posture for extended periods of time can begin to place pressure on the neck and upper back, leading to problems that could cause headaches. The majority of these types of headaches occur due to tightness between the shoulder blades, which in turn causes the muscles on the top of the shoulders to tighten and radiating pain into the head.
If the source of the headaches is related to a complication of the cervical spine or other regions of the spine and muscles, chiropractic care, such as chiropractic adjustments, manual manipulation, and physical therapy, can be a good treatment option. Also, a chiropractor may often follow up chiropractic treatment with a series of exercises to improve posture and offer advice for future lifestyle improvements to avoid further complications.
We live in a stressful world. Life happens; it moves so fast. Pressures coming at you from all directions. Eventually, it catches up with you, and it�s your body that bears the brunt of it. Tension is your body�s way of telling you that it is under stress � probably too muchstress.
It�s hard to escape stress in today�s society so if you find that you are exhibiting physical symptoms of stress, it might be time to make some changes. If tension headaches are one of those symptoms, you�re in good company � about 90% of adults in the US have headaches. Many of them are tension headaches.
Symptoms of Tension Headaches
Tension headaches are distinctive and can be very painful. The good news is, they are rarely an indication of a more serious condition � other than a stressful lifestyle. Some of the most common symptoms of tension headaches include:
Muscle tightness in the neck, jaw, and shoulders � may also be sore.
A Headache that originates at the back of the head and moves forward over the top and sides.
Sleep problems.
Squeezing pain or dull pressure in the head may also be described as a tight band or vice around the head.
Trouble eating.
Pain or pressure on both sides of the head equally.
Sometimes tension headache symptoms can occur prior to a migraine. In other words, a tension headache can turn into a migraine headache and may be considered a migraine trigger.
Causes of Tension Headaches
The actual cause of tension headaches is not known. Researchers have some idea of potential triggers, but recent advancements in medicine have debunked the belief that they are caused by the tightening of muscles in the scalp, shoulders, neck, and jaw. Scientific tests show that then a person has a tension headache, muscle tension does not increase. Newer theories indicate that a likelier cause involves changes neurotransmitters (chemicals in the brain) which includes serotonin. This is similar to a migraine.
While researchers do not know the exact levels of neurotransmitter fluctuations, they do have evidence that it activates the brain�s pain pathways. The tightness in the muscles could be part of the physiological changes that trigger the fluctuations in neurotransmitters, or the neurotransmitter fluctuations could cause muscle tightness.
Some common triggers of tension headaches include:
Stress
Clenching the jaw
Alcohol or drugs
Overexertion
Certain medications (even some medications for headaches which can cause rebound headaches)
Keeping your head in one position for too long (like using a cell phone or computer)
Depression
Fatigue
Grinding teeth
Neck or head injury (even old injuries)
Sleeping in a cold room or in an awkward position.
Arthritis
Anxiety
Hormonal changes
Sleeping on a worn-out mattress or the wrong pillow
Dehydration
Skipping meals
Eye strain
Certain foods can also be triggers for tension headaches. Additives and preservatives in prepared foods, even high sodium, can cause a headache.
Sinus and allergy problems can also accompany or lead to tension headaches.
Tension Headache Treatment
Over the counter and prescription medication may be recommended for tension headaches, but a good portion of the treatment involves lifestyle changes. Relaxation techniques, dietary changes, and exercise are all common treatments for tension headaches. Patients may be advised to stop smoking, limit alcohol consumption, or avoid certain foods.
Many patients find that keeping a headache journal is very useful in pinpointing triggers. There are several headache tracking apps that you can install on your smartphone and use them to get a better handle on your headaches.
Chiropractic for Tension Headaches
Chiropractic is a very effective, natural treatment for tension headaches. In addition to recommended lifestyle changes, the chiropractor may also make adjustments to realign the vertebrae and spine. The chiropractor may also use massage and other treatments that encourage relaxation of the muscles and relieve stress. He or she will use spinal manipulation of the neck and upper back to bring the body back into alignment, relieving not only the pain but the tension as well.
Headaches are a real pain (insert eye-roll here). Many individuals suffer from them, and there are a variety of causes, symptoms, and treatment options. For some, they are a rare occurrence, while others deal with them weekly or even daily. They can range from minor inconveniences to full-fledged life-changing afflictions.
The first step in treating headaches is to understand the type of headache you are experiencing. Some people think they have a migraine when in fact, they are suffering from a tension headache. While tension headaches are more common, it’s estimated by the Migraine Research Foundation that 1 in 4 U.S. Households include someone with a migraine.
Determining which headache is being dealt with takes a bit of research. Individuals suffering from headaches need to ask themselves these questions to determine if they are having a migraine or experiencing a tension headache.
When in life did the headaches begin? According to the Mayo Clinic, migraines start in adolescence or early adulthood. In contrast, tension headaches can start at any time in a person’s life. If an adult just began suffering from headaches, they are most likely tension headaches.
Where does it hurt? The location of the pain is a vital indicator of the type of headache. Migraines typically occur on one side of the head. Tension headaches affect both sides of the head and can produce a feeling of pressure in the forehead area.
What kind of pain is it? If it is a dull pain, a feeling of pressure, or tenderness around the scalp, it’s most likely a tension headache. If, on the other hand, the pain is throbbing or pulsing pain, it could be a migraine. Both headaches can offer up severe pain, just different types.
Are there any other symptoms?Migraines typically come with symptoms beyond head pain. Nausea, light and sound sensitivity, bright flashing or sparkling lights, pins and needle sensations down one or both arms, or dizziness are common. Individuals who don’t experience any of these symptoms are most likely dealing with a tension headache.
Can you function? While painful and frustrating, many people with a tension headache can still perform their jobs, drive, read, and deal with daily life. A migraine is a different story. Lying in a dark, quiet room with a sleep mask on until the headache passes is how most people handle migraines. If the headache is life-disrupting, it could very well be a migraine.
Do regular painkillers work? Tension headaches can often be relieved by over-the-counter pain medications. Migraines don’t budge with these treatments. Once a migraine is in full force, the sufferer must ride it out. If a headache reacts well to a couple of non-prescription painkillers, it’s most likely a tension headache.
Most individuals will, unfortunately, deal with a headache at one point in their lives. It’s important to note that tension headaches are much more common than migraines, but that doesn’t rule out the possibility of a headache being a migraine. The answers to the above questions give insight into the type of headache occurring and how best to handle the treatment proactively. No matter the type of headache, if the pain is severe, or begins after a head injury, seek medical treatment immediately.
45 million Americans suffer headaches on a regular basis. There are the traditional methods used to treat them, which include taking over the counter medications or taking pharmaceutical concoctions to eliminate pain and reduce swelling. However, none of these solutions provide permanent relief that address the core of the problem.
Alternative Treatment
In recent years, people throughout the country are seeking alternative forms of therapy for all types of conditions, especially headaches. One treatment that is promising for physical and other types of pain is chiropractic treatment.
This form of alternative care has been used for over a hundred years and is a regular part of the American healthcare delivery system. Insurance providers are growing and are willing to pay for chiropractic because of its effectiveness.
Chiropractic school begins by studying human anatomy in great detail, like other medical professionals. In addition to looking at how the body works together physically, training primarily revolves around the diagnosis and treatment of misalignments in the spine known as subluxations.
Theses subluxations compress nerve tissue that affects organ function, soft tissue like muscle, ligaments and tendons and can eventually manifest as other health problems if not treated.
Once the nerves are disrupted pain will result. While it usually manifests itself as physical pain, this is not always the case. In some instances, the person may experience difficulties with sleep or other routine habits.
�How Does Chiropractic Help People Who Suffer From Headaches
On the first visit with a chiropractor, a review of health history will be completed. These include x-rays (if they are needed), in order to determine the type of nerve blockage that may be occurring. They will listen to the patient, make an assessment, and determine what type/s of treatment is best.
With headaches, there is usually a misalignment (subluxation) in the cervical spine. This may be accompanied by muscles that are tight in the neck, shoulders and surrounding area. Pressure on the nerves can cause sharp stabbing pain or a continual throbbing pain in the region.
The chiropractor will assess the area and then begin treatment, known as a chiropractic adjustment. The adjustment is what relieves the pressure and pain. The relief is usually instantaneous, with an increase in positive symptoms for the following few hours.
Chiropractors don�t just focus on relieving symptoms but getting to the root cause and correcting the problem. That is why additional treatments/adjustments are often required, as one adjustment is usually not enough. A chiropractor will take time to educate patients on treatment, therapy exercises, fitness, nutrition, sleep, and regular adjustments.
If you’re tired and no longer want to suffer from headaches, see how beneficial chiropractic care can be, then please give us a call to schedule an appointment!
Injury Medical Clinic:�Chiropractic Care Migraines & Headaches
My treatment with Dr. Alex Jimenez has been helping me by simply making me less tired. I’m not experiencing as many headaches. The headaches are going down dramatically and my back feels much better. I would highly recommend Dr. Alex Jimenez. He’s very friendly, his staff is very friendly and everybody goes well beyond what they can do to help you. –Shane Scott
Neck pain can develop due to a variety of reasons, and it can vary tremendously from mild to severe. Most of the population has suffered from this well-known nagging health issue; however, did you know that headaches can sometimes be caused by neck pain? While these headaches are commonly referred to as cervicogenic headaches, other types, such as cluster headaches and migraines, have also been determined to be caused by neck pain.
Therefore, it’s fundamental to seek a proper diagnosis if you’ve experienced headaches or neck pain to determine the root cause of your symptoms and decide which treatment option will be best for your specific health issue. Healthcare professionals will assess your upper back, or the cervical spine, including your neck, the base of the skull and cranium, and all the surrounding muscles and nerves to find the source of your symptoms. Before seeking help from a doctor, it’s essential to understand how neck pain can cause headaches. Below, we will discuss the anatomy of the cervical spine or neck and demonstrate how neck pain is connected to headaches.
How Neck Pain Causes Headaches
The muscles between the shoulder blades, the upper portion of the shoulders, and those surrounding the neck, or cervical spine, may all cause neck pain if they become too tight or stiff. This can generally occur due to trauma or damage from an injury, as well as in consequence of bad posture or poor sitting, lifting, or work habits. The tight muscles will make your neck joints feel stiff or compressed, and it can even radiate pain toward your shoulders. Over time, the balance of the neck muscles changes, and those specific muscles that support the neck become weak. They can ultimately begin to make the head feel heavy, increasing the risk of experiencing neck pain as well as headaches.
The trigeminal nerve is the primary sensory nerve that carries messages from the face to your brain. Furthermore, the roots of the upper three cervical spinal nerves, found at C1, C2, and C3, share a pain nucleus, which routes pain signals to the brain and the trigeminal nerve. Because of the shared nerve tracts, pain is misunderstood and thus “felt” by the brain as being located in the head. Fortunately, many healthcare professionals are experienced in assessing and correcting muscular imbalances, which may lead to neck pain and headaches. Moreover, they can help to relieve muscle tension, enhance muscle length and joint mobility, and retrain correct posture.
What Causes Neck Pain and Headaches?
Cervicogenic headaches, otherwise known as “neck headaches,” are caused by painful neck joints, tendons, or other structures surrounding the neck, or cervical spine, which may refer to pain to the bottom of the skull, to your face or head. Researchers believe that neck headaches, or cervicogenic headaches, account for approximately 20 percent of all headaches diagnosed clinically. Cervicogenic headaches and neck pain are closely associated, although other types of headaches can also cause neck pain.
This type of head pain generally starts because of an injury, stiffness, or lack of proper functioning of the joints found at the top of your neck, as well as tight neck muscles or swollen nerves, which could trigger pain signals that the brain then interprets as neck pain. The usual cause of neck headaches is dysfunction in the upper three neck joints, or 0/C1, C1/C2, C2/C3, including added tension in the sub-occipital muscles. Other causes for cervicogenic headaches and neck pain can include:
Cranial tension or trauma
TMJ (JAW) tension or altered bite
Stress
Migraine headaches
Eye strain
The Link Between Migraines and Neck Pain
Neck pain and migraines also have an intricate connection with each other. While in some cases, severe trauma, damage, or injury to the neck can lead to severe headaches like migraines; neck pain might result from a migraine headache in different situations. However, it’s never a good idea to assume that one results from the other. Seeking treatment for neck pain when the reason for your concern is a migraine often will not lead to effective pain management or pain relief. The best thing you can do if you’re experiencing neck pain and headaches is to seek immediate medical attention from specialized healthcare professional to determine your pain’s cause and the symptoms’ root cause.
Unfortunately, neck pain, as well as a variety of headaches, are commonly misdiagnosed or even sometimes go undiagnosed for an extended period. One of the top reasons neck pain may be so challenging to treat primarily because it takes a long time for people to take this health issue seriously and seek a proper diagnosis. When a patient seeks a diagnosis for neck pain, it may already have been a persistent problem. Waiting an extended amount of time to take care of your neck pain, especially after an injury, may lead to acute pain and even make the symptoms more difficult to control, turning them into chronic pain. Also, the most frequent reasons people seek treatment for neck pain, and headaches include the following:
Chronic migraines and headaches
Restricted neck function, including difficulties moving the head
Soreness in the neck, upper back, and shoulders
Stabbing pain and other symptoms, particularly in the neck
Pain radiating from the neck and shoulders to the fingertips
Aside from the symptoms mentioned above, individuals with neck pain and headaches can also experience additional symptoms, including nausea, diminished eyesight, difficulty concentrating, severe fatigue, and even difficulty sleeping. While there are circumstances in which the cause of your headaches or neck pain may be apparent, such as being in a recent automobile accident or suffering from sport-related trauma, damage, or injuries, in several instances, the cause may not be quite as obvious.
Because neck pain and headaches can also develop as a result of bad posture or even nutritional problems, it’s fundamental to find the origin of the pain to increase the success of treatment, in addition to enabling you to prevent the health issue from happening again in the future. It’s common for healthcare professionals to devote their time working with you to ascertain what could have caused the pain in the first place.
A Health Issue You Can’t Ignore
Neck pain is typically not a problem that should be ignored. You may think that you’re only experiencing minor neck discomfort and that it’s irrelevant to any other health issues you may be having. Still, you can’t know for sure more frequently than not until you receive a proper diagnosis for your symptoms. Patients seeking immediate medical attention and treatment for their neck-centered problems are surprised to learn that some of the other health issues they may be experiencing may be correlated, such as neck pain and headaches. Thus, even if you think you can “live with” not being able to turn your neck completely, other health issues can develop, and these problems might be more challenging to deal with.
There are circumstances in which a pinched nerve in the neck is the main reason for chronic tension headaches, where a previous sports injury that was not adequately addressed before is now the cause of the individual’s limited neck mobility and in which a bruised vertebrae at the base of the neck induces throbbing sensations throughout the spine, which radiates through the shoulders into the arms, hands, and fingers. You might also blame your chronic migraines on a hectic schedule and stressful conditions. However, it might be a consequence of poor posture and the hours you spend hunched over a computer screen. Untreated neck pain might lead to problems you never expect, such as balance problems or trouble gripping objects. This is because all the neural roots located on the upper ligaments of the cervical spine or neck are connected to other parts of the human body, from your biceps to each of your tiny fingers.
Working with a healthcare professional to relieve the root cause of your neck pain and headaches may significantly enhance your quality of life. It may be able to eliminate other symptoms from turning into a significant problems. While another health issue or nutritional deficiency generally causes the most common causes of chronic migraines, you might also be amazed to learn how often the outcome may be resolved with concentrated exercises and stretches recommended by a healthcare professional, such as a chiropractor. Additionally, you may understand that the health issues you’ve been having often develop from compressed, pinched, irritated, or inflamed nerves in your upper cervical nerves.
Dr. Alex Jimenez’s Insight
Although it may be difficult to distinguish the various types of headaches, neck pain is generally considered to be a common symptom associated with head pain. Cervicogenic headaches are very similar to migraines, however, the primary difference between these two types of head pain is that a migraine occurs in the brain while a cervicogenic headache occurs in the base of the skull or in the cervical spine, or neck. Furthermore, some headaches may be caused by stress, tiredness, eyestrain and/or trauma or injury along the complex structures of the cervical spine, or neck. If you are experiencing neck pain and headaches, it’s important to seek help from a healthcare professional in order to determine the true cause of your symptoms.
Treatment for Neck Pain and Headaches
Foremost, a healthcare professional must determine the cause of an individual’s symptoms through the use of appropriate diagnostic tools as well as to make sure they have the utmost success in relieving the headache and neck pain without prolonging the duration of the symptoms and extra cost of incorrect therapy. Once an individual’s source of neck pain and headaches has been diagnosed, the kind of treatment a patient receives should depend on the type of headache. As a rule of thumb, treatment starts once the diagnosis has been made. A healthcare professional will work with you to create a treatment plan appropriate for your specific health issues. You’ll be taken through procedures that help build flexibility and strength in your sessions.
Chiropractic care is a well-known alternative treatment option focusing on diagnosing, treating, and preventing various musculoskeletal and nervous system injuries and conditions. A chiropractic doctor or chiropractor can help treat neck pain and headache symptoms by carefully correcting any spinal misalignments, or subluxations, in the cervical spine or neck, through spinal adjustments and manual manipulations, among other therapeutic techniques. Chiropractors and physical therapists may also utilize a combination of gentle Muscle Energy Techniques, muscle building, joint slides, Cranio-sacral therapy, and specific posture and muscle re-education to lower the strain being placed on the structures surrounding the cervical spine. The staff will also help you understand how to better position yourself during your daily life to prevent relapses, like ergonomic and posture tips. Contact a healthcare professional for them to be able to assist you immediately.
In cases where alternative treatment options have been utilized without any results or sometimes used together with other complementary treatment approaches, pain drugs and medications may be contemplated, such as non-steroidal anti-inflammatory drugs (NSAIDs) and anti-seizure agents such as gabapentin, tricyclic anti-depressants, or migraine prescriptions. If pain medications prove ineffective, injections may be contemplated, including peripheral nerve blocks, atlantoaxial joint blocks administered at C1-C2, or aspect joint blocks administered in C2-C3. Surgical interventions may also be other treatment options. However, healthcare professionals suggest attempting all other treatment options before considering surgery. The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss the subject matter, please ask Dr. Jimenez or contact us at 915-850-0900.
Curated by Dr. Alex Jimenez
Additional Topics: Back Pain
Back pain is one of the most prevalent causes of disability and missed days at work worldwide. Back pain has been attributed as the second most common reason for doctor office visits, outnumbered only by upper-respiratory infections. Approximately 80 percent of the population will experience back pain at least once. The spine is a complex structure of bones, joints, ligaments, and muscles, among other soft tissues. Because of this, injuries and aggravated conditions, such as herniated discs, eventually lead to back pain symptoms. Sports or automobile accident injuries are often the most frequent cause of back pain; however, sometimes, the simplest movements can have painful results. Fortunately, alternative treatment options, such as chiropractic care, can help ease back pain through spinal adjustments and manual manipulations, ultimately improving pain relief.
Many headaches that people classify as migraines are actually not migraines at all. Two of the most common headaches confused with migraines are sinus headaches and occipital neuralgia.
The condition can be debilitating but there are treatments, including chiropractic, that are very effective. Understanding occipital neuralgia can help patients better manage it so they can minimize the pain and symptoms of the condition.
What Is Occipital Neuralgia?
Occipital neuralgia is a neurological condition that affects the occipital nerves which run from the top portion of the spinal cord, through the scalp, transmitting messages to and from the brain. There are two greater occipital nerves, one on each side of the head, from between the vertebrae located in the upper neck through the muscles that are located at the base of the skull and back of the head.
While they do not cover the areas on or near the ears or over the face, they can extend over the scalp as far as the forehead. When those nerves are injured or become inflamed, occipital neuralgia is the result. A person with this condition may experience pain at the base of their skull or the back of their head.
What Are The Symptoms Of Occipital Neuralgia?
Pain is the prevalent symptom of occipital neuralgia. It often mimics the pain of migraine headaches or cluster headaches and is described as throbbing, burning, and aching.
There may also be intermittent shooting or shocking pain. Typically, the pain begins at the base of the skull but may radiate along the side of the scalp or in the back of the head. Other symptoms include:
Pain is experienced on one side (but sometimes both sides)
Pain behind the eye of the side that is affected
Tenderness in the scalp
Sensitivity to light
Pain triggered by neck movement
What Causes Occipital Neuralgia?
Irritation or pressure to the occipital nerves are what actually cause the pain. This may be due to tight muscles in the neck that squeeze or trap the nerves, injury, or inflammation.
However, much of the time doctors are unable to determine the cause. There are several medical conditions linked to occipital neuralgia:
Tight neck muscles
Diabetes
Trauma or injury to the back of the head
Gout
Tension in the neck muscles
Whiplash
Inflammation of the blood vessels in and around the neck
Infection
Neck tumors
Cervical disc disease
Osteoarthritis
What Are The Treatments For Occipital Neuralgia?
Occipital neuralgia treatment focuses on pain relief. It often begins with conservative treatments that include:
In more severe cases the patient may be prescribed a stronger anti-inflammatory medication, muscle relaxants or in some cases an anticonvulsant medication.
If these therapies are not effective or do not bring about the desired level of pain relief, then doctors may recommend percutaneous nerve blocks and steroids. Sometimes surgery is recommended in cases where the pain is severe, chronic, and is unresponsive to more conservative treatments.
Chiropractic For Occipital Neuralgia
Chiropractic was once considered an �alternative� treatment for occipital neuralgia, but now it is often a regular part of recommended patient care. The advantage of chiropractic over medication or surgery is that chiropractic does not come with the side effects of drugs or the risks of surgery.
Another advantage is that chiropractic seeks to correct the root of the problem, not just manage the pain like other treatments.
Chiropractic treatment for occipital neuralgia may include lift adjustments, heat, massage, and traction. This will bring the body back into proper alignment and take the pressure off of the nerves as it loosens the neck muscles.
The patient stands a better chance of staying pain free when taking this treatment route.
Injury Medical Clinic: Doctor Of Chiropractic Near Me
Concussions are traumatic brain injuries that affect brain function. Effects from these injuries are often temporary but can include headaches, problems with concentration, memory, balance and coordination. Concussions are usually caused by a blow to the head or violent shaking of the head and upper body. Some concussions cause loss of consciousness, but most do not. And it is possible to have a concussion and not realize it. Concussions are common in contact sports, such as football. However, most people gain a full recovery after a concussion.
Can also happen due to excessive shaking of the head or acceleration/deceleration
Mild injuries (mTBI/concussions) are the most common type of brain injury
Glasgow Coma Scale
Common Causes Of Concussion
Motor vehicle collisions
Falls
Sports injuries
Assault
Accidental or intentional discharge of weapons
Impact with objects
Prevention
Prevention of concussive injuries can be paramount
Encourage Patients To Wear Helmets
Competitive sports, especially boxing, hokey, football and baseball
Horseback riding
Riding bicycles, motorcycles, ATVs, etc.
High elevation activates such as rock climbing, zip lining
Skiing, snowboarding
Encourage Patients To Wear Seatbelts
Discuss the importance of wearing seatbelts at all times in vehicles with all of your patients
Also encourage use of appropriate booster or car seats for children to ensure adequate fit and function of seat belts.
Driving Safely
Patients should never drive while under the influence of drugs, including certain medications or alcohol
Never text and drive
Make Spaces Safer For Children
Install baby gates and window latches in the home
May in areas with shock-absorbing material, such as hardwood mulch or sand
Supervise children carefully, especially when they�re near water
Prevent Falls
Clearing tripping hazards such as loose rugs, uneven flooring or walkway clutter
Using nonslip mats in the bathtub and on shower floors, and installing grab bars next to the toilet, tub and shower
Ensure appropriate footwear
Installing handrails on both sides of stairways
Improving lighting throughout the home
Balance training exercises
Balance Training
Single leg balance
Bosu ball training
Core strengthening
Brain balancing exercises
Concussion Verbiage
Concussion vs. mTBI (mild traumatic brain injury)
mTBI is the term being used more commonly in medical settings, but concussion is a more largely recognized term in the community by sports coaches, etc.
The two terms describe the same basic thing, mTBI is a better term to use in your charting
Evaluating Concussion
Remember that there does not always have to be loss of consciousness for there to be a concussion
Post-Concussion Syndrome can occur without LOC as well
Symptoms of concussion may not be immediate and could take days to develop
Monitor for 48 post head injury watching for red flags
Blurred eyesight or other vision problems, such as dilated or uneven pupils
Confusion
Dizziness
Ringing in the ears
Nausea or vomiting
Slurred speech
Delayed response to questions
Memory loss
Fatigue
Trouble concentrating
Continued or persistent memory loss
Irritability and other personality changes
Sensitivity to light and noise
Sleep problems
Mood swings, stress, anxiety or depression
Disorders of taste and smell
Mental/Behavioral Changes
Verbal outbursts
Physical outbursts
Poor judgment
Impulsive behavior
Negativity
Intolerance
Apathy
Egocentricity
Rigidity and inflexibility
Risky behavior
Lack of empathy
Lack of motivation or initiative
Depression or anxiety
Symptoms In Children
Concussions can present differently in children
Excessive crying
Loss of appetite
Loss of interest in favorite toys or activities
Sleep issues
Vomiting
Irritability
Unsteadiness while standing
Amnesia
Memory loss and failure to form new memories
Retrograde Amnesia
Inability to remember things that happened before the injury
Due to failure in recall
Anterograde Amnesia
Inability to remember things that happened after the injury
Due to failure to formulate new memories
Even short memory losses can be predictive of outcome
Amnesia may be up to 4-10 times more predictive of symptoms and cognitive deficits following concussion than is LOC (less than 1 minute)
Return To Play Progression
Baseline: No Symptoms
As the baseline step of the Return to Play Progression, the athlete needs to have completed physical and cognitive rest and not be experiencing concussion symptoms for a minimum of 48 hours. Keep in mind, the younger the athlete, the more conservative the treatment.
Step 1: Light Aerobic Activity
The Goal: Only to increase an athlete�s heart rate.
The Time: 5 to 10 minutes.
The Activities: Exercise bike, walking, or light jogging.
Absolutely no weight lifting, jumping or hard running.
Step 2: Moderate activity
The Goal: Limited body and head movement.
The Time: Reduced from typical routine.
The Activities: Moderate jogging, brief running, moderate-intensity stationary biking, and moderate-intensity weightlifting
Step 3: Heavy, non-contact activity
The Goal: More intense but non-contact
The Time: Close to typical routine
The Activities: Running, high-intensity stationary biking, the player�s regular weightlifting routine, and non- contact sport-specific drills. This stage may add some cognitive component to practice in addition to the aerobic and movement components introduced in Steps 1 and 2.
Step 4: Practice & full contact
The Goal: Reintegrate in full contact practice.
Step 5: Competition
The Goal: Return to competition.
Microglial Priming
After head trauma microglial cells are primed and can become over active
To combat this, you must mediate the inflammation cascade
Prevent repeated head trauma
Due to priming of the foam cells, response to follow-up trauma may be far more severe and damaging
What Is Post-Concussion Syndrome (PCS)?
Symptoms following head trauma or mild traumatic brain injury, that can last weeks, months or years after injury
Symptoms persist longer than expected after initial concussion
More common in women and persons of advanced age who suffer head trauma
Severity of PCS often does not correlate to severity of head injury
PCS Symptoms
Headaches
Dizziness
Fatigue
Irritability
Anxiety
Insomnia
Loss of concentration and memory
Ringing in the ears
Blurry vision
Noise and light sensitivity
Rarely, decreases in taste and smell
Concussion Associated Risk Factors
Early symptoms of headache after injury
Mental changes such as amnesia or fogginess
Fatigue
Prior history of headaches
Evaluation Of PCS
PCS is a diagnosis of exclusion
If patient presents with symptoms after head injury, and other possible causes have been ruled out => PCS
Use appropriate testing and imaging studies to rule out other causes of symptoms
Headaches In PCS
Often �tension� type headache
Treat as you would for tension headache
Reduce stress
Improve stress coping skills
MSK treatment of the cervical and thoracic regions
Constitutional hydrotherapy
Adrenal supportive/adaptogenic herbs
Can be migraine, especially in people who had pre-existing migraine conditions prior to injury
Reduce inflammatory load
Consider management with supplements and or medications
Reduce light and sound exposure if there is sensitivity
Dizziness In PCS
After head trauma, always assess for BPPV, as this is the most common type of vertigo after trauma
Dix-Hallpike maneuver to diagnose
Epley�s maneuver for treatment
Light & Sound Sensitivity
Hypersensitivity to light and sound is common in PCS and typically exacerbates other symptoms such as headache and anxiety
Management of excess mesencephalon stimulation is crucial in such cases
Sunglasses
Other light blocking glasses
Earplugs
Cotton in ears
Treatment Of PCS
Manage each symptom individually as you otherwise would
Manage CNS inflammation
Curcumin
Boswelia
Fish oil/Omega-3s � (***after r/o bleed)
Cognitive behavioral therapy
Mindfulness & relaxation training
Acupuncture
Brain balancing physical therapy exercises
Refer for psychological evaluation/treatment
Refer to mTBI specialist
mTBI Specialists
mTBI is difficult to treat and is an entire specialty both in the allopathic and complementary medicine
Primary objective is to recognize and refer for appropriate care
Pursue training in mTBI or plan to refer to TBI specialists
Sources
�A Head for the Future.� DVBIC, 4 Apr. 2017, dvbic.dcoe.mil/aheadforthefuture.
Alexander G. Reeves, A. & Swenson, R. Disorders of the Nervous System. Dartmouth, 2004.
�Heads Up to Health Care Providers.� Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 16 Feb. 2015, www.cdc.gov/headsup/providers/.
�Post-Concussion Syndrome.� Mayo Clinic, Mayo Foundation for Medical Education and Research, 28 July 2017, www.mayoclinic.org/diseases-conditions/post- concussion-syndrome/symptoms-causes/syc-20353352.
Origin: The most common cause of�migraines/headaches�can relate to neck complications. From spending excessive time looking down at a laptop, desktop, iPad, and even from constant texting, an incorrect posture for extended periods of time can begin to place pressure on the neck and upper back leading to problems that can cause headaches. The majority of these type of headaches occurs as a result of tightness between the shoulder blades, which in turn causes the muscles on the top of the shoulders to also tighten and radiate pain into the head.
Arteriovenous malformations and expanding aneurysms
Lupus cerebritis
Venous sinus thrombosis
Cervical fracture or malformation
Fracture or dislocation
Occipital neuralgia
Vertebral artery dissection
Chiari malformation
Metabolic
Hypoglycemia
Hypercapnea
Carbon monoxide
Anoxia
Anemia
Vitamin A toxicity
Glaucoma
Subarachnoid Hemorrhage
Usually due to ruptured aneurysm
Sudden onset of severe pain
Often vomiting
Patient appears ill
Often nuchal rigidity
Refer for CT and possibly lumbar puncture
Meningitis
Patient appears ill
Fever
Nuchal rigidity (except in elderly and young children)
Refer for lumbar puncture – diagnostic
Neoplasms
Unlikely cause of HA in average patient population
Mild and nonspecific head pain
Worse in the morning
May be elicited by vigorous head shaking
If focal symptoms, seizures, focal neurologic signs, or evidence of increased intracranial pressure are present rule our neoplasm
Subdural Or Epidural Hemorrhage
Due to hypertension, trauma or defects in coagulation
Most often occurs in the context of acute head trauma
Onset of symptoms may be weeks or months after an injury
Differentiate from the common post-concussion headache
Post-Concussive HA may persist for weeks or months after an injury and be accompanied by dizziness or vertigo and mild mental changes, which will all subside
Exquisite tenderness and/or swelling over the temporal or occipital arteries
Evidence of arterial insufficiency in the distribution of branches of the cranial vessels
High ESR
Cervical Region HA
Neck trauma or with symptoms or signs of cervical root or cord compression
Order MR or CT cord compression due to fracture or dislocation
Cervical instability
Order cervical spine x-rays lateral flexion and extension views
Ruling Out Dangerous HA
Rule our history of serious head or neck injury, seizures or focal neurologic symptoms, and infections that may predispose to meningitis or brain abscess
Check for fever
Measure blood pressure (concern if diastolic >120)
Ophthalmoscopic exam
Check neck for rigidity
Auscultate for cranial bruits.
Complete neurologic examination
If needed order complete blood cell count, ESR, cranial or cervical imaging
Episodic Or Chronic?
<15 days per month = Episodic
>15 days per month = Chronic
Migraine HA
Generally due to dilation or distension of cerebral vasculature
Serotonin In Migraine
AKA 5-hydroxytryptamine (5-HT)
Serotonin becomes depleted in migraine episodes
IV 5-HT can stop or reduce severity
Migraine With Aura
History of at least 2 attacks fulfilling the following criteria
One of the following fully reversible aura symptoms:
Visual
Somatic sensory
Speech or language difficulty
Motor
Brain stem
2 of the following 4 characteristics:
1 aura symptom spreads gradually over ?5 min, and/or 2 symptoms occur in succession
Each individual aura symptom lasts 5-60 min
1 aura symptom is unilateral
Aura accompanied or followed in <60 min by headache
Not better accounted for by another ICHD-3 diagnosis, and TIA excluded
Migraine Without Aura
History of at least 5 attacks fulfilling the following criteria:
Headache attacks lasting 4-72 h (untreated or unsuccessfully treated)
Unilateral pain
Pulsing/pounding quality
Moderate to severe pain intensity
Aggravation by or causing avoidance of routine physical activity
During headache nausea and/or sensitivity to light and sound
Not better accounted for by another ICHD-3 diagnosis
Cluster Headache
Severe unilateral orbital, supraorbital and/or temporal pain
�Like an ice pick stabbing me the eye�
Pain lasts 15-180 minutes
At least one of the following on the side of headache:
Conjunctival injection
Facial sweating
Lacrimation
Miosis
Nasal congestion
Ptosis
Rhinorrhea
Eyelid edema
History of similar headaches in the past
Tension Headache
Headache pain accompanied by two of the following:
Pressing/tightening (non-pulsing) quality
�Feels like a band around my head�
Bilateral location
Not aggravated by routine physical activity
Headache should be lacking:
Nausea or vomiting
Photophobia and phonophobia (one or the other may be present)
History of similar headaches in the past
Rebound Headache
Headache occurring on ?15 days a month in a patient with a pre-existing headache disorder
Regular overuse for >3 months of one or more drugs that can be taken for acute and/or symptomatic treatment of headache
Due to medication overuse/withdrawal
Not better accounted for by another ICHD-3 diagnosis
Sources
Alexander G. Reeves, A. & Swenson, R. Disorders of the Nervous System. Dartmouth, 2004.
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