Medical treatment for headaches and neck pain and implications for massage application

Chapter 3 Medical treatment for headaches and neck pain and implications for massage application



CHAPTER CONTENTS



Introduction


The diagnostic process


Medical treatment


Muscle/soft tissue contraction tension headache


Vascular headache treatment


Neck pain treatment



INTRODUCTION


Those experiencing head and neck pain usually seek help from a family practitioner (MD, DO, ND, DC). If the problem is not relieved by standard treatments, the patient may then be referred to a specialist such as an internist or neurologist. Additional referrals may be made to psychologists.


The massage therapist needs to understand the diagnostic process and target of various treatments so that the massage application can support specific medical treatment. When therapeutic massage is used in conjunction with typical medical treatments such as medication, supplements or herbs, surgery, manipulation, physical therapy, etc. it is necessary to evaluate the massage application so that it is supportive of medical intervention as well as taking into account potential risks for massage associated with treatment.



THE DIAGNOSTIC PROCESS


The process of identifying the cause of the symptoms related to headache and/or neck pain includes typical assessment procedures such as history taking, physical assessment, specific assessment (X-rays, blood tests, strength and stability testing, etc.) and interpretation of the information gathered.



History taking


A physician’s detailed question-and-answer session with a patient can often produce enough information for a diagnosis. Many types of headache and neck pain have clear-cut symptoms which fall into an easily recognizable pattern. Most physicians will also obtain a full medical history from the patient, inquiring about past head and neck trauma or surgery, eye strain, sinus problems, dental problems, difficulties with opening andclosing of the jaw, occupation-related strain, lifestyle behaviors, sleep habits, levels of emotional and physical stress, and the use of medications both prescribed and over the counter. Typical health history questions used to diagnose headache and neck pain include:



• Were you injured and if yes what was the nature of the injury?


• Have you experienced head impact and loss of consciousness?


• Do you experience radiating pain and the presence of any symptoms that suggest nerve problems such as:


– weakness?

– numbness?

– tingling or loss of function, particularly in the upper extremities?

– difficulty breathing?

– dizziness, nausea or vomiting?

– ringing in the ears or decreased hearing?

• Do you experience only headache or neck pain or both together?


• How often do you have headaches or neck pain?


• Where is the pain?


• How long do the headaches or neck pain last?


• When did you first develop headaches or neck pain?


• What factors that make you feel better (relieving) or worse (exacerbating)?



Physical examination



Observation


This includes checking posture, gait, facial expression, willingness to move for examination and ease of movement, as well as the specific head and neck area to include:



• the position of the chin and head seated, standing, and possibly lying down


• habitual posture and the symmetry of the neck contour formed by the trapezius muscle


• the position of the shoulders to see if they are level when relaxed in standing, seated, or lying down (asymmetry often indicates muscle spasm)


• evidence of any increased pressure in the neck veins (distended or bulging jugular veins)


• signs of inadequate blood supply (ischemia) in the upper limbs


• signs of inflammation such as looking for edema and changes in skin color.



Physical tests and palpation




• Neuromuscular testing to determine whether there are any injuries to the nerves and joints in the neck. These tests typically involve moving the body both passively and actively to assess for strength, range of motion, and any loss of sensation.


• Assessment of the blood vessels in the neck by feeling the pulses to assess for briskness of upstroke and fullness, and the presence of any abnormal sounds.


• Soft tissue will be palpated for tender areas, signs of inflammation (heat and edema), tissue texture changes, differences in temperature and dryness or excessive moisture, tremor (shaking) and muscle twitches, and changes in muscle and motor tone.



Diagnostic imaging



Plain film radiography (X-rays)


Plain X-rays are still the primary means of looking for trauma to bones involving the cervical spine. They have the advantages of low cost, wide availability, and good anatomic resolution. X-rays do not give a good image of soft tissue structures (muscles and ligaments).



Computed tomography (CT) scan


This painless, noninvasive technique produces cross-sectional images of tissues. CT scans offer far better tissue contrast resolution when compared to plain X-rays and are excellent for displaying bony architecture, although soft tissues are seen less well.


It is useful in assessing for complex fractures and dislocations, disk protrusions and disease of the joints of the vertebrae, and spinal stenosis (a narrowing of the space containing the spinal cord). CT scans produce X-ray images of the brain that show structures or variations in the density of different types of tissue.



Magnetic resonance imaging (MRI)


MRI is a noninvasive, painless imaging technique used to obtain images of bone and soft tissue. It uses magnetic fields and is based on detecting the effect of a strong magnetic field on hydrogen atoms contained in water. MRI scans use magnetic fields and radio waves to produce an image that provides information about the structure and biochemistry of the brain.


MRI cannot be used for people with implanted or other metallic foreign bodies not firmly fixed to bone but is reportedly safe with prosthetic joints and internal fixation devices. It is often preferred over myelography for the assessment of disk disease because it is noninvasive. Its principal disadvantages include cost and lack of availability.



Myelography (spinal cord imaging)


A water-soluble contrast dye is injected into the epidural space via lumbar puncture and allowed to flow to different levels of the spinal cord. Plain X-rays, or more commonly CT scan, are then performed to indirectly visualize structures outlined by the dye.


This technique is very sensitive at detecting disk disease, disk herniation, nerve entrapment, spinal stenosis, and tumors of the spinal cord. Side effects of the procedure include headache, dizziness, nausea, vomiting, and seizures.



Diskography


This involves the injection of radiopaque dye into the center of an intervertebral disk (nucleus pulposus), using radiographic guidance, and may be used to determine disk disruptions.



Blood tests


Blood tests may be ordered to screen for thyroid disease, anemia, or infections which might cause headache or neck pain.



The Diagnostic Process


The combination of a detailed history, physical examination, and one or more imaging procedures and blood tests should enable the physician to exclude, or identify, any serious injury to the head or neck in order to arrive at a diagnosis and develop an appropriate treatment plan.


The massage therapist would utilize the information gathered during diagnosis as well as gather similar information themselves as they develop and implement an appropriate massage intervention.



MEDICAL TREATMENT


Understanding the mechanisms of action of medical treatment, especially medication, helps the massage therapist make logical decisions about when massage may either support the outcome of treatment, and therefore reduce the medication dosage, or in some cases replace the medication.


All over-the-counter and prescription medications can have side effects. Overusing medications, beyond the labeling instructions and doctor’s prescription, can lead to dependence and rebound headaches.


Since medications and surgery especially have an increased potential for side effects it is advisable to treat head and neck pain with conservative care such as massage and other noninvasive methods if possible.



MUSCLE/SOFT TISSUE CONTRACTION TENSION HEADACHE




• Treatment for muscle-contraction headache varies. The first consideration is to treat any specific disorder or disease that may be causing the headache. For example, arthritis of the neck can be treated with anti-inflammatory medication, and temporomandibular joint dysfunction (TMJD) may be helped by corrective devices for the mouth and jaw.

Related posts:

Pain How headaches and neck pain occur, and when is pain a sign of a serious condition? Headache types and neck pain and dysfunction Modalities working with massage Adjunctive treatment for headache and neck pain: what else should you know, and what else might help? Assessment strategies and selected interventions

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Jun 14, 2016 | Posted by in PAIN MEDICINE | Comments Off on Medical treatment for headaches and neck pain and implications for massage application

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