RSSHeadache
July 1, 2009 by David Fitzgerald
|
| Print
Filed under Headache, Physiotherapy Blog
Differentiation of the pathogenesis of headaches is a complex clinical challenge. The International Headache Society have classified 126 types of headache on the basis of:
symptoms
behavioural characteristics
regional distribution
temporal characteristics
responsiveness to pharmacological intervention.
Many patients are diagnosed as Migraine sufferers but do not fit the classical ” migraine with aura” classification and are then classified as “atypical migraine without aura”.
While many of these patients can identify specific triggers (alcohol, dairy products, chemical irritants, ambient lighting, fatigue and dehydration many are unable to determine triggers.
Unfortunately, many chronic migrainuers develop “Tension type headache” or alternatively “chronic daily headache”
Physiotherapists dealing with this type of caseload commonly find a multitude of clinical signs in the cervical & thoracic spine together with TMJ dysfunction.
The clinical challenge is to determine the relevance of co-existing physical signs and the prioritisation of legitimate targets to treat.
The pain producing structures may be….
Articular
Myofascial
Neural
Common mechanisms may precipitate sensitisation of these structures
Such as
postural adaptation
occupational factors
ergonomics
previous musculoskeletal history
and the clinician must prioritise the primary target tissue.
Often this is influenced by clinician bias as to whether they utilise a manual therapy approach, a general exercise regime, a specific muscle imbalance protocol, myofascial techniques or dry needling.
The direction for future research into cervicogenic headaches needs to look at the testing and interpretation of musculoskeletal clinical signs which are frequently associated with headaches in order to establish clinical prediction rules and a clinical efficacy protocol for the management of these challenging patients.
Share your experiences with fellow clinicians by adding your comments below.
Enjoy the clinical challenge
David
How soon will you update your blog? I’m interested in reading some more information on this issue.
Thanks for the comment . As you can see I cover a broad range of topics so I don’t know when we will come back to Headache. The feedback from readers determines the frequency and depth we explore topics. Let me know what area’s you would like me information.
David