ANATOMY IN ACTION SERIES: Stress Headache
Educational articles designed to help CAs understand the underlying anatomy and physiology of conditions presenting to the chiropractic office.
Laurie Mueller
Origins of the Stress Headache
Headaches are a common condition presenting to chiropractic offices. This article will focus on the specific anatomy contributing to the stress headache, also known as the muscle tension headache. Stress can come from mental or physical sources. Emotionally it can come from small things, like irritation in traffic, or from something more serious, like going through a divorce, having anxiety or worry, or having a difficult time at work. Day-today demands are certainly a source of stress for many people. Physical stress can be another strong contributor. It can stem from poor posture, prolonged ill-positioning, repetitive motions (assembly line work for example), or injuries (sprain/strain or whiplash). Whether mental, physical, or both, the final result can be muscle tension. This is commonly seen in today's world where so many individuals are overstressed with life's responsibilities. Sedentary lifestyles and workstations, such as sitting at desks and computers for long hours at a time, can also contribute to the problem.
Muscles and Bones
Many different muscles can be involved with tension, but for headaches, our top muscular culprits include the suboccipital muscle group and the trapezius. This is especially true of our desk workers who may be ill positioned ergonomically, with their heads hanging forward in anterior weight bearing, putting tension into the suboccipitals.
The suboccipitals include rectus capitis minor and major, and obliquus capitis inferior and superior. We'll also acknowledge a few neck muscles that can
contribute like the splenius, semispinalis, and SCM. These all have attachments on the skull, most of them on the occipital bone at the back of the skull. The different muscles insert at various locations in the upper cervicals and all the way down to the upper thoracics.
Tension in these muscles can easily cause stress to other muscles of the skull and contribute to subluxations of the occiput, neck, and upper back.
Thetrapezius is our giant diamond-shaped muscle that covers the back. We see the left half of it in this diagram. It has attachments on the occiput, nuchal ligament, spinous processes of C7-T12, lateral third of the clavicle, and scapula. When someone gives you a shoulder rub, they are actually massaging the upper belly of the trapezius muscle. That muscle belly is a common place to find spasm and trigger points, and it is a big contributor to neck discomfort and headache.
Management of Stress Headache
Ergonomics, how the patients position themselves at their workstations, will be an issue that the doctor will explore and try to remedy with the patient. If positioning is bad and not corrected, then the patients
may find themselves in an endless cycle of muscle spasm and subluxation. The goal is to find causative factors and help remedy them.
During the course of examination and diagnosis, the doctor will also rule out other headache types (such as migraine, which could have a different origin), or other conditions such as food sensitivities. Occasionally, doctors may even find or suspect serious issues, such as brain tumors, and need to refer out.
Headaches invariably go hand in hand with muscle spasm and subluxations, and so adjusting the needed segments is a first line of defense in a chiropractic office.
Muscle/trigger-point work/stretching should be expected. The doctor may perform this technique if the office doesn't have a massage therapist in-house. This can be coupled with muscle strengthening exercises that the patient performs at home.
Passive care modalities can also be used and are often administered by the CA. This could include ice, heat, ultrasound, or electric muscle stimulation (EMS) over the spasmed muscles.
Special Considerations
Note that we never perform EMS over the thyroid gland or the carotid sinus area. Why? Because stimulation of the gland could cause a hormonal surge, and the carotid sinus is full of baroreceptors, which tell the brain about blood pressure. Stimulation in this region can cause a dramatic drop in blood pressure and the patient could pass out.
If you are instructed to administer modalities in the anterior or lateral neck, do be sure to avoid these structures!
Education Fosters Understanding
An understanding of anatomy and clinical applicability helps all health-office employees better communicate with patients and provide care more safely. Online training programs in particular make
“Headaches invariably go hand in hand with muscle spasm and subluxations, and so adjusting the needed segments is a first line of defense in a chiropractic office.”
high-quality training affordable and convenient and can be taken any time of day. At www.CCCAonline. com, learners can engage in a streamlined 24-hour training program that meets or exceeds FCLB guidelines in every area of study and fulfill the training requirements needed for the national examination!
DCs will often pay fortheir employees to train. Full price for this training is an affordable $339 for the entire 24-hour program. At www.CCCAonline.com, there is also a special discount available for you! If you are receiving this article through The American Chiropractor magazine use AMCHIRO as your dis-
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Learners can expect text, images/schematics, dynamic video lectures, and robust, customized, experiential interactivities in a thorough 19-module program. Plus, an extensive note-packet of nearly 200 pages is included and can be downloaded, printed, and studied off-line. Learners work at their own pace and can conveniently take programming around work hours to avoid disruption in the office. Questions? Visit our website or send us an e-mail at [email protected]
Laurie Mueller; BA, DC, C.FMP served in private practice in San Diego, California. She was the postgraduate director at Palmer College from 2000 to 2010; served as the ACC postgraduate subcommittee chair for six years; peer-reviewed for the Research Agenda Conference; and wrote the informal role determination study that aided in the development of FCLB's guidelines for chiropractic assistants. Dr. Mueller currently works as a private eLearning consultant with a focus on healthcare topics and functional medicine through her company, Impact Writing Solutions, and its subsidiary, www.CCCAonline.com. She is a clinician, an educator; and an expert in online educational pedagogy.
