resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Dysautonomia: The Medical Condition You May Already Be Treating
TCM practitioners have spent thousands of years healing patients without knowing or needing the names of their diseases as defined by allopathic medicine. We have syndrome names that are both poetic and efficient.
Integrative Cancer Care: Chiropractic for Chemotherapy-Induced Hiccups
Hiccups (singultus) are a frequent occurrence during cancer treatment. The cause of the hiccups may be the chemotherapy drug itself, such as Cisplatin; or the prophylactic use of corticosteroids such as Decadron, which is used to prevent nausea and/or vomiting.
Going Beyond Just Feeling Good
We all know that most patients come to us for some pain complaint: neck pain, back pain, sciatica, carpal tunnel, etc. We also all know that acupuncture is a great first-line care for these issues, as well as supporting overall health and wellness.
Six Things Every DC Should Know About the Zika Virus
The Zika outbreak continues to spread across the continental United States and U.S. territories. We offer this brief overview on this important public health problem for the practicing doctor of chiropractic.
National Board Apologizes for Testing Issues
The National Board of Chiropractic Examiners (NBCE) has issued a formal apology following a series of computer-based testing malfunctions that impacted two separate examinations (March and June 2016) and caused "widespread confusion and frustration" to the nearly 1,500 examinees taking the tests.
First Annual ICD-10 Updates Take Effect
Yes, there was an update to ICD-10 codes on Oct. 1. It was a regular update to the diagnosis coding system and will take place every Oct. 1, just as it did when the ICD-9 system was in place.
Workers' Back Pain: Causes, Costs & Solution
You will want to share two important papers published in the past several months. Why? When read separately, each provides valuable information relevant to your patients, community and practice; together, they tell a compelling story.
Power to the Patient
Against a backdrop of splintered political parties, polarizations within nations, civil unrest, and distrust of established government (such as the growing anti-Washington, D.C. sentiment) comes the not-so-surprising finding that health care authorities and practitioners (with perhaps the exception of insurers) are turning over more and more powers to the individual patient.
Natural Cancer Prevention: Pomegranate for the Prostate
In recent years, the ingestion of pure pomegranate juice (8 ounces per day) has been shown in clinical studies with human subjects to slow, and to some degree, reverse, the progression of prostate cancer – the second leading cause of cancer death in North American men.
Decoding the Mystery of Medical Insurance Acceptance
In the constantly evolving profession of acupuncture, one of the least understood areas is medical insurance acceptance. The profession is filled with controversy surrounding this topic: Is it ethical?
Update from the International AIDS Conference
The 21st International AIDS Conference in Durban, South Africa, brought together more than 15,000 of the world's leading scientists, activists, funders, policy makers, and consumers from 153 countries.
Treating Peripheral Neuropathy: Multi-Faceted Approach Including Laser Therapy
Peripheral neuropathy affects at least 20 million people in the United States1 and nearly 60 percent of all people with diabetes suffer from diabetic neuropathy. Many suffer from the disorder without ever identifying the cause.
Upgrade to "Parker 2.0" in Las Vegas
Continuing your education and refining your practice: two key elements of a successful chiropractic career. Parker Seminars promises both as it celebrates its 65th anniversary in Las Vegas next February, according to Parker University President, Dr. William Morgan, and seminar consultant Dr. Mark Sanna.
Getting Paid by Medicare Is Getting a Major Adjustment
The 2015 Medicare Access and CHIP Reauthorization Act (MACRA) was signed into law to implement a new approach to clinician payments and replace the Sustainable Growth Rate formula.
Pediatric Asthma: A Case Study
I have had very good success with pediatric asthma, combining acupuncture with Chinese herbal products. Treatment is given over four to eight months, twice monthly, with herbal formulas rotated every month.
Four Ways to Attract Patients
Acupuncturist A has been in practice for six years and has struggled since day one. She spends as much time and money on marketing as she can, but since her practice is slow, her budget isn't that big.
Treatment Success at the Won Institute
According to the World Health Organization's 2003 report titled, "Acupuncture: Review and Analysis of Controlled Clinical Trials," acupuncture has been shown to improve many physical, emotional, and mental conditions.
Pediatric Footwear: Function Over Fashion
As practitioners, it is not uncommon for parents to bring us their children to treat or ask us questions related to the pediatric population. Children's feet tend to be a perplexing region for parents and practitioners alike.
Using the Lens of Chinese Medicine
One of the most common medications I see in clinical practice on a daily basis is fluoxetine or Prozac. Consequently, I hear many complaints concerning the side effects of this medication and am frequently asked by patients to help manage these side effects with acupuncture and Chinese medicine.
U.S. Olympians Have a DC in Their Corner
It's probably old news to you that doctors of chiropractic play an increasingly prominent role in treating athletes, from youth sports participants to weekend warriors, to elite / professional competitors.
March, 2016, Vol. 16, Issue 03
Treating Headaches and Migraines with Trigger Point Therapy
By Valerie DeLaune, LAc
Tension headaches, migraines, and cluster headaches account for 90% of all headaches. Tension headaches are the most common and people who experience migraines typically also have tension headaches in between their migraines. Studies have shown that patients who have headaches (including migraines) are almost twice as likely as healthy control subjects to have postural abnormalities, including head-forward posture and also have trigger points in the back of the neck, particularly in the suboccipital muscles.
Patients who suffer from both migraines and tension-type headaches are far more likely to have a greater number of active trigger points. The greater the number of active trigger points, the more frequent and severe the headaches. With one-sided headaches, a greater number of active trigger points are found on the same side as the headache.
The most common causes of tension headaches are trigger points, with underlying perpetuating factors including poor posture and ergonomics, emotional distress, fatigue, noise, glare, and jaw clenching. Tension headaches can also be associated with arthritis, disk problems, or degenerative bone disease in the neck or spine.
About one in ten people get migraines and about 75% are women. Trigger points play a far greater role in migraines than previously thought; one study found that 93.9% of migraine subjects had trigger points with referred pain patterns that reproduced their migraine pain and other symptoms. Pressing the trigger points could reproduce the location of pain, the throbbing quality, light and sound sensitivity, and other symptoms that were common for each subject. The longer the history of migraines and the more frequent the attacks, the greater number of trigger points the subject had in their muscles. In other words, the longer migraines are left untreated, the greater number of trigger points will form, and the more migraines the patient will get – a self-perpetuating cycle. Most of the triggers for migraines are also those that cause and perpetuate trigger points, such as allergies, alcohol, smoking, stress, hormonal changes, caffeine, and insufficient nutrition, water, sleep, or exercise.
Cluster headaches primarily affect men 20 to 40-years-old. As with tension headaches and migraines, triggers such as alcohol, tobacco use, allergies, and sleep apnea (which causes oxygen-deprivation) also cause and perpetuate trigger points.
Neck injuries are the most common cause of post-traumatic headaches. In a study of patients following rear-end motor accidents, 62% of patients reported feeling neck pain within six to seventy-two hours, and of those, 82% also reported headaches. Twelve weeks after their accidents, 73% still had headaches. Injuries are one of the most common initiators of trigger points.
Treating Trigger Points
It is important to have a clear idea of where your patient is experiencing pain. Many patients will refer to facial pain or pain at the C1 level as a headache. In order to decide which trigger points to search for first, have your patient color in their referral patterns on a body drawing.
It is also important to remember that, in general, at least 74% of trigger points are not located in the area in which your patient feels pain. Trigger points in the trapezius, posterior neck, and sternocleidomastoid muscles can all refer upward into the head. These are called primary trigger points. Trigger points in the temporalis, orbicularis oculi, zygomaticus major, frontalis, occipitalis, masseter, lateral pterygoid, medial pterygoid, and digastric muscles can be either primary trigger points, or satellite trigger points (formed due to being within the referral zone of the primary trigger points). You will also need to keep in mind that headaches can be a composite of trigger point pain referral patterns from various muscles of the neck and in and around the mouth and jaw, so it may be impossible to match up common referral patterns with just one muscles' common referral patterns.
Being able to reproduce the referral patterns when palpating trigger points can be a confirmation that you have located at least some of the pertinent trigger points, but being unable to reproduce the referral pattern should not rule that trigger point out. If your patient is experiencing symptoms consistent with that trigger point, treat it and see if symptoms decrease by the next treatment. Also, remember that trigger point referral charts and pictures only show common referral patterns. Your patient's referral pattern may look somewhat to very different from a chart. Gathering information from the patient about all of their symptoms, palpation, and asking if symptoms have decreased in between treatments is the best way to confirm that you have successfully located the pertinent trigger points.
Remember that treating the trigger points is only part of the treatment – all underlying perpetuating factors need to be identified and addressed. Common perpetuating factors include mechanical stresses, injuries, spinal misalignments, nutrient deficiencies, poor dietary habits, food allergies, emotional factors, sleep problems, acute or chronic infections, hormonal imbalances, and organ dysfunction and disease. For this reason, it often takes a team approach to treat trigger points, since no one type of practitioner may be able to diagnose and treat all the pertinent perpetuating factors.
Trapezius trigger points can cause pain behind the eye, dizziness or vertigo (probably indicating simultaneous involvement of the sternocleidomastoid), and stiffness and/or limited range-of-motion (ROM) in the neck. Common perpetuators include postural and ergonomic issues, whiplash injuries, structural inequalities, fatigue, stress, and several types of sports activities, including biking and swimming.
In addition to the pain referral patterns, trigger points can cause pain shooting through the head to the back of the eye, blurry vision, and neck stiffness and/or limited ROM. Common causes and perpetuators include head-forward posture (including compensation for kyphosis), poor posture and ergonomics at a desk including cradling the phone between the ear and shoulder, whiplash, subluxation, stress or depression, and exposure to cold drafts.
In addition to the pain referral patterns, other trigger point symptoms can include sinus congestion (often attributed to a sinus infection, even though there is no discharge), dizziness or vertigo, earaches, nausea and loss of appetite, seasickness/car sickness, one-sided deafness or tinnitus, visual disturbances, eye tearing or reddening, eyelid drooping or twitching, a sore throat, or a dry, tickling cough.
Perpetuating factors include head-forward posture, tilting the head back or to the side for prolonged periods, improper pillows, tight neckties or collars, a chronic cough or improper breathing mechanics, chronic or acute infections, tight pectoralis major muscles, structural inequalities, severe scoliosis, whiplash, and alcohol consumption.
In addition to the common pain referral patterns, other trigger point symptoms can include teeth sensitivity or pain, improper bite alignment, teeth clenching, or the jaw may zig-zag while opening or closing. Common perpetuating factors may include head-forward posture, chronic infections or inflammation, folate deficiency, hypothyroidism, clenching/grinding, gum-chewing, dental work, and primary trigger points in the trapezius and/or sternocleidomastoid muscles.
Frontalis and Occipitalis Muscles
Frontalis trigger points may develop from primary trigger points in the sternocleidomastoid muscle, from raising eyebrows frequently, and from wrinkling the forehead. Occipitalis trigger points can form as a result of primary trigger points in the posterior neck muscles, or squinting due to poor vision or glaucoma.
These are only some of the trigger points, muscles, referral patterns, additional symptoms, causes, and perpetuators of trigger points that can cause headaches and migraines. You may also need to treat the scalene and possibly other muscles if your patient has head-forward posture, even though they don't directly refer symptoms to the head.
By locating and treated pertinent trigger points, and identifying and rectifying causes and perpetuating factors of trigger points, you can likely help your patients reduce or eliminate their headache pain and other associated symptoms. (Click here for a complete set of trigger point referral patterns.)
Valerie DeLaune is a licensed acupuncturist and certified neuromuscular therapist. DeLaune has authored eleven books on trigger point self-help techniques. Pain Relief with Trigger Point Self-Help, a book on CD ROM was released in 2004 and the print format was released in 2011. DeLaune teaches workshops in the U.S. and currently resides in Alaska. For more information, visit www.triggerpointrelief.com.
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