resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Paperwork Done Wrong, Done Right
I was visiting a doctor's office recently and a member of his staff brought a stack of forms to his private office and laid them on the doctor's desk. She informed him he needed to complete the forms for patients and a few third parties.
Getting Unstuck: Healing From Trauma With TCM, Qigong & Movement
We all come into this world vulnerable, with seeds to grow into our strength. Some of us — through a combination of good fortune (i.e., family and culture we are born into, constitutional inheritance, or ability to learn) grow with minimal interruption from traumatic injuries and experiences.
The Acupuncture Channel System (Part 2)
The primary channels (main channels) are introduced in chapter 10 of the Ling Shu, these channels are referenced in many chapters throughout the Su Wen and the Ling Shu. The primary channels have become the main channel system used in TCM.
4 Things Every DC Should Know About Levels of Care & Prevention
As health practitioners, we help people with their health problems and assist them with health promotion and disease prevention.
Near-Infrared Therapy for Diabetic Neuropathy
The pain experienced by people with diabetes is a symptom of diabetic neuropathy. The impact on quality of life is significant. Pain makes walking difficult, sleep troublesome, and eventually contributes to a decrease in social interaction.
Helping Patients With Parkinson's Disease
Parkinson's disease (PD), a long-term degenerative disorder of the central nervous system that mainly affects motor function, has a slow onset over time.
News in Brief
The American Association of Acupuncture and Oriental Medicine (AAAOM) board members recently met with the Korean Customs Service, which is similar to the FDA, to discuss herbal safety and importation issues.
The Large Intestine Official
The large intestine (AKA colon) is the great eliminator, or as J.R. Worsley called it, "The Drainer of the Dregs." Dregs are defined as the remnants of liquid with its sediment left in a container, or the basest, least valuable portion of anything.
House Calls With Dad
My father was a chiropractor and he did house calls. On Wednesday nights, while my mother attended the weekly women's meeting at the Odd Fellows and Rebekahs hall in our small town, dad loaded up the portable adjusting table, fired up the Pontiac and drove off to treat a few patients in their homes. I went with him.
Reader Beware: Consider the Source
The aftermath of last year's presidential elections brought a running conversation on the role played by "fake news" that was largely presented via social media.
Chiropractic in Texas Is Under Attack
The profession of chiropractic faces an unprecedented challenge in Texas, an attack that is more aggressive, sustained and dangerous than anything previously seen. The medical lobby has launched a coordinated, multi-front assault.
AOM Residency at NUNM
Imagine you're a recent acupuncture graduate, worried about making enough income as you forge your new career and seek more in-depth training in a particular treatment style.
Spiritual Initiation: Opening Your Higher Healing Abilities
People drawn to the field of acupuncture and Oriental Medicine tend to be those who march to the beat of a different drummer.
Correcting Rib Dysfunction: Improve Patients' Pain, Posture and Breathing
As chiropractors, we tend to focus on the spine, and rightly so. Many problems our patients face can be corrected by manipulating the correct spinal level.
TCM & the Caregiving Population: Treatment Considerations & Our Vital Role
Informal caregiving is increasingly a reality for many Americans who find themselves providing unpaid care for a loved one or a family member with a long-term, terminal, or chronic illness.
Advancing the "Whole Organ" Spine Model
Historically, the human spine has been organized by body region utilizing specific anatomical landmarks and transition zones.
VF Works / DMX Works Epilogue: Almost Two Decades Later, the Lawsuits Continue
An article in the March 8, 1999 edition of Dynamic Chiropractic examined whether then-VF Works / Nu-Best Franchising was selling its franchises illegally to doctors of chiropractic.
Latest Cassidy Study on Stroke Risk Published
The latest study to investigate whether a unique association between chiropractic manipulation and risk of cervical artery dissection / stroke exists has yielded similar encouraging findings, with the authors noting "no excess risk of carotid artery stroke after chiropractic care" and no significant risk difference between patients receiving care from a DC or a primary care medical provider.
ICA Goes on the Vaccine Offensive
Have you watched the vaccination documentary, "Vaxxed: From Cover-Up to Catastrophe," by Andrew Wakefield MD, director, and Del Bigtree, producer? This is the documentary Robert DeNiro was pressured to remove from his Tribeca Film Festival.
A Brief History of Acupuncture and Oriental Medicine Doctoral Programs
A doctorate in acupuncture and Oriental medicine has been a goal of the profession since its beginnings in the late 1970s. At that time, however, the maturity of the educational institutions and the regulatory environment made it a goal with only a distant completion date.
Waist Circumference: A Conversation Starter
New estimates suggest more than two-thirds of Americans are either overweight or obese. The medical significance of this statistic is astounding.
Gather & Grow
I recently attended a faculty seminar held by one of the acupuncture schools. There was a facilitator who led us through some very interesting experiences. The attendees were a diverse group with varying opinions.
Treating the Lower Pelvis (Pt. 2): Midline Structures and Fascia
My previous article [October 2016 issue] outlined evaluation and treatment of pelvic issues involving the sacrotuberous ligament and the pubic symphysis. Now let's discuss two case studies that illustrate how to address additional problematic areas of the pelvis.
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.
Join the conversation
Comments are encouraged, but you must follow our User Agreementcomments powered by Disqus
Keep it civil and stay on topic. No profanity, vulgar, racist or hateful comments or personal attacks. Anyone who chooses to exercise poor judgement will be blocked. By posting your comment, you agree to allow MPA Media the right to republish your name and comment in additional MPA Media publications without any notification or payment.