Teenage Headaches

[bluebear]

I would not suggest she would be wasting her time if the neck was not the problem. The therapist should be ruling it in or out and if it is ruled out then they would move on to examination of other hypotheses and/or refer on to others for advice.

My point exactly.
My comment goes to the assessment. How are we "ruling in" or "ruling out" the neck other than by trying treatment and seeing if it works?
If you had an aching pain in the ankle with no history of trauma, you might consider through the course of DDx that you may need to exclude the lumbar spine or neural tissues proximal to the pain. Starting to treat the ankle in that scenario may work, but you may also be treating the wrong body part, and would effectively be a "waste of time" in that a more thorough differential diagnosis might reveal the better place to direct treatment.

I would also argue that, having used "traditional techniques" for many years with varying degrees of success, that there is a significant difference in using headache specific techniques in both assessment and treatment, and the lack of success of traditional approaches would not satisfactorily "rule out" the neck in my opinion.

If cervical retraction is not contraindicated in this person I would try her with passive sustained end of range plus overpressure cervical retraction - 20 second hold x 4. See what effect that has on her headaches if any.

Cheers,
Roger O'Toole
Director and Senior Clinician - Melbourne Headache Centre
Melbourne Headache Centre - Headache Treatment, Migraine Treatment,

[raafox]

If cervical retraction is not contraindicated in this person I would try her with passive sustained end of range plus overpressure cervical retraction - 20 second hold x 4. See what effect that has on her headaches if any.
Melbourne Headache Centre - Headache Treatment, Migraine Treatment,

Thanks for the input Roger, in fact the cervical retraction is one of the first techniques that the patient has reported an easing of symptoms. Nothing dramatic but a definte lessening of pressure and pain in the head. If she tries cervical retraction herself she is unable to achieve the same effect due to the obvious work load and increased tension in her neck muscles. How would you proceed in this situation in terms of treatment approach and also home exercise if any?

Thanks

[bluebear]

If she is showing response to cervical retraction then the neck is definitely involved.

Within treatment you could do Cx retraction, (passive with therapist control and overpressure), hold 20-30 seconds, repeat x 4.

Try active retraction, get her to bring her hands up to her chin to support the head, then relax the neck (i.e. get her to stop pulling her head back and hold it there with her hands). Hold for 20 seconds. Repeat 4 times.

As she gets better at relaxing the Cx muscles, add overpressure with the hands ensuring not pulling the chin down into flexion. Hold for 20 seconds. Repeat x 4. 4 x per day and add during times off increased stress - i.e. after 15-20 mins of watching iPad - you can download apps with reminders on them that will go off to remind her to stretch.

Cervical retraction is far more effective once the underlying issue, being the C2/3 disc has been dealt with. Again, I would seek out someone trained in the Watson Headache approach nearby to assist further should Cx retraction help, but not resolve the issue.

Let me know how you get on.