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,