Headaches and Osteopathy
Introduction:
According to the International-Headache-Society (2014; classification section), there are many types of headaches, the most common of which include migraine, cluster and tension headaches: – Headaches can be associated with head trauma (or any trauma), vascular problems, infection, substance use and their withdrawal, non-vascular intracranial disorders (e.g. a tumour), disorders of homeostasis, psychiatric disorders and other possible causes.
As an Osteopath, the most common types of headache patients will present with are migraine and tension type headaches, and as so I will primarily explore these headaches from a holistic anatomical perspective in order to give some insight into how an Osteopath may approach assessment and treatment of clients with headaches. It is important to keep in mind however, due to the multi-factorial nature of causative elements (physical, psychological, pharmaceutical, nutritional, infectious, and so on), an Osteopath may need to work in conjunction with the appropriate health care professional (e.g. Medical specialist, Psychologist, Naturopath, etc) in order to achieve optimal health benefits.
Pain Pathways:
According to Ward (1997), pain sensitive structures of the head region include; the arteries and venous sinuses and their branches, the muscles of the head and neck, the skin and its blood supply, portions of the Dural membranes and Dural arteries, intracranial arteries, cervical and some cranial nerves. Pain pathways above the tentorium cerebelli (a membranous structure between the upper brain and the cerebellum in the temporal-occipital region) are suggested to involve the trigeminal nerve (cranial nerve V) and are often felt in the frontal, parietal and temporal areas of the head; whilst pain below the tentorium cerebelli is often perceived in the occipital region and pain pathways involve the Glossopharyngeal (cranial nerve IX) and Vagus (cranial nerve X – which also contributes parasympathetic innervation to the heart, lungs and the upper gastrointestinal to the mid transverse colon) and the upper cervical nerves (Ward, 1997). The pain and symptoms of migraine for example, may involve any of the above mentioned structures and pain pathways and is also suggested to be associated with the vasoconstriction and vasodilation of the intracranial arteries (under the control of the Autonomic nervous system – comprising the parasympathetic and sympathetic divisions) and which can also be affected by local chemical/metabolic factors (Ward, 1997). The sympathetic nerves which supply the blood vessels of the head and neck originate from sympathetic ganglia under the rib heads in the upper thoracic spine (T1-4). Thus, when looked at from a symptomatic angle, it is common for many practitioners to assess and treat the upper thoracic and neck areas, with some including the skull and its internal contents (i.e. in addition to the musculoskeletal elements – membranes, fluids, nerves, vascular and other elements can be all included in the assessment), depending on the assessment and treatment methods employed.
Other Anatomical considerations:
As an Osteopath however, I have been taught that symptoms are only one aspect of the total picture (i.e. they are often the effects of other preceding causes) and that causes of the patterns of dysfunctions setting up the symptom picture can be located anywhere within the whole human mechanism. Other areas and relationships within the body also need to be considered and assessed (via a full postural assessment) in order to identify these other key areas of the body contributing in some way to headaches. A more thorough consideration of the anatomy potentially involved will make this clearer. For example: from a lymphatic and fluid drainage perspective, the upper thoracic region is also important and this area needs to be free for there to be good blood and lymphatic flow to and from the head and neck. The diaphragm region (lower thoracic and ribs through to the mid lumbar) also is important for fluid drainage and also respiratory function (important for chest/ribcage expansion and also for oxygenation through the blood supply to the brain and other organs of the body). The ribcage is where many of the muscles originate which subsequently attach to the head and neck and thus can also be involved from muscular and postural perspective. Postural restrictions and imbalances in the lower body, pelvis and legs can unbalance weight bearing resulting in tilting/rotating/excessive curving of the thorax above with subsequent effects on tension and symmetry in the shoulders, neck and head above which then can contribute to headaches. The core region between the lower thorax and pelvis (e.g. the abdominal/back muscles and pelvic floor muscles) may not be well supported and may be weak and collapsing posturally, resulting in asymmetry and increased compensatory recruitment and over-use of the muscles and tissues of the upper body stressing this area and again, contributing to headaches. The digestive system in the abdomen is also important from a nutritional perspective. The membranes which surround the brain and spinal cord attach more firmly at the frontal region (which can relate to frontal headaches) – around the top, sides and back of the skull and into the upper neck and also to the sacrum/coccyx (tail bone region). The membranes surround the veins of the skull and also 95% of the venous drainage from the skull occurs between the temporal and occipital bones either side of the skull and 2/3 of the blood supply to the skull enter in through the two temporal bones and the other 1/3 through the occiput. Personal experience has shown that the membranes (and other tissues potentially also) are often taut and not ebbing and flowing in migraines limiting skull movement and effecting the nervous, vascular and other fluid systems and rhythms of the head and neck. The primary restriction is often at the sacral end of attachment can often cause pain at the other end, much like if you pulled on one end of a hair the other attached end may be painful where it attaches (i.e. the attached end being the cause “of the pain” but not “of the problem”).
Similarly, there is a connective tissue covering, called fascia, with surrounds all tissues, muscles, and organs of the body. A relationship which should also be considered is an internal fascial link which connects with the base of the skull and extends down around the throat, heart and lungs and attaches to the diaphragm. This could have interesting potential effects on the brain and cognitive function, health and drainage because, as the diaphragm contracts with proper breathing, it can help through fascial links with motion of the heart, lungs and cranial base function, thereby effecting motion and functioning of lung, heart and brain tissues (and fluid drainage). Furthermore is someone is mentally/emotionally stressed (anxious or angry, for example) they tend to tighten the upper body (recruiting accessory respiratory muscles) and not breath through the diaphragm/abdomen and back region effectively thus effecting function and balance between upper and lower body. A lot of mental and emotional issues in the personality often relate to the solar plexus and sacral areas also which subsequently effect physical mechanics. Breathing and relaxation exercises, along with good treatment to appropriate involved sites may therefore help relax the nervous system and also the areas of the body which tend to hold these stresses thereby effecting physical function through some of these connections. As with many symptomatic effects, there is often too much happening at one end and not enough at the other end.
Conclusion:
It can be seen from the above discussion that an in-depth exploration of anatomical relationships on the body indicate a need for a holistic and thorough assessment in order to identify important involved components and their relationships. Although symptoms and pain pathways may be similar in any particular type of headache, because each patient is unique and their issues may involve a complex interaction in the relationships between numerous involved components in their case (once uncovered), an individualized treatment plan needs to be utilized for best results in that individual. This is the Osteopathic approach and the approach of any holistically minded practitioner in any field and what they can potentially offer clients suffering with this condition. It’s the relationships which are important because there needs to be a integrated balanced function between one area of the body and the other so that all of the tissues, organs and systems of the body can work in harmonious relationship and take the stress off the symptomatic tissues and help bring the person back in to healthy balanced function (which will subsequently alleviate the pain). This integrated function cannot occur if only the part with symptoms is investigated and treated on its own, and furthermore how could we tell if one area is working well with respect to another area if the different areas are not compared to see if they are in balanced relationship. If a good integrated flow can occur between the sacrum right though to the skull – this usually helps (in this authors clinical experience) markedly, in helping people recover from headaches (especially, when a patient has been investigated and there is found to be no their other serious medical emergency or explanation for their pain, and which needs more immediate attention first). It’s all about balanced function in the whole person.
As a concluding thought; observing the “Health” within the body can give a practitioner a clue about where to start, if attuned to, as it tends to focus itself in the areas which need attention at the appropriate time (which is a bit like observing where the healthy water is interacting with an obstruction in a clogged pipe – the pressure builds up where it is trying to break through the obstruction and once it does, it then moves on to the next obstruction which needs dealing with). This is particularly interesting and important when someone is in the acuteness of a migraine or headache as it will indicate the safest way (and from where) to help settle the person, without flaring them up. By recognizing these points of interaction between the problem patterns and the healthy tissues – practitioners can more adequately recognize where to support the self-healing mechanisms of the body and when, during a treatment and thus achieve better results.
This discussion has hopefully provided an awareness of some of the important relationship connections which need to be considered in order to successfully treat patient suffering headaches, both for patients and for practitioners. I hope they have given you food for thought.
Dr Paul Turner. B.App.Sc.(Osteopathy); B.HSc(Hons).
Reference List:
International-Headache-Society. (2014). Retrieved October 3rd, 2014, from http://ihs-classification.org/en/02_klassifikation/
Ward, R. C. (Ed.). (1997). Foundations for Osteopathic Medicine. Baltimore, Maryland: Williams & Wilkins.
