How To Overcome Chronic Myofascial Headaches: Insights From A Case Report

Patient History

Jane sought treatment at our clinic to address chronic headaches and neck pain. Six years prior, she had sustained a significant injury, which involved a laceration and fracture at the right occipital area of her skull. Over the course of the next two years, Jane began to experience complete numbness in the distribution of the greater occipital nerve, which affected one side of her scalp. This numbness eventually progressed into chronic headaches. The original injury site remained extremely sensitive to pressure.

As the years passed, Jane developed persistent daily headaches that wrapped around her entire head. She also experienced sharp, stabbing pain that radiated from the back of her skull to just above her eye. Despite undergoing multiple MRIs, all of which yielded normal results, Jane found only mild, temporary relief through chiropractic treatment, physical therapy (with a focus on exercise and stretching), and massage therapy.

Case Description

Upon examining Jane, palpation of the scar tissue in her occipital region reproduced the sharp, shooting pain and revealed restricted motion in the fascia of her scalp. Further palpation of her neck and upper back also showed tenderness and restricted motion between several cervical vertebrae.

The neurological exam revealed no issues with spinal nerve roots, the spinal cord, or cranial nerves. Similarly, Jane’s cardiovascular examination came back unremarkable.

Treatment Plan

After thorough evaluation, it was determined that Jane’s chronic headache was secondary to the injury she had sustained to the muscles and fascia surrounding the greater occipital nerve. We discussed her available treatment options, which included a combination of cervical spine manipulation therapy and active release technique. These therapies were specifically chosen to help improve the mobility of her scar tissue and to reduce tension in the suboccipital muscles at the base of her skull.

Outcome

Following her first treatment session, Jane reported just one additional episode of the sharp, shooting head pain. After completing the first week of treatment (three sessions), she no longer experienced any of the acute head pain. By the time of her one-month follow-up, Jane was thrilled to report that she had not experienced a single headache since completing her treatments.

Discussion

Headache pain can arise from multiple underlying causes, and determining the precise source is crucial to developing an effective treatment plan. In Jane’s case, the daily headaches that encircled her head were likely caused by tension-type headaches, which are typically associated with muscle and joint dysfunction in the cervical spine. These types of headaches are often exacerbated by poor posture, muscle stiffness, and spinal misalignment.

In addition to the tension-type headaches, Jane’s one-sided, shooting pain, which was triggered by pressure on her old scar, pointed toward myofascial restrictions. These restrictions occur when there is a buildup of tension in the muscles and fascia, leading to restricted movement and pain. The scar formed by the original injury resulted in adhesions between the muscles, fascia, and skin, contributing to her ongoing discomfort.

To address these issues, we utilized the active release technique, a specialized form of myofascial release therapy. This technique involves using manual pressure to evaluate the texture, tightness, and movement of Jane’s muscles, fascia, tendons, ligaments, and nerves. By applying targeted pressure and guiding Jane through specific, purposeful movements, we were able to break up the adhesions and improve the overall mobility of the affected tissues.

The combination of cervical spine manipulation, active release technique, and targeted movement helped Jane achieve significant relief. Her treatment plan was tailored to address both the mechanical and neurological factors contributing to her headaches, leading to a marked improvement in her symptoms and overall quality of life.