Understanding Myofascial Headaches A Time For Paradigm Shift

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Understanding Myofascial Headaches A Time For Paradigm Shift

Headache is one of the most common pain complaints encountered by healthcare professionals, including physicians of various specialties and emergency room doctors. Much has been said and written about this problem. Various diagnoses, remedies and therapies have been used to treat this common ailment, which affects millions in the world, among them one in every six to seven Americans. Headaches make up more than half of the patient population in doctors’ offices, emergency rooms and ambulatory centers. As a result of these headaches, millions of work hours are lost daily and millions of active workers (5-10%) have to take sick leave. This not only affects the individual’s life in many ways, but also puts a huge drain on the economy of the entire nation.
In the 20th century, much emphasis has been laid on the diagnosis of migraines, but according to recent studies, more than 90% of headaches are myofascial (muscle contraction) in nature and only 5-6% are migraines, while the remainder fall in the miscellaneous or variant categories.
Migraines, A Misdiagnosis!
Migraine is a French word, which means one-sided headache. However, this term has been used by doctors and laymen alike incorrectly to describe many different types of pain in the head and neck area. All types of classifications and criteria have been employed to define and explain migraines, but most of these efforts have been less than optimal in reaching the precise definition needed for an accurate diagnosis. Numerous therapies like anti-migraine medication, various types of cocktails, narcotic analgesics, tranquilizers, aspirin and aspirin-like products, biofeedback and acupuncture, among other therapies, have been employed to treat headaches, but invariably the long-term results have been disappointing. All this has led to more confusion, dismay, frustration and depression, not only on the part of the patient, but also on the part of treating physicians.
After all the failed attempts to get pain relief, headache sufferers, often not knowing what is causing their headaches, become unwilling riders on a never-ending merry-go-round in search of relief from this crippling pain disorder. Their life becomes an endless misery, with quality of life deteriorating to the point that they become depressed and lose the will to live a productive and happy life.
What Are Myofascial Headaches?
Muscle Contraction Headaches have been making headlines lately, but they have not yet captured the attention of the public at large and physicians in particular. Reason for that failure include the overly general nature of the term, lack of understanding of the sign and symptoms and last, but not least, the lack of availability of specific treatments for these types of headaches. This has lead to further confusion and despair.
As a qualified pain specialist (fellowship trained and certified in pain management/medicine), I am delighted to introduce a new terminology, called myofascial headaches, to describe these headaches. This better understanding of this common pain disorder sheds a new light on one of the most common problems humanity faces and brings hope to providing effective and long-lasting relief of pain. My effort is directed at making the medical community and public change their frame of reference regarding their perception, evaluation and treatment of this commonly misdiagnosed pain disorder.
Myofascial headaches are very commonly misdiagnosed as migraines. They are linked to the muscles surrounding the head, neck, shoulders and upper back muscles. The traditional diagnostic methods like MRI or CT scan, EEG, x-Rays, etc. often fail to identify the underlying cause, namely the myofascial trigger points that are producing these headaches. Acute trauma or chronic wear and tear of these muscles leads to the development of myofascial trigger points in one or many of these muscle groups, often causing these debilitating headaches along with other associated symptoms. These headaches can be unilateral or bilateral; that is to say, on one side of the head or on both.
Predisposing Factors Multiple factors can play a primary role in the development of myofascial headaches. They often result from acute trauma to the head and neck regions (like a car accident) or more commonly from a subtle and prolonged wear and tear, atrophy and deconditioning of neck, shoulder or upper back muscles, which can be caused by a short leg, short hemi pelvis, poor posture (sitting in poorly designed car seat or chair), bird watching or ill-fitting glasses.
Psychological stressors, anxiety and depression, repetitive trauma to neck and shoulder muscles, like computer use, exposure to extreme temperatures, and hypothyroidism (clinical or sub-clinical) are among the additional causes of these headaches.
Mechanism of Myofascial Headaches Myofascial headaches are produced and perpetuated by muscle contraction and myofascial trigger point activity involving the various neck, shoulder and upper back muscles and the associated fascia like trapezius, sternocleidomastoid and splenius muscles. It is often this vicious cycle that determines the chronic nature of these headaches.
Pain Cycle These headaches can be short-lived with varying intensity, or may occur periodically or frequently, lasting for months, years or even one’s entire lifetime. Childhood headaches are often dismissed as growing pains or as the child seeking time off from studies by parents and medical professionals alike, often leaving the headache sufferer puzzled and hurt by a sense of betrayal on the part of the two most important groups of people in his or her life. This often leads to a painful journey for the future, where the child commonly gets labeled as learning disabled because of inability to focus and concentrate. Hence, the pain cycle often continues, unless active and appropriate treatment interventions are done and perpetuating factors are eliminated.
Symptoms Myofascial headaches are often experienced in the entire head in the frontal, temple, center part or on the side or back of the head. The pain and tenderness experienced in the head usually results from the trigger point activity in one or many muscles and fascia in the head, neck, shoulder and upper back area, causing the pain to be referred to the zone of reference, along with local and/or distant tenderness of muscles. The zone of reference is the area where the pain and tenderness are felt. For example, if the trigger point is in the shoulder, the pain will be felt in the neck and temple region. Each muscle has its distinctive myofascial pain pattern, specific to trigger points in that muscle.
Commonly associated symptoms may include pain in the cheeks, pain in the jaw, pain in the teeth, pain in the eyes, congestion of eyes (reddening), pain behind the ears, congestion of nose, stiffness of neck and shoulder muscles, dizziness or vertigo-like sensation, occasional postural dizziness (spinning of head), blurriness of vision, nausea, vomiting and sensitivity to light, difficulty opening the jaw and fullness in ears. Involvement of certain neck muscles can cause a “bursting of the head” type of feeling, among others.
Causes of Failure?
Failure to bring relief from these headaches has become a major concern for all healthcare professionals and the pain sufferers themselves. Traditional approaches such as biofeedback, acupuncture, prescribing narcotic analgesics, anti-migraine medications like sumatriptin, ergot preparations, aspirin and aspirin-like products, non-steroidal anti-inflammatory drugs like ibuprofen, or narcotic analgesics such as oxycodone, hydrocodone and acetaminophen, among others, may be of no avail.
Some of the reasons for the failure of traditional therapies may be as simple as misdiagnosis of myofascial headaches as migraines because of a lack of understanding on the part of physicians about this syndrome. Shortage of trained and skilled pain specialistsis another factor. And last, but not least, the barrage of television advertising by the pharmaceutical companies peddling their anti-migraine medications as a cure-all, reinforces the damage done by misdiagnosis of the myofascial headaches as migraines.
Treatment Relief from myofascial headaches is a challenge for millions who suffer daily from this debilitating pain disorder, yet despite all the attempts, failure to receive the appropriate care leads to dismay and depression, at times even inclination towards suicide. But it need not be, because myofascial headaches do respond to treatment. There is a cure or at least long-lasting relief on the horizon.
Treatment begins with a thorough evaluation and appropriate diagnosis of the myofascial headache. Once the diagnosis has been made, the pain specialist will design a treatment plan, which includes multi-modality therapies. The most important modality is trigger points injections.
Therapeutic exercises, including stretching and strengthening of the affected muscles, also play a significant role. In addition, narcotic and non-narcotic pain medication, as well as antidepressants, are prescribed and reinforced by psychotherapy if necessary. The patient’s active participation, cooperation and compliance, including close follow-ups and treatments, is absolutely essential for a favorable treatment outcome. Dr. Ajrawat’s Air Pulse Autonomic Meditation Therapy is another important treatment for myofascial headaches.
Parallel with these treatment modalities, the pain specialist introduces measures to deal with factors that perpetuate the pain or may have triggered it in the first place. One example would be to correct the inequality of the length of the patient’s legs. Ergonomics may also play a role in the treatment or even prevention of pain. For example, for a person sitting all day in front of a computer, a properly designed computer chair and night use of an appropriate-sized pillow to sleep is of vital importance.
As we have noted, after all the failed attempts to get pain relief, myofascial headache sufferers, often not knowing what is causing their headaches, become unwilling riders on a never-ending merry-go-round in search of relief from this crippling pain disorder. A qualified pain specialist can help them get off that merry-go-round so that they may enjoy life again.