Headache or Migraine Pain Case Study

Postural related headache or migraine in the forehead/frontal lobe of the head.

A 22 year old female presented with a two month history of Migraines that come on mid-afternoon and then stay with her until she goes to sleep that same night. She had been to see her GP and was prescribed Topamax which is used to help prevent migraines in sufferers. She found this useful, but the dose that was required to prevent the migraines was making her feel drowsy and she did not like the idea of being on this drug long term without actually knowing what the underlying cause was. The only way she found relief from her symptoms once they had started was by lying down and going to sleep.

The patient has a history of neck tightness and reported she was told many years ago about trying to improve her posture by a physiotherapist. Over the last year she had been working her gap year in an office based environment and found this did not help her neck mobility and general postural positioning. The patient had in the last few weeks had an eye test which was normal and was going to have an allergy test as well to see if there was another factor that could be causing her symptoms.

Examination

On examination this patient had very protracted/forward positioned shoulders, and she would sit with her arms folded leaning forwards on her legs regularly. Her neck range of movement sideways ear to shoulder was very restricted on both sides for her age (half the normal range). On palpation of her upper trapezius muscles (muscles between the neck and the shoulder) these were very tight and painful, along with some of the other smaller muscles around the neck. When she lied flat on her back her shoulders sat up forwards off the bed and when asked to bring them back down to the bed this was hard work and very unnatural for her. When I retracted her shoulders passively back to neutral she felt very tight across her chest/pectoral region. Palpation of her pectoralis minor muscles then confirmed these were very tight, short and over active on both sides. Even just trying to set her shoulders back in the correct position felt like a big pectoral stretch at the front of her shoulders. The anterior/frontal neck muscles were weak and underactive which was allowing the chin to creep forwards and but further strain through the neck and the upper trapezius muscles.

Treatment

We started off treating the pain and spasm in both upper traps using trigger point acupuncture, postural taping/kinesiology taping, postural correction, neck stretches and deep neck flexor strengthening (the core of the neck or pilates for the neck). After the first session of acupuncture the upper traps were much softer and easier to stretch, when the patient came back the week after she had not had a headache all week. We repeated the acupuncture alongside some further some tissue work around the upper neck, pectoral muscles and thoracic spine (upper back). The next week the patient reported she was able to reduce her medication by half and still had not had a headache/migraine. When she previously had tried the same reduction her migraine returned. After a further session of the same treatment her upper traps were completely soft and non-tender. She reported having stopped her medication the day after the last session and has had no symptoms at all for the first time in months. Her anterior neck muscles were much stronger and her pectoral muscles had started to improve their length with regular stretching. The patient was still finding holding her improved postural position very hard, but we discussed this would take many months to even feel remotely normal for her.

Conclusion

This patient was very happy with the outcome of her treatment. An upper trapezius spasm/build-up of scar tissue/tension can be a real source of pain referring to the neck, lateral head and front of the head. This can manifest as headaches or more severe migraines. This onset of pain seems to be driven by an over activity of the trapezius muscle in people with rounded shoulders, forward head postures, and weak neck muscles at the front of the neck. It seems to be more common in females than men.

I think the important message is seek advice if you are getting regular muscle aches or tightness in your neck muscles, as a simple improvement in your posture, either sitting or standing could help prevent or reduce the frequency of your headaches and/or migraines.

David Bradbrook