The sudden pain of cluster headaches is one of the worst pains we can have. With intense pain on one side of your head, nausea, vertigo and other symptoms, it seems like a migraine.
Mercifully, they don’t last too long. Secondary trigger point activations are common.
If you have chronic cluster headaches – myofascial treatment can help ! For general headache info, please see this intro.
Cluster Headache (CH) is a neurological disorder characterized by recurrent severe headaches on one side of the head. Typically, they are around the eye. There is often accompanying eye watering, nasal congestion, or swelling around the eye on the affected side.
Cluster headaches are named for the occurrence of groups of headache attacks (clusters). The cause is unknown. Risk factors include a history of exposure to tobacco smoke and a family history of the condition. Exposures which may trigger attacks include alcohol and nitroglycerin.
Cluster headache is a primary headache disorder.
For treatment of cluster headache – myofascial triggerpoint therapy can be a powerful tool for relief.
In a word, “Yes!”
Cluster headaches have some symptoms that are similar to migraines. They can be trigger like migraines. They may some variation of aura, which suggests a vascular component.
However, cluster headache is a neurological disorder. There are several distinguishing symptoms. These include the rapid cycling of the headaches, extreme pain, autonomic symptoms and prevalence in men.
Extensive studies of the brain, in particular specific areas of the hypothalamus, have shown unusual activity.
Current therapy focuses on medications that target these areas.
Myofascial trigger points and dysfunction often develop in muscles of the head and neck in response to the rapid cycling, extreme pain.
Cluster Headache Characteristics
Cluster headaches are recurring bouts of severe headache attacks on one side. Is often particularly above the eye, in the temple.The duration of a typical CH attack ranges from about 15 to 180 minutes. About 75% of untreated attacks last less than 60 minutes.
The onset of your attack is rapid. Classically you don’t have an aura. Preliminary sensations of pain in the general area of attack are referred to as “shadows”. They may signal an imminent CH. In addition, these symptoms may linger after an attack has passed, or between attacks. This could be another form of aura.
Rarely, cluster headaches will “side-shift” between cluster periods.
The pain is typically greater than in other headache conditions, including migraines. The pain is typically described as burning, stabbing, drilling or squeezing. It may be located near or behind the eye. It is reported as one of the most painful conditions.
Lately, you’ve been keeping a headache diary and you noted these things:
- You find yourself getting restlessness (for example, pacing or rocking back and forth).
- You get a drooping eyelid, pupil constriction, redness of the conjunctiva, tearing, runny nose.
- Sometimes, facial blushing, swelling, or sweating, happens on the same side of the head as the pain.
- You have trouble organizing thoughts and plans, physical exhaustion, confusion, agitation, aggressiveness, depression and anxiety.
- Certain things seem to trigger your headaches, similar to migraines.
Negative Adjustments to Pain
People with CH may dread facing another headache We adjust our physical or social activities around a possible future occurrence. Likewise we may seek assistance to accomplish what would otherwise be normal tasks. We may hesitate to make plans because of the regularity. Conversely, the unpredictability of the pain schedule can be worse. These factors can lead to generalized anxiety disorders, panic disorder, serious depressive disorders, social withdrawal and isolation.
Symptoms typically last 15 minutes to 3 hours.
Attacks often occur in clusters which typically last for weeks or months and occasionally more than a year. There can be two to eight headaches per day during a cluster period.
The condition affects about 0.1% of the general population at some point in their life and 0.05% in any given year. The condition usually first occurs between 20 and 40 years of age. Men are affected about four times more often than women.
Treatments for acute attacks include oxygen or a fast-acting triptan. Measures recommended to decrease the frequency of attacks include steroid injections, civamide, or verapamil. Nerve stimulation may occasionally be used if other measures are not effective.
Myofascial trigger point therapists are more concerned about the muscles contributing to myofascial dysfunction in your head and neck.
Cluster Headache – Myofascial TriggerPoint Therapy
We focus on history, lifestyle, pain patterns and other symptoms to sort out your myofascial pain. There is a myofascial component to many types of headaches.
Notably, myofascial pain is not caused by contracted or ‘tense’ muscles. They have no electrical activity.
Chronic Headache – Myofascial TriggerPoint Referral Patterns
We can clearly see how referral patterns of head and neck muscles evoke the pain patterns of migraines, tension headaches, cervicogenic headaches. They even overlay the symptoms of cluster headaches and TMJ headache pain. Some of the factors that activate those muscles may not covered by doctors. Those activation factors are things we care a lot about.
Myofascial activations are a part of most headache patterns!
Sometimes, when people are in chronic pain, medical history reveals problems with body mechanics. Body mechanics includes all the various ways that hold ourselves and move as we do things. Sometime is it how we hold ourselves when we are NOT doing things, like sitting.
When ever we are making repetitive movements, we should be mind of using proper body mechanics. This will help minimize repetitive stress injuries and myofascial activations. For instance, lifting in a stooped posture and then twisting is always ill-advised. Doing it repetitively is worse. Therefore, if this type of lifting is required, we should rethink the task and try to organize it in a way that reduces stooping and twisting.
However, even simple movements matter. For instance, what if your desk is arranged phone on the wrong side. In fact, with every call, you have to twist your head and neck and reach over with your arm to the wrong side of the desk This is poor body mechanics. Fixing it might be as simple as moving the phone.
It pays to think about basic body mechanics in this common sense way each time we engage in a repetitive activity. Fortunately, we’re starting to teach this important skill to young people, as in this student guide at University of Michigan.
We can experience chronic overload when we do things like wear high heels, carry a heavy bag or lean into our work.
However, acute overload happens when we decide to lift, push, pull or otherwise move something that is too heavy for us. Most often, we overload our muacles with an eccentric contraction.
For example, lifting a heavy box, correctly using your legs instead of your back, requires concentric contractions of your quads. However, setting that same heavy box down, slowly and with control, require eccentric, lengthening contractions. These should be done carefully.
Of course, if you have a diagnosis from your doctor, we need to know. If you have recent imaging or other test results, even better!
We’ve all been knocked around a bit. We’d like to know everything you can think of about prior accidents, injuries, surgeries and other treatments.
It is important to know about previous or current medical conditions that could impact our treatment. Anything from high blood pressure to TMJD to disc problems are vital information.
Hopefully, medications align with your diagnosis. Sometimes, certain medications will also modify our reatment options. Some drugs interfere with nutrient absorbtion.
Increasingly, supplement use is common. Typically, we’re on the look out to make sure you whether you taking certain supplements.
Cluster Headache – Myofascial TriggerPoint Referrals Overlap
Typically, if you have cluster headaches, we are treating secondary myofascial pain. You are receiving other treatment for the underlying neurological cause of cluster headache.
There are a wide variety of muscles in your face, head and neck that might be harboring myofascial trigger points.
The pain of cluster headache itself usually focuses above your eye.
Where Does Your Pain Refer?
When looking for trigger point referrals, we are considering the whole range of head and neck muscles. The pain patterns are extremely varied. They can also extend into your shoulder and arm.
With cluster headache – myofascial triggerpoint therapy is a secondary treatment
Treatment of cluster headache focuses on underlying neurological problems.
Notably, the SCM muscle in the front of the neck is closely associated with the C2/C3 nerve roots. Furthermore, these nerve roots are associated with pain patterns and other issues with your eyes and ears.
Determining which muscles are causing myofascial pain is crucial to treating secondary pain of cluster headache.
From the outset, education is important. It is our job as therapists to educate you about our assessment and our process. Then, throughout our treatment, we continue this education process.
Myofascial treatment can get at some aspects of cluster headache pain that you might not have thought of!
Unfortunately, sleep posture and sleep disturbances contribute to many myofascial pain syndromes. However, this is especially important for relief from chronic headaches. Because of this, we always have a thorough discussion about how you sleep during an initial assessment.
Diaphragmatic breathing is at the foundation of myofascial trigger point treatment. But, if you don’t know how to do it, we will teach you. On the other hand, if you already know about it, we will help you deepen the technique.
Of course, the medications and supplements you are taking matter too. Usually, reducing drug consumption is a good thing. However, it should be done gradually and in consultation with your physician.
Keeping a headache diary is an important tool for understanding headaches. Also, it is how we clearly see things that improve our headaches – or not.
Structural variations need to be explored and understood. Once treatment begins, they can be accomodated or corrected in various ways.
It is surprising, but most of us our not taught proper body mechanics. Whether we are at home or at work, we need to learn how to use our body correctly.
Most people are self-conscious about their posture. But, identifying the postural aspects that should be improved is a challenge. Even harder, is understanding how they vary with movement. Ultimately, devising a strategy for improving them is essential.
All of these issues can be successfully addressed!
However, it usually takes more than hands on work to really erase the pain and keep it away.
First, the chances are that we were not your first stop. As a general rule of thumb, the longer you have experienced headaches, the longer it will take to make them go away.
Secondly, there are usually at least some factors that might be part of your headache picture that are out of our scope of practice.
In contrast, if we are treating someone for tennis elbow, we can work on the muscles at play. We can talk with you about some modifications for your game and your lifestyle. Then, we can tell you that if you feel the OTC pain reliever you are taking isn’t needed anymore that you can stop taking it. Finally, we can offer you stretches and other self-care advice that are pretty straightforward
However, if you are suffering from serious headaches, you may have some other more complex factors at play. Often, you may be working with other providers on vascular (blood vessel), neurological, psychological and other issues. You may be taking prescription medications that you should discuss with your doctor.
Chronic headache treatment is often inter-disciplinary.
Myofascial tigger point therapy – it’s how you work this!
Education is the first step in the myofascial treatment protocol.
Sometimes, we may not be good enough at explaining how myofascial pain works and how it activates your headaches.
However, we believe that people can make more progress when they know more about their condition. So, we try to understand what your learning style is give you as much information as you want – but hopefully not too much!
Typically, we performing series of miniature cycles of test/assess, treat and test/assess again. It is an informed exploration for both of us.
We have an initial assessment from your history, postural and range of motion exams, etc. Then, we use various treatment techniques before testing and assessing again.
Manual Therapy Techniques
First, we specifically expertly use manual pressure release therapy, neuromuscular techniques, and deep stroking, friction, skin rolling. When indicated, we also use fascial stretching. Sometimes, we use less common techniques like cupping, spray and stretch and acoustic compression.
In addition, we may also use active and passive muscle activation techniques. This includes reciprocal inhibition, postisometric relaxation, contract/relax, strain/counter-strain and muscle energy techniques. Sometimes, we also use hot/cold therapy.
Range of Motion/Testing
Finally, routinely run the muscle we are treating through its entire, pain-free range of motion. This is part of your treatment. However, it also the start of a new test/assess cycle.
We learn together whether your range of motion has increased and whether your pain is reduced. We may have you get up and use your body in the way that causes pain to ‘test’ more dynamically.
As we finish our hand-on work, we transition into learning new movement strategies and self-care.
Myofascial tigger point therapy – it’s how you work this!
For general myofascial wellness, a quiet, regular self-inspection of our own bodies will often tell us where trouble lies. In addition, it will also give us the opportunity to address problem areas.
For example, in Tai Chi, we go through a slow, controlled series of movements. However, we are not trying to stretch or strengthen anything. Rather, we are re-calibrating our nervous system and our myofascial system with each other. Instead, it is basically a form of movement or neuromuscular therapy.
However, during these gentle movements, we may notice variations in our range of motion. In fact, limited range of motion is a symptom of an unhappy muscle. Plus, we may experience pain. That is also a symptom of an unhappy muscle.
In activities like the Yamana rolling ball technique, we also go through series of movements. However, as we move, we are rolling over muscles that may be sore. So, we also have the opportunity to treat them with manual compression.
Cluster Headache – Myofascial TriggerPoint Compression
First, the most basic self-care tool is the tennis ball. Actually, we suggest using two tennis balls in a sock. Also, the sock gives you a “handle” so you don’t drop the ball. Finally, two balls will give you more options and control.
Sometimes, we use fitness balls, large foam rollers or handheld rollers such as the Tiger Tail for self-compression.
However, awesome tools like the Backknobber can be used sitting, standing or lying down. Happily, it allows you to target specific areas in each muscle you want to work with. In fact, the leverage of the tool and pinning it between your body and floor allows access to quite a number of back and neck muscles. In addition, this approach can also be used with some large chairs, recliners and couches when sitting.
There are other approaches to passive self-compression for muscles of the head.
Myofascial self-care helps reduce the frequency and severity of migraines!
Cluster Headache – Myofascial TriggerPoint Self-Care Stretches
Typically, certain muscles tend to be tight in most chronic headache patients. Your therapist will give you specific advice about muscles that you should stretch.
However, most of us need to stretch our pecs, SCM, upper traps and levator scapula. After self-compression, these muscles can be stretched gently and effectively. You may also benefit from stretches of certain muscles on the back of your neck. Unfortunately, most of these muscles are over-stretched by head forward posture anyway. Your therapist can help you target specific muscles in the back of the neck.
Neck rolls and other vigorous neck stretches are always a bad idea.
It is the time to explore problems with the muscles of your TMJ more thoroughly. In addition, this is the time to strengthen your deep cervical flexors, serratus anterior, lower traps and other postural muscles.