Occipital HeadachesOccipital Headaches(Occipital Neuralgia)(Occipital Neuralgia)

Demonstration of a Technique to Unlock the Occipto-atlantal Demonstration of a Technique to Unlock the Occipto-atlantal (O-A) joint(O-A) joint

ByBy

Jeffrey Pearson, D.O.Jeffrey Pearson, D.O.www.medicine-in-motion.comwww.medicine-in-motion.com

Occipital HeadachesOccipital HeadachesType of headache that Type of headache that results from results from restriction/locking of restriction/locking of one or both occipito-one or both occipito-atlantal (O-A) joints.atlantal (O-A) joints.– These are the two joints These are the two joints

on the very top on the very top vertebra in the neck vertebra in the neck (the atlas)(the atlas)

– Imagine 2 “cups” on Imagine 2 “cups” on either side of the atlas. either side of the atlas. The base of the skull The base of the skull (occiput) rests balanced (occiput) rests balanced in them.in them.

Occipital HeadachesOccipital HeadachesIn the vicinity of In the vicinity of the O-A joints lie the O-A joints lie the muscles of the the muscles of the suboccipital suboccipital triangle and the triangle and the greater occipital greater occipital nervenerve..– This nerve runs This nerve runs

from the base of from the base of the skull, up and the skull, up and around the skull.around the skull.

Occipital HeadachesOccipital HeadachesAwkward, static Awkward, static postures can cause postures can cause one or both O-A one or both O-A joints to lock.joints to lock.– Discomforts often Discomforts often

NOT felt at the NOT felt at the time.time.

– Symptoms Symptoms generally develop generally develop over course of over course of subsequent hours.subsequent hours.

Occipital HeadachesOccipital HeadachesMost commonly Most commonly present as unilateral present as unilateral (one-sided), throbbing (one-sided), throbbing headache often headache often associated with associated with nausea, dizzy/woozy nausea, dizzy/woozy sensations with sensations with movement.movement.– Often confused with Often confused with

migraine headaches.migraine headaches.

Occipital HeadachesOccipital HeadachesHeadaches need not be present to cause Headaches need not be present to cause symptoms.symptoms.– May present with sudden dizziness or May present with sudden dizziness or

unexplained nauseaunexplained nausea

Better term for this condition is Better term for this condition is occipital occipital neuralgianeuralgia– Irritation of nerve may induce autonomic Irritation of nerve may induce autonomic

nervous system reflex symptomsnervous system reflex symptomsE.g. hitting finger with hammer may be associated E.g. hitting finger with hammer may be associated with nausea in addition to the pain.with nausea in addition to the pain.

Occipital HeadachesOccipital HeadachesPostures commonly Postures commonly associated with occipital associated with occipital neuralgia/headaches:neuralgia/headaches:– Tucking telephone under Tucking telephone under

chinchin– Poor computer ergonomicsPoor computer ergonomics

Monitor too high/too lowMonitor too high/too low– Watching TV while lying on Watching TV while lying on

couchcouch– Reading in bedReading in bed– Working above your headWorking above your head

Trimming trees, painting, Trimming trees, painting, etcetc

Occipital HeadachesOccipital Headaches

May be acuteMay be acute– AtraumaticAtraumatic (e.g. “Honey do’s”) (e.g. “Honey do’s”)

Paint the ceilingPaint the ceiling

Prune treesPrune trees

Fix the plumbing under the sinkFix the plumbing under the sink

– Head traumaHead traumaSports and motor vehicular injuriesSports and motor vehicular injuries

Occipital HeadachesOccipital Headaches

Often chronicOften chronicChronic headaches are attributed to a Chronic headaches are attributed to a variety of things including withdrawal from variety of things including withdrawal from caffeine, pain relievers, etc.caffeine, pain relievers, etc.

We are creatures of habit; hence we tend to We are creatures of habit; hence we tend to perform similar tasks using similar postures perform similar tasks using similar postures on a repetitive basis over time.on a repetitive basis over time.

– Receptionist using telephone without headset.Receptionist using telephone without headset.– Kids playing video games on the floor while Kids playing video games on the floor while

looking up at television screen.looking up at television screen.

Occipital HeadachesOccipital Headaches

TreatmentTreatment– AcuteAcute

ICE ICE

Unlock the joint (GENTLE mobilization)Unlock the joint (GENTLE mobilization)

Pain relieversPain relievers– Naproxen sodium (Aleve), Tylenol, narcoticsNaproxen sodium (Aleve), Tylenol, narcotics

– ChronicChronicpreventionprevention

Occipital HeadachesOccipital Headaches

Do it yourself treatment optionsDo it yourself treatment optionsYou must be very gentle!You must be very gentle!

– Any fast attempts will be met with reflex spasm, Any fast attempts will be met with reflex spasm, making mobilization difficult.making mobilization difficult.

– Also want to avoid further injury.Also want to avoid further injury.

Occipital HeadachesOccipital Headaches

3 planes of motion3 planes of motion– Flexion/extensionFlexion/extension

Extension: gazing up at the ceilingExtension: gazing up at the ceiling

Flexion: touching chin to chestFlexion: touching chin to chest

– SidebendingSidebendingTouching ears to shouldersTouching ears to shoulders

– RotationRotationTurning head/neck to look over shoulderTurning head/neck to look over shoulder

Occipital HeadachesOccipital Headaches1. Palpate both O-A 1. Palpate both O-A joints using index joints using index fingersfingers

Occipital HeadachesOccipital Headaches2. Extend your 2. Extend your neck backwards to neck backwards to gaze up at the gaze up at the ceiling.ceiling.

Occipital HeadachesOccipital Headaches3. Sidebend to one 3. Sidebend to one side, then gently side, then gently rotate your head rotate your head to the opposite to the opposite sideside– It’s as if you were It’s as if you were

trying to look back trying to look back and up at a star and up at a star over your shoulder.over your shoulder.

Occipital HeadachesOccipital Headaches4. Slowly work 4. Slowly work your way around your way around towards the other towards the other side, monitoring side, monitoring the O-A joints all of the O-A joints all of the time.the time.

Occipital HeadachesOccipital Headaches

If you’re REALLY gentle, you might If you’re REALLY gentle, you might be able to feel the restricted joint be able to feel the restricted joint “unlock.” “unlock.” – Then apply some ice and consider an Then apply some ice and consider an

over-the-counter over-the-counter anti-inflammatory/analgesic agent such anti-inflammatory/analgesic agent such as Aleve.as Aleve.

Occipital HeadachesOccipital Headaches

Alternative maneuverAlternative maneuver– Lie supine (face up) with a towel roll Lie supine (face up) with a towel roll

supporting your neck (possibly with a supporting your neck (possibly with a cold gel pack)cold gel pack)

– Slowly allow your neck to gently rotate Slowly allow your neck to gently rotate from one side to another, back and from one side to another, back and forth. If you can relax enough, the joint forth. If you can relax enough, the joint might “unlock.”might “unlock.”

– Follow-up with Aleve, as before.Follow-up with Aleve, as before.

Occipital HeadachesOccipital HeadachesRecurrences/chronic headachesRecurrences/chronic headaches– Best treatment is Best treatment is preventionprevention

Look at daily postures both at home and at Look at daily postures both at home and at work.work.Fix poor ergonomics.Fix poor ergonomics.

– Use telephone headsets; adjust computer Use telephone headsets; adjust computer monitors.monitors.

Avoid awkward neck postures. [If you Avoid awkward neck postures. [If you cannot, try to apply ice and perform some cannot, try to apply ice and perform some gentle range-of-motion stretching/exercises gentle range-of-motion stretching/exercises as soon as possible to prevent things from as soon as possible to prevent things from locking up.]locking up.]

Occipital HeadachesOccipital Headaches

If you have symptoms of occipital If you have symptoms of occipital neuralgia and they do not respond to neuralgia and they do not respond to these simple home maneuvers, these simple home maneuvers, contact your physician to verify contact your physician to verify diagnosisdiagnosis..– If true migraine, should respond to a If true migraine, should respond to a

“triptan” type of medication.“triptan” type of medication.– If elderly, stroke might need to be ruled If elderly, stroke might need to be ruled

out. out.

Occipital HeadachesOccipital HeadachesSometimes, the joint(s) are so restricted that not Sometimes, the joint(s) are so restricted that not even a physician/chiropractor can unlock it.even a physician/chiropractor can unlock it.– Consider nerve block Consider nerve block

Inject local anesthetic (without a steroid) into the affected Inject local anesthetic (without a steroid) into the affected suboccipital triangle.suboccipital triangle.Generally lasts 4-6 hours; patient goes home to rest and Generally lasts 4-6 hours; patient goes home to rest and perform the previously described “alternative maneuver.” perform the previously described “alternative maneuver.” The hope is that the anesthetic will permit the local The hope is that the anesthetic will permit the local muscles to relax enough to finally unlock.muscles to relax enough to finally unlock.

– ““Good drugs”Good drugs”Muscle relaxants, analgesics (“pain killers”) such as Muscle relaxants, analgesics (“pain killers”) such as Fioricet, hydrocodone. Fioricet, hydrocodone.

– These might make subsequent attempts, later on in week, at These might make subsequent attempts, later on in week, at mobilization easier.mobilization easier.

Hope this helps!Hope this helps!