David S. Klein, MD, FACA, FACPM
Headache is one of the most prevalent of all complaints that might bring a patient to seek medical attention. Diagnostic evaluation of the patient may be simple or comprehensive, dictated by the clinical situation and patient presentation. Statistically, however, the most common etiology of headache is found to be muscle tension in nature.
While the diagnosis of muscle tension headache might suffice for most circumstances, unless the clinician locates the precise physical site of the ‘pain generator,’ the chances of successful treatment are slim. On the other hand, treatment is likely to be successful, if diagnosis is refined from the generic ‘muscle tension headache,’ to the more specific diagnosis.
The most common cause of muscle tension headache (MTH) results from inflammatory changes at the site of muscular attachment on the occipital ridge. In the adult, this occurs most often at the attachment of the Splenius Capitis and Semispinalis Capitis Muscles. As inflammation develops, entrapment and irritation of Greater Occipital Nerve results. The typical symptom complex results from muscle spasm as well as from neuralgia.
Occipital neuralgia results in a distinct type of pain that is most commonly characterized by piercing, throbbing, or lancinating pain in the upper neck, back of the head, and behind the eyes Most commonly the problem is unilateral and because pain in the eye is typical, the mis-diagnosis of ‘migraine’ is made. The pain of Splenius Capitis Syndrome (SCS) begins in the neck and then spreads cephalad with referred pain behind the eye. Anatomic variation is the rule, rather than the exception, and clinical presentations will therefore vary.
The pain is caused by inflammation, irritation or injury to the nerves that inntervate the nerve, called the nervi nervorum. Muscular spasm results in a second pain constellation. Interestingly, the pain of muscle spasm and the pain that results from the neuralgia need not occur simultaneously and the nature of the pain will, therefore, change from episode to episode, adding to clinical confusion.
Causes of Splenius Capitis Syndrome result of trauma to the back of the head, pinching of the nerves by overly tight neck muscles, and compression of the nerve as it leaves the spine due to osteoarthritis. Localized inflammation or infection can result in SCS, although this is quite rare. It is possible that it can be caused by diabetes (mononeuritis multiplex), and blood vessel inflammation (vasculitis). Clearly, the most frequent cause is postural, that is, from prolonged periods of keeping the head in a downward, rotated and forward position. The muscle tension results in micro trauma to the muscular attachment, swelling ensues, and myalgia/neuralgia result. In many cases, however, no precipitant cause can be found.
w Occipital & Shoulder Pain
w Pain behind the eyes
– Awaken with pain
w Pain looking up.
w Pain looking down, particularly with rotation.
w “Migraine” diagnosis is common.
w Worse with menses, ovulation & salt load.
w Anticipate sleep disorder.
Causes of Splenius Capitis Syndrome
w Trauma of a rotational nature
w Blunt Trauma, pugilism
w Flexion/Extension injury
w Vigorous Cervical Manipulation
– Dental chair
– Mastoid Surgery
The causes of SCS can be quite distant from the site of pain. That is, postural problems can result from foot pathology, ankle, knee and hip problems that result in muscular dystony. As occurs in other species, such as the horse physical problems in the lower extremity can cause physical changes in the axial skeleton. Postural pathology can result from an arthritic toe or heel spur, resulting in contralateral hip pain, and same-sided headache.
Treatment can be initiated through the use of high concentration MSM Cream. For this purpose, Kink-ease (40% w/v) MSM works quickly and is relatively inexpensive. (www.bestpaincream.com) The cream is applied to the neck, beginning at the boney prominance at midline, the C& vertebral prominence and working it into the scalp where the two muscular prominances occur in the scalp
If exacerbation of pain is triggered by ovulation or dietary salt-load, routine or periodic administration of a mild diuretic is worthwhile.
David Stephen Klein, MD, FACA, FACPM
Pain Center of Orlando, Inc. 407-679-3337
225 W. SR 434 Suite #205 Longwood, Florida 32750