Occipital Headache: You Believe It Is Caused by Trigger Points? Put The Bible to The Test
Travell JG et al's books (1999) on Trigger Points (TrPs) & Myofascial Pain is the bible in musculoskeletel medicine. According to the bible, TrPs leads to myofascial pain. So there came “trigger point therapies”. But under scientific testing, such therapies have advanced to nowhere since the bible came into place in 1940s to 1980s.
Are TrPs necessary? Jay Shah, a senior staff physiatrist in the NIH Clinical Center among many critical thinkers, questioned the tenet (Shah J et al, 2015).
The Answer to The Question
Are TrPs necessary for myofascial pain? The answer is “hidden” in an ancient healing art – the acupuncture widely practiced 2000 years ago in China -- Neijing acupuncture. This healing art works for pain (not limited to myofascial pain) like a magic bullet: precisely shut down the pain at any spot on the body, with instant effect at 95% certainty, no TrP as defined in the bible book whatsoever involved.
Put the Bible to The Test: Occipital Headache
The bible described at least 27 TrPs which are related to headache and/or migraine. But it did not give any TrPs which are specifically related to occiput headache (OH) – the pain at occipital area.
The specific referred pain described in the bible that is most close to the occiput bone is the pain at the mastoid bone just behind the ear. The bible described 4 TrPs which are related to mastoid pain. These 4 TrPs are located at upper back on the trapezius muscle (Fig 1).
If indeed “TrPs are central to the myofascial pain”, then we can anticipate that the intervention not targeting any TrPs for headache or migraine as described in the bible would not work, or would work very poorly for OH.
To test the dogma, we can perform a treatment of OH by avoiding doing anything which may cause a stimulation to any of the 27 TrPs which the bible considers to cause the pain at head.
If the test treatment can effectively relieve OH consistently and reliably, we should be able to conclude that the TrPs are not necessary at least for this specific headache – the pain at occiput.
The Procedure of The Test
We will use dry needling to do the test. When we perform dry needling, we will put the needles far away from the location where the bible TrPs are located.
The occiput pain is what the brain perceives when an action potential change is transmitted to the brain from the free nerve endings (nociceptor terminals) located at occiput area. Compared to the size of a nociceptor terminal, the area called “occiput” is a huge area.
To precisely target any specific painful spot, we need to further divide this big area into at least 6 regions on each side of the occiput, as shown in Fig 2.
The areas marked A, B, … F are all possible locations of occipital pain complained by a patient. The pain may cover all over the occiput from A to F, on either side or both sides, or only covers A only, or B only, …. or any combination of A to F on either side or both sides. To instantly shut down or reduce OH at 95 % of certainty, we need to precisely identify the location of the occipital pain.
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For each specific occiput pain (A, B, C … or F), there are at least 8 body parts far away from the head where you can identify a pressure pain spot, which, once pricked by a needle, will instantly and consistently take this very specific pain away.
In this post, I will focus on the occiput pain at A, B, and C only, which happens in over 90% of patients complaining occipital pain as observed in my clinic. Corresponding to the A, B and C at the occiput, the A, B, and C marked on the lateral hindfoot (Figure 3 and 4) is where you will insert needles after you identified tender spots in hindfoot by palpation.
Your first try will always start from the hindfoot opposite to the occipital pain (opposite side usually gets the best results). The size and the intensity of the tenderness of the spots you identified in hindfoot is roughly proportional to the severity of the corresponding specific pain at the occiput.
The patents will lie supine with a pillow under the knees so he or she watch what you are doing and communicate with you comfortably. After needle insertion, you will go back to the patient's occipital area and gently press and massage where the patient felt pain, or just ask patient to gently rotate his or her head for a few times. In a few seconds he or she will stare at you wowing: are your a magician?
For more detailed information of the procedure, read:
Science Does Not Advance on Blind Beliefs
“Science is the belief in the ignorance of experts…” Says Richard Feynman (1918-88), Quantum Physicist. Science does not move forward if we blindly accept everything of what we see, hear or read (including this post). Instead, we need to keep thinking, testing and retesting.
Don't blindly believe what this post is talking about. Don't make any conclusion until you have tried the procedure on at least 10 patients with occiputal pain (at the area of A, B, or C).
References
Jay P Shah et al., , Myofascial Trigger Points Then and Now: A Historical and Scientific Perspective, PM R.. 2015 Jul;7(7):746-761.
Travell JG et al, Travell & Simons' myofascial pain and dysfunction : the trigger point manual. 1999
#headache #migraine #occipitalpain #triggerpoints #myofascialpain #bible #criticalthinking #skeptism #blindbeliefs