Download OMT in Family Practice: Treating Headaches

“OMT in Family Practice: Treating Headaches”
Jennifer A. Lorine, D.O.
Treatment of Headaches in
the Primary Care Setting
Jennifer Lorine, DO
POFPS
August 6, 2016
Objectives
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Discuss basic OMT for headaches
Differentiate between direct and indirect
techniques
Discuss indications and contraindications for
each treatment
Every year 40-50 million Americans seek
treatment for headaches, making headaches
a common complaint in the primary care
office
Headaches are classified by the International
Headache Society as either primary or
secondary
POFPS 41st Annual CME Symposium
August 5-7, 2016
1
“OMT in Family Practice: Treating Headaches”
Jennifer A. Lorine, D.O.
Classification
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Primary
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Tension-Type
Migraine
Idiopathic Stabbing
Exertional
Cluster
Secondary
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Systemic Infection
Head Injury
Vascular Disorder
Subarachnoid
Hemorrhage
Brain tumor
Exam
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Physical: HEENT, Neurologic,
Musculoskeletal, etc
Any necessary testing
Osteopathic structural exam
What does a musculoskeletal assessment
include?
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Temporomandibular joint
Temporalis
Masseter
Occipito-frontalis
Buccinator
Pterygoid
Cranial rhythmic activity
Suture mobility
Basioccipital attachments at
the atlas
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Cervical region
Upper thoracic region
Leg length
Sacropelvic base
Active & Static body
analysis
POFPS 41st Annual CME Symposium
August 5-7, 2016
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“OMT in Family Practice: Treating Headaches”
Jennifer A. Lorine, D.O.
Autonomic Considerations
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Sympathetic: T1-T4
Parasympathetic: CN VII, IX, X
Somatic Dysfunction Leading to
Parasympathetic Dysfunction
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Facial Nerve CN VII
Glossopharyngeal nerve CN IX
Vagus Nerve CN X
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OA, AA, C2 dysfunction
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Look for tenderpoints, tissue texture changes, or
vertebral dysfunction
Occipitomastoid suture compression or
occipitoatlantoid joint compression
Somatic Dysfunction Leading to
Sympathetic Dysfunction
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T1–T5 or T1-T4
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Look for tender points, tissue texture change, or
vertebral dysfunction (facilitated segments)
POFPS 41st Annual CME Symposium
August 5-7, 2016
3
“OMT in Family Practice: Treating Headaches”
Jennifer A. Lorine, D.O.
Other Places to Check
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Cervical dysfunction
Sternocleidomastoid
Trapezius
OA
Temporomandibular joint dysfunction
Cranial dysfunction
Osteopathic Treatment
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Address the lymphatics
Address the vasculature
Address the autonomics
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Treat attachments to the sympathetic sites in the upper
thoracic and lower cervical area. Consider ribs and
myofascial attachments
Consider myofascial restrictions in the head, neck,
thoracic, area, and the shoulders
Consider the joints in the head and neck
Consider trigger points
Soft Tissue Techniques
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Direct
Lateral or Linear stretching
Deep pressure/ traction/ separation of origin
and insertion
Monitoring tissue response
POFPS 41st Annual CME Symposium
August 5-7, 2016
4
“OMT in Family Practice: Treating Headaches”
Jennifer A. Lorine, D.O.
Soft Tissue Indications &
Contraindications
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Indications
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Part of musculoskeletal
screening exam
Reduce muscle
hypertonicity
Improve circulation
Improve lymphatic
drainage
Potentiate effect of other
Osteopathic techniques
Contraindications
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Acute sprain (relative)
Fracture/dislocation
Neurologic or vascular
compromise
Malignancy
Infection (in the area that
you are treating)
Suboccipital Release
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Patient lies supine
Physician at head of
table
Physician places finger
pads palm up, applying
upward pressure until
tissue texture change
occurs
Counterstrain
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Indirect Technique
Created by Lawrence H. Jones, DO, FAAO
Place patient in position of comfort to
alleviate symptoms
POFPS 41st Annual CME Symposium
August 5-7, 2016
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“OMT in Family Practice: Treating Headaches”
Jennifer A. Lorine, D.O.
Counterstrain Indications &
Contraindications
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Indications
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Somatic dysfunctions
Contraindications
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Articular
Myofascial
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Adjunctive treatment for a
systemic complaint
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Traumatized tissues
Severe illness
Instability in area being treated
Vascular or neurologic
syndromes
Severe degenerative
spondylosis
Patients who cannot relax
Stoic patients
Patients who cannot
understand instructions
Patients who are unable to be
positioned (ex severe arthritis)
Trapezius Counterstrain
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Find the tenderpoint
Say : “this is a 10”
Move the patient into
the position of comfort
(Ex: Flexion)
Inquire: “if it were at 10
before, what is it now?”
Hold for 90 seconds,
periodically rechecking
Muscle Energy
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Direct Technique
Developed by Fred L. Mitchell Sr., DO
Patient’s muscles are used actively upon
request, from a precise position, in a specific
direction, against a counterforce
POFPS 41st Annual CME Symposium
August 5-7, 2016
6
“OMT in Family Practice: Treating Headaches”
Jennifer A. Lorine, D.O.
Muscle Energy
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Indications
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Somatic dysfunction:
myofascial
Somatic dysfunction:
articular
Improve circulation
Balance neuromuscular
relationships
Increase tone in
hypotonic/ weak muscles
Contraindications
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Moderate to severe
muscle strain
Osteoporosis (severe)
Severe illness
Fracture or dislocation
Uncooperative patient
Trapezius Muscle Energy
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Patient lies supine,
physician at head of table
Physician flexes neck to
barrier
Physician instructs the
patient to extend the
neck/head backward
Contraction held for 3-5
seconds
At relaxation, physician
finds new barrier
Technique repeated 3-5
times
A special thank you to:
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Matthew Costa OMS V PCOM: pictured in
demonstration photos
Patience Ekipari, DO: photographer
POFPS 41st Annual CME Symposium
August 5-7, 2016
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“OMT in Family Practice: Treating Headaches”
Jennifer A. Lorine, D.O.
Resources
Channell, M. & Mason, D. (2009). The 5 Minute Osteopathic Manipulative Medicine
Consult. Philadelphia: Lippincott Williams & Wilkins.
Chila, A.G. (2011). Foundations of Osteopathic Medicine (3rd edition). Philadelphia:
Lippincott Williams & Wilkins.
Digiovanna, E.L. 2008. An Osteopathic Approach to Diagnosis and Treatment (3rd
edition). Philadelphia: Lippincott Williams & Wilkins.
Goadsby P.J., Raskin N.H. (2012). Chapter 14. Headache. In D.L. Longo, A.S.
Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison's
Principles of Internal Medicine, 18e. Retrieved November 30, 2013 from
http://www.accessmedicine.com/content.aspx?aID=9094791.
Nicholas, A.S., Nicholas E.A. (2012). Atlas of Osteopathic Techniques (2nd
edition). Philadelphia: Lippincott Williams & Wilkins.
Ward, R. C. (2003). Foundations of Osteopathic Medicine (3rd edition).
Philadelphia: Lippincott Williams & Wilkins.
POFPS 41st Annual CME Symposium
August 5-7, 2016
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