Pain Doctor: No Need to Suffer. Pain Center of Orlando

Splenius Capitis Syndrome: Muscle Tension Headache

 

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. 

Symptom Complex

 

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

w        Surgery

–        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.

 

Injection is performed in a short series, that is, once or twice with pain relief lasting from a few weeks to many months.  Skillful injection technique results in the most satisfactory results, and concurrent use of common anti-inflammatories speed recovery, particularly when combined with a low-dose diuretic. Muscle relaxant or anti-convulsants, dosed at bed time provide relief of the neuralgia and side effects are minimized by the bed-time administration.

 

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

www.suffernomore.com                   www.stages-of-life.com

Nutritional Conditioning, Stretch and Prevention of Muscular Injury

Nutritional Conditioning, Stretch and Prevention of Muscular Injury

 

It is well known that stretch is necessary to prevent sports-related muscular injury.  What is less well appreciated is what additional steps must be taken to minimize trauma to muscle, tendon and connective tissues.

 

A warm up is intended to raise body temperature, increase blood flow, and permit time to focus on the physical challenge to come.  The time investment required is rather individual.  The length of time required will increase with the age of the athlete.  Younger athletes may require as little as 15 to 20 minutes, the  time investment will increase to as much as 45 minutes for more mature participants.  The warm up begins with systematic stretch of the extremities and torso, and should precede cardio challenge.  A gradual warm up will increase range of motion, permit muscular stretch, prior to challenging aerobic performance.

A satisfactory warm up will result in a 2 to 3 degree rise in body temperature.  This rise in body temperature reflects an increase in metabolic rate, and can be expected to last 30 to 45 minutes after exercise ceases. The degree of temperature rise reflects hormonal status, thyroid function and level of conditioning. 

The increase in temperature results in dilation of the peripheral vasculature, resulting in increased blood flow to the muscles, connective tissue and joints.  The increase in temperature should increase flexibility of the joints and connective tissues.  The intention, of course, is to reduce the risk of injury to joint, muscle and tendon. 

Nutritional conditioning is another matter, entirely. The athlete can influence blood flow to the muscles, increase toxin wash-out, and improve stamina by selecting nutraceutical supplementation. Every athlete has a preferred dietary protein and calorie regimen, and it is well beyond the scope of this brief article to opine as to the relative benefits and risks of different approaches.  There are interventions that can be taken irrespective of the individual preferences, beliefs and intentions.

Enhancing Blood Flow

After eliminating discussion of protein and carbohydrate loading, consideration should be given to enhancing muscular stamina through modulation of regional blood flow, capillary resistance and anti-oxidant reserve. 

Blood flow can be enhanced by decreasing blood viscosity (thinning the blood), opening the microvasculature thereby tempering the effects of lactic acid accumulation, the net effect will be an increase in blood flow and an increase in oxygen delivery to muscle tissue. This can be accomplished with selective use of fish oil products and/or olive oil.  Only the highest quality fish oil should be used due to mercury contamination and fish protein intolerance.  A ‘concentrated’ fish oil is generally distilled, and this removes mercury and most fish protein.  The concentrated fish oil should be taken, at a minimum, of 2 grams twice daily.  Alternatively, one ounce of olive oil, preferably taken in a ‘shot glass’ followed by fruit juice of choice.

Small vessel dilation can be accomplished with hawthorn berry extract, vinpocetin and huperzine.  Taken in combination, these nutraceuticals dilate small vessels through blocking the phosphodiesterase (PDE) receptors in various organs and tissues.

Huperzine 100 mcg, combined with vinpocetin 20-40 mg and hawthorne berry extract 450-600 mg daily.

Anti-Oxidants for Improved Stamina

Clever use of anti oxidants can improve muscular function and improve stamina.  These anti-oxidants are not necessarily widely recognized but they are widely available.  Alpha lipoic acid, taken 250 mg four times daily, combined with taurine 500 mg twice daily will provide an anti-oxidant reserve that will increase muscular stamina and endurance.   

Conclusion

Muscular endurance and athletic stamina can be enhanced through the thoughtful use of nutraceuticals that increase microvascular blood flow, decrease blood viscosity and enhance anti-oxidant reserve.

Applicable to most nutritional regimens, the addition of a few easily specific nutraceuticals can provide noticeable improvement in performance and comfort.

 

David S. Klein, MD, FACA, FACPM, FAAMIMS

Pain Center of Orlando, Inc.

225 W. SR 434 Suite #205

Longwood, Florida 32779

407-679-3337

www.suffernomore.com

www.stages-of-life.com

Dr. Klein has practice pain medicine for the past 25 years and is the author of over 50 published articles and textbook chapters.  He has lectured extensively both nationally and internationally.

Curcumin and Curcuminoids in the Treatment of Inflammatory Bowel Diseases

Curcumin and Curcuminoids in the Treatment of Inflammatory Bowel Diseases Including Crohn's Disease and Ulcerative Colitis

Curcumin inhibits a number of enzymes that are involved  in the synthesis of inflammatory chemical modulators. Curcumin has been recognized as an anti-inflammatory agent as well as a pain reliever.  Research studies have demonstrated that the anti-inflammatory activity of curcumin is comparable in strength to steroidal and non-steroidal prescription medications. 

TNF-alpha elevation is an important component of the inflammatory process,  involved in the pathogenesis of many inflammatory disorders, including Crohn's Disease, Irritable Bowel, rheumatoid and lupus.

Curcumin, a flavonoid from the herb turmeric is a well studies known inhibitor of TNF-alpha. Studies have demonstrated that TNF-alpha increased intestinal permeability and curcumin inhibited the NFkappa Beta- induced-TNF-alpha-stimulated increase in intestinal 'leakiness.'

Curcumin inhibits several of the cytokines and genes involved in the pathogenesis of inflammatory bowel disease, and curcumin down regulates or shuts down the production of  several pro-inflammatory prostaglandins and leukotrienes. 

Inflammation results from a complex cascade of chemical changes that are triggered by  responses to tissue damage.  Chronic inflammation leads to degenerative conditions like arthritis, arteriosclerosis, etc. 

The rate, route and amount of administration of curcumin will depend entirely on the gender, age and other disease states that may exist in a patient.  Curcumin is very inexpensive, but it must be taken properly for it to be most effective.  We keep it in the office for our patients, but it is in our catalogue, as well. 

Follow this link:  CURCUMIN

Please feel free to pass this note along.  Inflammatory bowel diseases, auto-immune disorders and many chronic pain problems can be treated with this agent.

For more information:  Pain Center of Orlando   www.suffernomore.com

[email protected]

David S. Klein, MD, FACA, FACPM