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
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
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.
Occipital & Shoulder Pain
Pain behind the eyes
Awaken with pain
Pain looking up.
Pain looking down, particularly with rotation.
“Migraine” diagnosis is common.
Worse with menses, ovulation & salt load.
Anticipate sleep disorder.
of Splenius Capitis Syndrome
Trauma of a rotational nature
Blunt Trauma, pugilism
Vigorous Cervical Manipulation
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
If exacerbation of pain is
triggered by ovulation or dietary salt-load, routine or periodic administration
of a mild diuretic is worthwhile.