It's very important when we talk about triggers for headache, to address what I like, will refer to as muscle dysfunction. Doctor Fricton some years ago here at the University of Minnesota began a program for treatment of temporomandibular disorder. Previously known at TMJ and here is a list of from articles about the presenting symptoms of people with temper mandibular disorder. And it shows here that beside jaw and joint pain as, as, primary complaints, people often, often complain of. Temporal pain, occipital pain, forehead pain, which would be, the typical type of complaints a neurologist would see for people that are complaining having a tension-type headache or migraine. And so this is another example of where there's this overlap of different diagnosis. When we're talking about management of benign headaches. And that many people, that you go see a neurologist, will be given the diagnosis of either migraine, or tension type headache. Or if you go see your dentist, or a TMD specialist, he might give you the diagnosis of temporomandibular disorder. But there's a huge overlap between these conditions, and it's important to understand this muscle dysfunction. To summarize it very simply, is what is the muscle dysfunction that people get involved in, get experience with headaches? Some people are squinters, They get, the forehead gets tight. Some people are clenchers, they get on the side of the head. And some people are turtlers, they builds from their neck and some people do all three. So when we think about addressing some of the muscle dysfunction that occurs with headaches, we talk about those behavioral patterns and help, helping people understand them and recognize them in themselves. Other types of muscular patterns that are important with headache deal with people's posture and work environment. In this slide as you can see Peggy a data processor is being awarded for key punching in 3700. Records in one eight hour shift, employee of the year, Peggy Neal. And you can see that when we do a certain behavior, we have a certain pattern of sitting. It becomes habituated, it becomes over learned. The nervous system just does it automatically. And, and, and Peggy. And the presenter and everybody in the audience seems to be doing the same thing an awful lot of the time. How do these muscle factors then flow into people's lives? And with that, we start talking about mind-body interactions. These mind-body interactions. Are very much illustrated by this picture of this gentleman, where you can see which muscles are going to become tight and constricted with different types of postures. And you can see, when one's mood changes, our mood is how we feel. It's not only a feeling, but it's expressed as a body experience. It comes out in body language, body posture and it is conveyed in a mind-body way. And, therefore, when we start addressing muscle dysfunction we really have to take a much more. Holistic approach and managing all the aspects that contribute to muscle dysfunction. And so, to summarize this sec, section, talk about the overlap and how different people see the same problem. If you go see a neurologist, he's going to talk to you about migraines being a disorder of the brain, disorder of neurotransmitters that need to be managed with medications that address, you know, transmitters. If you go to see a clinical health psychologist, they're going to talk about behavioral factors, such as clenching, and poor posture, and stress, and anxiety, and something called autonomic dysfunction, kind of that fight or flight response. And, spending too much time in the flight or flight response. And, of, that of course is, typical of, your typical type A personality. They're so focused on achievement, it's tainting their goal, that they tend to do what? They tend to ignore. Mild headaches. They ignore tension. They ignore posture. They focus on their goal. And those things then tend to add up and can be a factor that transforms an episodic condition into a chronic condition. If you go see a dentist, he's going to tell you you have a TMJ problem, that the muscles are sore. They'll talk about. Myofascial pain. And of course the physical therapist focuses more on your posture dysfunction and muscle imbalances and correcting those imbalances with stabilization exercises and stretching program. So that is an introduction to both classification headaches, how to diagnose headaches and a little bit about kind of the triggers for headaches. We're just going to give an example right here of a typical patient that comes to clinic and and Pamela is a 27 year old female office worker. Mother who complains of four different things. She's having these mild frontal temporal headaches about twice a week. They become severe, and throbbing, once a month with, with her menstrual cycle. They began about six years ago when she was in college. And, she's pretty much been managing them with over the counter medications. And she will occasionally miss work, primarily when she has the more severe menstrual-related headache. And so, the question is, is this a primary or secondary disorder? And I think from what we've talked about we'd say this, this sounds like this is a person who has both tension type headaches a couple times a week and then she will build to have more of a migranous type of headache with her cycle once a month. There's no real red flags, that I would be worried about. Neurologically her exam was normal. There's no atypical features, and there's, at this point she's not really overusing medications because she's only taking medications a few times a week. And so her diagnosis would be a migraine headache. Menstrual migraine, and tension type headache without warn, there's no or, or warning for it. And I would not recommend. A big diagnostic work up in her. What's interesting about this, this gets to that case of, is this, would this person's tension type headache that she has twice a week respond to a tryptin, or migraine specific medication? And it probably would. If we if if Pamela. Gave the same story but did not have the menstrual-related migraine but just had episodic tension type headaches, then it, it's a good chance that, that headache would not respond to atryptin. [BLANK_AUDIO]
