headache in horizontal position

[pht3k]

hi,

i have a patient, woman 45, with frontal headache, mostly unilat on the right side. no other symptoms, except some cervical tightness.
strangely, the headache is worst 2-3 minutes after she lay down to sleep. pain is not waking her up, mostly constant during the day.
no pulsatil quality.
symptoms began 2 moths ago gradually.
stable since that time.
i found c1/c2 lesion with suboccipital tightness and deep flexor weakness.
neurodynamics normal.
i treated c1/c2 and muscle tightness and signs/symptoms got much better, with pain around 80% better.
i then let her go for 3 weeks with deep flexor strenghtening exercices.
but when she came back, pain were back and still constant and again worst 2-3 minutes after going to sleep, whatever the position; lateral, supine, etc.
a bit weird like presentation
i am guessing of maybe a release phenomenon from dorsal area. i have to evaluate this area next visit.
since it's the opposite of intracranial hypotension (headache 2-3 minutes after getting up), i tought about intracranial hypertension, but when googling i found out that there should be visual disturbances, which is not the case.
any other thoughts?

[BB]

Has this person had a medical workup?

The fact that her symptoms are present to the same degree no matter what position of horizontal she is in is red-flaggy to me.

I'd be interested in her BP in horizontal and upright. Vestibular testing too. Hallpike manuever test, maybe?

Probably prudent to be very cautious and gentle with that neck too.

[Erica]

Did you treat her for just that one visit and then let her go for the 3 weeks? Other thoughts-I had HA for yrs-mostly sinus and frontal related. They were always worse in the am when I woke up. I lived with them-they were not so bad-more frustrating and annoying- but then a couple of months ago I did a complete diet overhaul (like a cleanse for 1 mos-got rid of everything-dairy, wheat, sugar, soy etc) and got rid of my headaches. I would question the diet in addition to what Cory mentioned.
Erica

[Diane]

pht3k, have you examined/treated the ocipital nerves, greater and lesser? the superficial cervical plexus, both sides? (Usually it will be in more trouble on the side toward which there is least rotation.)

[pht3k]

Has this person had a medical workup?

The fact that her symptoms are present to the same degree no matter what position of horizontal she is in is red-flaggy to me.

I'd be interested in her BP in horizontal and upright. Vestibular testing too. Hallpike manuever test, maybe?

Probably prudent to be very cautious and gentle with that neck too.

yes she had medical workup. for me too it looked red-flaggy. that's why i searched about intracranial pressure. but it seems ok. and there is no other symptoms.

i havnt checked at hallpike or other vestibular testing since there is no vertigo/dizziness/diplopia.

[pht3k]

Did you treat her for just that one visit and then let her go for the 3 weeks? Other thoughts-I had HA for yrs-mostly sinus and frontal related. They were always worse in the am when I woke up. I lived with them-they were not so bad-more frustrating and annoying- but then a couple of months ago I did a complete diet overhaul (like a cleanse for 1 mos-got rid of everything-dairy, wheat, sugar, soy etc) and got rid of my headaches. I would question the diet in addition to what Cory mentioned.
Erica

no i saw her 4 times i think.
please note that her HA are not worst in the am. they are worst 2-3 minutes after laying down. diet might be in trouble it's true. i havt asked her to do a diary because here hA are almost constant, so it's not really easy to make some links with food... but yes i agree it might be a trigger. maybe i should ask her to do it anyway and we'll see what it looks like.
hormonal change might be a trigger too.

[pht3k]

pht3k, have you examined/treated the ocipital nerves, greater and lesser? the superficial cervical plexus, both sides? (Usually it will be in more trouble on the side toward which there is least rotation.)

yes Diane i checked at the occiptal nerves but i havnt examined the superficial cervical plexus. i will.
btw i use an other technique in this same area. i was teached this technique as a cranio-clavicular fascia stretching. i found it to be frequently tight, and it helps very often to stretch this fascia (or the skin!). but i have to admit i never saw this particular structure in any textbook. maybe you do? the way i was instructed to do this technique is: hold the head in traction with flexion like if we would want to strecth the suboccipital muscles, then push caudad with the other hand on the clavicular bone. i just keep it there for a couple of minutes.

and thanks everyone for your thoughts.

[Diane]

There are a few pictures of it in this thread (http://www.somasimple.com/forums/showthread.php?t=3078&highlight=superficial+cervical+plexus). Also, if you've downloaded the DNM manual, how to treat it is in there.

[Erica]

Sounds like you are treating the right areas-getting relief for a little bit. If OA and AA and even C2 are the problems you can cover with that with the manual work you are doing.
But are her sx's consistent with lying down at the end of the day? What I mean is if she were hypothetically to take a nap during the day-after 2 -3 minutes would she still have the same problem? Or is it always at nighttime? If so, what is she doing consistently at night to trigger them?
Erica

[pht3k]

What I mean is if she were hypothetically to take a nap during the day-after 2 -3 minutes would she still have the same problem? Or is it always at nighttime?

i had the same question for her!!
but she didnt know; she never lay down during the day.
havnt asked her to try it.
but it would be a nice idea
thanks!