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DIAGNOSING THE MUSCLE CONTRACTION HEADACHE
The diagnosis of muscle contraction headache, like that of migraine, is based heavily on noting the characteristic special symptoms of the headache and finding out exactly what activates the headache’s occurrence. A thorough physical examination is necessary, and during the examination, special attention must be given to the areas from which the pain seems to come. A careful manual search for sensitive points must be carried out. Cautious bending forward and bending backward, along with rotation of the head in a variety of positions, can sometimes point up the positions that provoke pain. Spasm and contraction of the neck muscles can occasionally be felt, but between attacks the muscles may feel normal.
X rays of the skull and neck are often performed to determine whether there is any evidence of bone abnormalities. The jaw and the jaw joint must be evaluated as well. The muscles, nerves, and spinal cord and other soft tissues cannot be evaluated effectively by routine X rays, which show only bone or tissue containing calcium. A manual examination of the head and neck should not be neglected simply because X rays are ordered.
Invasive diagnostic tests, the type that enter the body and cause risks, are generally not required unless important abnormalities are spotted during the X ray or the manual examinations. You and your doctor must recognize that the presence of muscle contraction means that there is a possibility that a specific disease is responsible for the contraction, and this must be considered in the evaluation.
Likewise, it is very important in some patients to look for relevant emotional distress. While many of our patients are offended if we raise the possibility, you should be receptive to a psychological interview to determine if, in fact, there are elements of anger, depression, rage, or other issues that are known to be present in many patients with muscle contraction headaches. It is our opinion that as long as your doctor shows an open-minded attitude towards all possible factors, not just emotional ones, you should not resist an inquiry into the emotional elements that could be important in creating your headache cycle.
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