Many people are misdiagnosed with migraine HA or even have migraines that are triggered by cervicogenic HA. These are my go-to treatments for mechanical HA.
1) Subcranial Shear Distraction
- Gapping this area increases subcranial space as proven by pre and post test MRIs (unpublished but Rocabado has literally 100s of slides showing this)
- this relieves pressure on upper cervical spine and greater occipital nerve both of which refer to the cranium, cervical spine and upper traps
2) Unilateral OA nod
- this is indicated when the patient has unilateral complaints and as a progression from the subcranial shear technique
- also indicated with transverse ligament laxity as it does not stress the ligament being a unilateral technique
- make sure to only perform 3-5 reps as it can be very uncomfortable
- prep the area first with some ST techniques
3) 1st rib
- TrPs in the upper traps also can refer superiorly to the cranium
- prepping this area with IASTM or FR works well prior to the first rib releases
4) prolonged OA gapping/cervical retraction in supine
- in supine, one hand on occiput, other on the forehead
- have the patient retract into a pillow and hold at near or end range, progressing into end range if not starting there 2-3 minutes
- for unilateral complaints, rotate head toward the involved side, SB the cranium away with the axis through the nose and gap the involved side for 2-3 minutes
- easily taught to the patient at the onset of a HA, they may use over heat
5) upper thoracic thrust manipulation
- shown by research to have similar effects to cervical thrust and mobilization
- a safer alternative risk wise to cervical thrust
- helps relieve thoracic and B upper trap "tightness"
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