TTH are the most common type of headache. More than likely even if a patient isn't referred to you for headaches, you should be able to help them some, if not fully, if you inquire more about any headaches. Dr. Arendt-Nielsen and colleagues do an excellent job at presenting the evidence on the role of muscle triggers (i.e. MTrPs) in specific musculature as nociceptor drivers causing symptomology. Acute and chronic sensitization from this barrage of information is described, as well as brief explanations on treatment options. I would suggest that nocioceptive input from several sources in the periphery is usually in the car, but may not always be driving it. A PT's thorough examination of aggravating and relieving factors, as well as an objective examination, should lead to the right treatment approach and prognosis.
CAD seems to be the hottest topic in any discussion of the cervical spine, particularly manipulation. The consensus now, briefly speaking, is that we need to do a better job at discerning someone with a spontaneous dissection that is already occurring who seeks us out for headache/dizziness/neck pain, etc.; vs us causing a dissection through a mechanical event (i.e. manual therapy, objective examination procedures, etc). Giossi and colleagues present data that links individuals who had a spontaneous CAD with signs suggesting connective tissue abnormalities. This differs from a very similar study by Dittrich in 2007 (who found no correlation) but opens up 68 vs 25 detectable signs that can be picked up by a clinical examination. I still think examining the hemodynamics and overall symptomology gives me more valuable information, but I wonder if this is a big missing link in detecting if someone is at high risk of a spontaneous event.
As always, looking forward to your input.
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_Harrison Vaughan, PT, DPT, OCS, Dip. Osteopractic, FAAOMPT
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