What is the likely cause of a unilateral headache on the right side of the head in a patient one month post slip and fall, which resolved with trigger point therapy massage on the right occipital region?

From the Guidelines

The patient's unilateral headache on the right side of the head, which resolved with trigger point therapy massage on the right occipital region, is likely caused by a musculoskeletal issue, specifically cervicogenic headache, resulting from tension or dysfunction in the upper cervical spine or occipital muscles following the slip and fall injury. This conclusion is supported by the fact that trigger point therapy, which releases tight muscle bands that can refer pain to the head, was effective in resolving the headache 1. The improvement with trigger point therapy suggests that the headache was likely caused by muscle tension or dysfunction in the occipital region, which is a common cause of cervicogenic headache.

Some key points to consider in this case include:

• The absence of neurological symptoms is reassuring, and the patient's response to trigger point therapy suggests a musculoskeletal cause for the headache.
• The patient's history of a slip and fall injury, which can cause trauma to the cervical spine and surrounding muscles, further supports the likelihood of a musculoskeletal cause.
• The effectiveness of trigger point therapy in resolving the headache suggests that the patient may benefit from ongoing management strategies, such as maintaining good posture, performing gentle neck stretches, and applying heat to tight muscles.
• Regular manual therapy sessions may also be beneficial in preventing future episodes of headache, as they can help to maintain proper spinal alignment and reduce muscle tension.

It is also important to note that while the patient's symptoms have resolved, it is still important to monitor for any new or worsening symptoms, particularly neurological signs like dizziness, vision changes, or persistent headaches, which could indicate a more serious underlying condition 1. However, based on the current evidence, the most likely cause of the patient's headache is a musculoskeletal issue, specifically cervicogenic headache, which can be effectively managed with trigger point therapy and other conservative treatments.

From the Research

Possible Causes of Unilateral Headache

• The likely cause of a unilateral headache on the right side of the head in a patient one month post slip and fall could be related to myofascial abnormalities and trigger points in the cervical muscles or the right occipital region 2, 3, 4, 5.
• Trigger points in the suboccipital muscles can refer pain to the head, including the occipital region, and can be a common cause of tension-type headaches 3, 5.
• The fact that the headache resolved with trigger point therapy massage on the right occipital region suggests that the headache was likely caused by myofascial trigger points in this region 6, 4, 5.

Role of Trigger Point Therapy

• Trigger point therapy, including massage and positional release therapy, has been shown to be effective in reducing the intensity, frequency, and duration of tension-type headaches 2, 6, 3, 4.
• The application of trigger point therapy can increase the pressure-pain threshold at myofascial trigger points, reducing pain and discomfort 5.
• Multiple massage sessions can lead to a cumulative and sustained increase in pressure-pain threshold, providing long-term relief from headache symptoms 5.

Relationship to Slip and Fall

• The slip and fall incident may have caused trauma to the cervical muscles or the right occipital region, leading to the development of myofascial trigger points and subsequent headache symptoms 2, 3, 4.
• The delayed onset of headache symptoms, one month post slip and fall, could be due to the gradual development of myofascial trigger points and the resulting pain referral patterns 3, 4.