Determination of active trigger points are done during office visit after evaluation of the patient’s CT scan (if indicated) along with studying patient’s headache log and forms. Therefore it is very important for the patients to take their time to go over the forms and fill them out precisely. It is also important to note where the headache starts from rather than where it radiates to. Usually patients remember the raditing part better than starting point since pain stays in radiated part for a longer time.In general:
In patients with frontal trigger point ,headache starts from the eyebrow or above it, these patients may have strong frowning muscles. These patients often see ophthalmologist before referring to neurologist because they thinks their headache is due to some eye problem .
In patients with temporal trigger point ,Headache usually starts in temple area, These patients sometimes have history of teeth grinding, clenching and some of these patients diagnosed with TMJ problem.
Patients with nasal trigger point have pain behind the eye, and/or sinus area.These patients headaches are triggered by weather or barometric pressure change, they also might have some issues with breathing through the nose. These group of the patient are often wrongly diagnosed with “sinus headache” and they usually seen by Ear, Nose, Throat doctors or allergist for years before they see headache specialists.
In patients with occipital trigger point pain usually starts in occipital area or back of the neck or shoulder. Headache usually starts in the afternoon and often we can find a tender point in occipital area. These group of patients often seeks relief from chiropractic care and some of them have undergone unnecessary neck manipulation which could make the headache worse or cause other complications.