SESSION 1
Watson Headache Approach Assessment
1. subjective exam
2. red flag screening
3. stability check
4. objective evaluation of upper cervical spine
5. headache pain area provocation tests
6. manual treatment
As appropriate
· Temporo-mandibular, thoracic, lumbar and posture evaluations
· Ergonomic assessment- home and office
· Hydration
· Stress management – breathing strategies, e-device hygiene, sleep, exercise.
· Sleep- habits to improve quality / consistency, air temperature and humidity, ambient noise, pillows, keeping neck neutral, refraining from excessive protraction or flexion.
· Exercise- Regular cardiovascular / weights exercise- micro dose strategy for habit formation and confidence
· Diet- low on processed foods, moderation with caffeine/alcohol especially after noon, water intake.
> Plan of action
· If NO, not a PT candidate, or the plan of care below is not agreed upon, then PT may refer to appropriate ‘other’ specialist, family physician, nurse practitioner, specialized massage therapist, vestibular therapist.
· If YES, a PT candidate (no red flags, nor medical assessment deemed needed), then from above, items are emailed for client to focus on, accountable to / and supported by, PT.
1. Goals are determined- functional, manual therapy wise, symptomatic (headache frequency, intensity, duration).
2. Subsequent 4 treatments booked within ~ 28 days.
3. Available to client via email between sessions for questions.
Phases of Care
1. Assessment
2. Re-assessment / trouble shooting
3. Reinforcement of gains
PHASE 1= ASSESSMENT
Sessions 1-3 (first 10 days)
- Assess above, ensure safety, and indication to treat as a PT.
- Manual therapy to accomplish centralization of the C2 vertebra.
- Increase, then abolish relevant AREA of headache (if applicable, ie. constant headache).
- Client starts home exercise / lifestyle modification program above.
- With consent, evaluation is faxed to preferred specialist(s).
PHASE 2= RE-ASSESSMENT / TROUBLE SHOOTING
Sessions 2-7 (first 5 weeks)
- Provoke, then abolish relevant AREA of headache (if applicable, ie. intermittent headache).
- As symptoms improve, progress exercises towards functional goals.
- Aim for consolidation of gains, stability in the newer, improved symptomatic state. Refine treatments to improve gains.
- Start treatment of secondary issues that are affecting above (eg. Jaw (may be primary), or back or knee etc.)- may include manual therapy, exercise, posture modification, acupuncture, cupping, taping).
PHASE 3= REINFORCEMENT OF GAINS
Sessions 5 onwards-‘variable’. (week 4 onwards)
- Continue to treat secondary issues above.
- Maintain improvements over time, schedule goals with aim of decreased frequency of PT sessions.
- Review holistic strategies for improvement of gains.
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