[a] very common cause of cephalgia and pelvic autonomic dysfunction.” (Pp.149-50) Dr. Upledger also notes that “continued stress on the dura in the suboccipital region may cause increased suboccipital muscular tension, which can cause pain, as well as result in fluid outflow obstruction at the jugular foramina and intracranial fluid congestion.” (Pp.298). While this patient did not exhibit a pure flexion dysfunction of the coccyx, the combined posterior shear, extension, and R deviation seemed sufficient to place excessive tension on the dura, which likely translated all the way up to the foramen magnum, falx cerebelli, and falx cerebri. In this case, the positional dysfunction seemed so pronounced, and the tension on the dura so extreme, that any further tension introduced to the system (even from something as simple as carrying a light purse, or lifting her baby) could not be dissipated by the craniosacral dura and related fascia/fluid. The increased tension would easily and repeatedly result in head pain.
The patient’s first treatment included transrectal release of the right coccygeus muscle, mobilization of the sacrococcygeal joint to decrease extension and right deviation of the coccyx, and all of the Craniosacral 10-step protocol techniques except mobilization of the cranial bones. At the end of this session, the patient stated that her neck felt less tight. At the start of the second treatment session a week later, the patient noted that she had not had a headache all week, even when carrying a light bag or when holding her baby. Palpation revealed only minimal right deviation and extension of the coccyx, improved mobility of the sacrococcygeal junction, decreased restriction at L5/S1, and a symmetrical CSR at the OCB. Craniosacral techniques above were employed again, with the addition of the frontal lift, and a brief transrectal treatment was performed to allow for a further mobilization of the deviated coccyx.
At the start of the third weekly session, the client reported that she was able to carry her 15 lb child 3 blocks without a headache, and that in fact she had once again not had a headache at all in the past week. Over the following 5 sessions, visit frequency was stretched to every 2, then every 3 weeks, with each session requiring little to no direct coccyx work to maintain positional integrity, and a greater focus placed on increasing dural freedom and decreasing tension at the OCB utilizing the techniques of the Craniosacral 10-step protocol. During the entire 3-month period in which the initial 8-session treatment course took place, the patient experienced only 3 headaches, each lasting only a couple of hours, with a max intensity of 5/10. This after experiencing a constant headache of 7/10-9/10 intensity for many years prior. The patient and I were overjoyed with her ability to hold and carry her child without fear of developing a migraine. She states, “I think [Debbie] is just as excited as I am every time I come in with good news about my migraine free days and my increased ability to function normally.”
This case highlights the importance of considering coccyx positional dysfunction and mobility as a contributing factor in headaches. Of course, a history of coccygeal trauma can clue the clinician in, however the coccyx can sometimes be implicated in cases where no trauma has been present. Assessing the coccyx to the degree in which the clinician’s practice act allows can provide an important piece of the headache puzzle. If practice regulations prevent internal assessment and treatment, consider referring out to the proper clinician for a session or two – the difference it can make in your client’s recovery may truly be life changing.