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Head Pain - Introduction
Herbert C. Miller, DO, FAAO, Kirksville, Missouri
Reprinted with permission of the American Osteopathic Association.
Pain has been defined in many ways, as the sensation "resulting from the stimulation of specialized nerve endings,"' or, more poetically, as a punishment or penalty, as for crime. Other definitions include acute discomfort of body or mind, bodily or mental suffering or distress; a distressing sensation, as in a particular part of the body, and trouble experienced in doing something. (2) One's concept of pain may be colored by diverse circumstances or, in scientific language, feedback. Head pain is usually interpreted by the clinician from the therapeutic point of view, that is, in terms of measures that may stop in, rather than in pathophysiologic terms.
When analyzing head pain, the physician often prefers to look at it as a phenomenon or as the result of stimulation of specialized nerve endings. In reality, pain may be an interpretation of bodily or mental distress. Boshes and Arieff (3) stated:
Certain aspects of pain are predicated exclusively on a neural substrate. Here the basis is an event or an alteration in the nervous system per se, as contrasted to pain caused by malignant disease, infected tissue, fractures or the like. Various divisions of the nervous system may be implicated and a description of the disability or the manner of posture and movement is often sufficient to enable the trained observer to gain an impression as to whether the pain is genuine or functional. Such involvement may be at the receptive, the conductive, the perceptive or the apperceptive level, or combinations thereof.
This would appear to be a generally accepted concept, and yet head pain often is described and interpreted on the basis of a symptom complex rather than in terms of the anatomic and physiologic organization of the central nervous system. It is the purpose of this paper to attempt to describe some of the mechanisms involved in head pain and to provide these mechanisms with an osteopathic orientation.
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