10. Osteopathic Approach to Head Pain, Migraines, TMJ Flashcards
What are the top causes of headache?
- Tension (frequent and chronic)
- Migraine
- Medication Overuse
- Cluster headache/Trigeminal cephalgias (rare)
Red flag: worst headache of your life
Subarachnoid hemorrhage
Red flag: new onset focal neuro weakness
stroke
Red flag: new onset headaches
Temporal arteritis
Neoplasm
Red flag: acute eye pain
Acute angle glaucoma
What aspect of the physical exam should you do if a patient comes in with headache?
neurological exam
These headaches are bilateral and achey. They radiated down into the occipital/cervical region.
Tension type Headaches
What is the suggested etiology of tension headaches?
Cervicogenic
-share nerves with trigeminal cervical complex
What are some common of referred pain causing tension type headaches?
Myofascial pain referral
Cervical facet referral
TMJ
Trigger or tender: characteristic pain pattern, elicits a radiating pain pattern, taut band of tissue, and twitch response
Trigger point
Trigger or tender: no characteristic pain pattern, no radiating pain, no twitch response
Tender point
How do you treat tension type headaches
conservative treatment mainly
Can do muscle relaxers and NSAIDs
What causes cervical facet referral pain?
Degeneration
Injury
Overuse
pain is generated over the cervical facet joint capsule
Which cause of tension type headache has decreased ROM of jaw, clicking and popping of jaw, and jaw deviation with pain of jaw in the morning?
TMJD
What should you do when considering the biomechanical approach for treatment?
Consider risk/benefit
- Splint
- OMT
- Injections
If a patient smokes, should they stop if they get chronic headaches?
Yes, smoking cessation can help
What type of headache can be associated with unilateral throbbing pain, aurea, nausea and photophobia?
Migraine
What are the four most common triggers of migraines?
- Emotional stress
- Hormones (females mostly)
- Irregular sleep
- diet
What is the abortive treatment of choice for migraines?
Triptans
What is used for prophylaxis of migraines?
Propranolol, amitripyline, topiramate
What’s the best behavioral treatment for migraines?
Avoid triggers
What type of headache is associated with a headache recurring around the same time every day and is always relieved with taking medication?
Medication overuse/Rebound
What type of medication causes overuse/rebound headaches?
Chronic pain meds
How do you treat medication overuse/rebound treatment?
Stop the offending meds
What type of headache is associated with unilateral stabbing pain around the eye and autonomic symptoms?
Cluster headaches/Trigeminal autonomic cephalgias
How do you treat cluster headaches?
Oxygen and triptans
What is used for prophylaxis of cluster headaches?
Varapamil (CCBs)
