10. Osteopathic Approach to Head Pain, Migraines, TMJ

Question 1

What are the top causes of headache?

Answer 1

1. Tension (frequent and chronic)
2. Migraine
3. Medication Overuse
4. Cluster headache/Trigeminal cephalgias (rare)

Question 2

Red flag: worst headache of your life

Answer 2

Subarachnoid hemorrhage

Question 3

Red flag: new onset focal neuro weakness

Answer 3

stroke

Question 4

Red flag: new onset headaches

Answer 4

Temporal arteritis

Neoplasm

Question 5

Red flag: acute eye pain

Answer 5

Acute angle glaucoma

Question 6

What aspect of the physical exam should you do if a patient comes in with headache?

Answer 6

neurological exam

Question 7

These headaches are bilateral and achey. They radiated down into the occipital/cervical region.

Answer 7

Tension type Headaches

Question 8

What is the suggested etiology of tension headaches?

Answer 8

Cervicogenic

-share nerves with trigeminal cervical complex

Question 9

What are some common of referred pain causing tension type headaches?

Answer 9

Myofascial pain referral
Cervical facet referral
TMJ

Question 10

Trigger or tender: characteristic pain pattern, elicits a radiating pain pattern, taut band of tissue, and twitch response

Answer 10

Trigger point

Question 11

Trigger or tender: no characteristic pain pattern, no radiating pain, no twitch response

Answer 11

Tender point

Question 12

How do you treat tension type headaches

Answer 12

conservative treatment mainly

Can do muscle relaxers and NSAIDs

Question 13

What causes cervical facet referral pain?

Answer 13

Degeneration
Injury
Overuse

pain is generated over the cervical facet joint capsule

Question 14

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?

Answer 14

TMJD

Question 15

What should you do when considering the biomechanical approach for treatment?

Answer 15

Consider risk/benefit

• Splint
• OMT
• Injections

Question 16

If a patient smokes, should they stop if they get chronic headaches?

Answer 16

Yes, smoking cessation can help

Question 17

What type of headache can be associated with unilateral throbbing pain, aurea, nausea and photophobia?

Answer 17

Migraine

Question 18

What are the four most common triggers of migraines?

Answer 18

• Emotional stress
• Hormones (females mostly)
• Irregular sleep
• diet

Question 19

What is the abortive treatment of choice for migraines?

Answer 19

Triptans

Question 20

What is used for prophylaxis of migraines?

Answer 20

Propranolol, amitripyline, topiramate

Question 21

What’s the best behavioral treatment for migraines?

Answer 21

Avoid triggers

Question 22

What type of headache is associated with a headache recurring around the same time every day and is always relieved with taking medication?

Answer 22

Medication overuse/Rebound

Question 23

What type of medication causes overuse/rebound headaches?

Answer 23

Chronic pain meds

Question 24

How do you treat medication overuse/rebound treatment?

Answer 24

Stop the offending meds

Question 25

What type of headache is associated with unilateral stabbing pain around the eye and autonomic symptoms?

Answer 25

Cluster headaches/Trigeminal autonomic cephalgias

Question 26

How do you treat cluster headaches?

Answer 26

Oxygen and triptans

Question 27

What is used for prophylaxis of cluster headaches?

Answer 27

Varapamil (CCBs)