11. DSA: Head Pain and Venous Sinus Technique

Question 1

How can occipitomastoid compression contribute to sinus congestion?

Answer 1

It results in reduced venous drainage through the jugular foramen
-producing dysfunction of cortex, thalamus, hypothalamus, CN IX and X

Question 2

Explain the trigeminal vascular reflex

Answer 2

1. Pain fibers from cortex, thalamus, and hypothalamus send impulses through CV VII
2. Impulses cause PSym dilation of carotids
3. Vasodilation of Internal Carotid stimulates trigeminal ganglion
4. =edema in dura

Question 3

After CN V1 is stimulated, neuropeptides are released which cause what?

Answer 3

Sterile inflammation, leading to platelet aggregation and 5HT release
-may potentiate migraine process

Question 4

Why is neck pain often involved in headpain/congestion?

Answer 4

CN V sends impulses to upper cervical cord of neck

Question 5

What causes the migraine associated symptoms?

Answer 5

brainstem reflexes are activated through the activation of CN V

Question 6

What does PSym activation of facial nerve cause?

Answer 6

Nasal congestion, rhinorrhea, and lacrimation

Question 7

Breakdown of what monoamine is found in the urine of those who just had a migraine?

Answer 7

Serotonin

Question 8

How does somatic dysfunction of upper thoracic spine contribute to migraine?

Answer 8

Increases Sym, which leads to vasoconstriction of vessels and decreases cerebral blood flow
-anoxia will lower threshold for vasodilation, and contribute to migraine symptoms

Question 9

Torsion of the sphenoid bone causes irritation of what nerve?

Answer 9

Trigeminal nerve

-can trigger trigeminal vascular reflex

Question 10

Sphenosquamous compression can cause compromise of which artery?

Answer 10

Middle meningeal

Question 11

What dysfunction of temporal bone can result in reflex vasodilation of internal and external carotid arteries via the facial nerve?

Answer 11

Internal rotation

Question 12

Somatic dysfunction of which synchondrosis is common in migraine?

Answer 12

Sphenobasilar synchondrosis

Question 13

Treffer states multiple times that pain from migraines is usually caused by the ________ system?

Answer 13

Trigeminovascular

Maybe know this, but who knows.

Question 14

What area of the body is most important for draining congestion from the head area?

Answer 14

Thoracic inlet!

Question 15

Venous sinus drainage is part of which biomechanical model?

Answer 15

Resp/Circ

-slide 11

Question 16

What channels on the feet of astrocytes facilitate the movement of CSF seen in the “glymphatic” system

Answer 16

Aquaporin 4 channels

-also a quiz Q, may be on the exam

Question 17

After draining from the aquaporin 4 channels into the paravenous sinuses, where does the lymph drain next?

Answer 17

Cervical lymphatic channels

Question 18

Does the glymphatic system replace the CSF it reabsorbs?

Answer 18

nope

-accelerates the loss of waste products

Question 19

Dysfunction of the glymphatic system may result in what neurodegenerative disease?

Answer 19

Alzheimers + others

Question 20

What type of techniques seem to help during an acute attack of migraine?

Answer 20

Indirect with venous and lymphatic techniques

Question 21

What are the absolute contraindications for venous sinus techniques?

Answer 21

Intracranial bleeds
Skull fractures
Acute CVAs
Cranial Infection

Question 22

What are the relative contraindiciations for venous sinus techniques?

Answer 22

Coagulopathies
Space Occupying lesions
Increased intracranial pressure
Acute concussion

Question 23

What are the three dural folds?

Answer 23

Falx Cerebri
Tentorium Cerebelli
Falx Cerebelli

Question 24

What is the reciprical tension membrane?

Answer 24

It is a unit of function between the spinal and cranial dura that applies a constant tension

Question 25

Which way does the tentorium cerebelli move during inhalation/flexion?

Answer 25

Flatten and shift anterior

Question 26

How does the petrous ridge of temporal bone move during inhalation/flexion?

Answer 26

Anterolaterally

Question 27

How does the falx cerebri move duirng inhalation/flexion?

Answer 27

Shifts forward follow arc, moves inferior, and curves under crista galli

Question 28

What is the fulcrum in which the reciprocal tension membrane moves?

Answer 28

Sutherland fulcrum (straight sinus)

Question 29

What is the myodural bridge?

Answer 29

Connecion between the rectus capitis posterior major and dura mater

May have role in cervicogenic pathologies

Question 30

Left head rotation produces traction on the right or left trigeminal ganglion?

Answer 30

Right

-opposite

Question 31

What are the seven steps of venous sinus drainage?

Answer 31

1. Inion (confluence of sinuses)
2. Occipital Sinus
3. Condylar Decompression
4. Transverse Sinus (fingers at nuncal ridge)
5. Straight Sinus (sweet spot)
6. Sagittal Sinus (cross thumbs)
7. Metopic Suture (spread fingers apart from midline of frontal)