11. DSA: Head Pain and Venous Sinus Technique Flashcards
How can occipitomastoid compression contribute to sinus congestion?
It results in reduced venous drainage through the jugular foramen
-producing dysfunction of cortex, thalamus, hypothalamus, CN IX and X
Explain the trigeminal vascular reflex
- Pain fibers from cortex, thalamus, and hypothalamus send impulses through CV VII
- Impulses cause PSym dilation of carotids
- Vasodilation of Internal Carotid stimulates trigeminal ganglion
- =edema in dura
After CN V1 is stimulated, neuropeptides are released which cause what?
Sterile inflammation, leading to platelet aggregation and 5HT release
-may potentiate migraine process
Why is neck pain often involved in headpain/congestion?
CN V sends impulses to upper cervical cord of neck
What causes the migraine associated symptoms?
brainstem reflexes are activated through the activation of CN V
What does PSym activation of facial nerve cause?
Nasal congestion, rhinorrhea, and lacrimation
Breakdown of what monoamine is found in the urine of those who just had a migraine?
Serotonin
How does somatic dysfunction of upper thoracic spine contribute to migraine?
Increases Sym, which leads to vasoconstriction of vessels and decreases cerebral blood flow
-anoxia will lower threshold for vasodilation, and contribute to migraine symptoms
Torsion of the sphenoid bone causes irritation of what nerve?
Trigeminal nerve
-can trigger trigeminal vascular reflex
Sphenosquamous compression can cause compromise of which artery?
Middle meningeal
What dysfunction of temporal bone can result in reflex vasodilation of internal and external carotid arteries via the facial nerve?
Internal rotation
Somatic dysfunction of which synchondrosis is common in migraine?
Sphenobasilar synchondrosis
Treffer states multiple times that pain from migraines is usually caused by the ________ system?
Trigeminovascular
Maybe know this, but who knows.
What area of the body is most important for draining congestion from the head area?
Thoracic inlet!
Venous sinus drainage is part of which biomechanical model?
Resp/Circ
-slide 11
What channels on the feet of astrocytes facilitate the movement of CSF seen in the “glymphatic” system
Aquaporin 4 channels
-also a quiz Q, may be on the exam
After draining from the aquaporin 4 channels into the paravenous sinuses, where does the lymph drain next?
Cervical lymphatic channels
Does the glymphatic system replace the CSF it reabsorbs?
nope
-accelerates the loss of waste products
Dysfunction of the glymphatic system may result in what neurodegenerative disease?
Alzheimers + others
What type of techniques seem to help during an acute attack of migraine?
Indirect with venous and lymphatic techniques
What are the absolute contraindications for venous sinus techniques?
Intracranial bleeds
Skull fractures
Acute CVAs
Cranial Infection
What are the relative contraindiciations for venous sinus techniques?
Coagulopathies
Space Occupying lesions
Increased intracranial pressure
Acute concussion
What are the three dural folds?
Falx Cerebri
Tentorium Cerebelli
Falx Cerebelli
What is the reciprical tension membrane?
It is a unit of function between the spinal and cranial dura that applies a constant tension
Which way does the tentorium cerebelli move during inhalation/flexion?
Flatten and shift anterior
How does the petrous ridge of temporal bone move during inhalation/flexion?
Anterolaterally
How does the falx cerebri move duirng inhalation/flexion?
Shifts forward follow arc, moves inferior, and curves under crista galli
What is the fulcrum in which the reciprocal tension membrane moves?
Sutherland fulcrum (straight sinus)
What is the myodural bridge?
Connecion between the rectus capitis posterior major and dura mater
May have role in cervicogenic pathologies
Left head rotation produces traction on the right or left trigeminal ganglion?
Right
-opposite
What are the seven steps of venous sinus drainage?
- Inion (confluence of sinuses)
- Occipital Sinus
- Condylar Decompression
- Transverse Sinus (fingers at nuncal ridge)
- Straight Sinus (sweet spot)
- Sagittal Sinus (cross thumbs)
- Metopic Suture (spread fingers apart from midline of frontal)
