Cephalgia Flashcards
cephalgia
headache
47% adults
suffer HA 1 time a year
2nd most common complaint
cephalgia
most common type
migraine
tension headaches
three degrees severity
infrequent
less than 1 per month
frequent
HA episode 2-14 days
chronic
HA 15 or more days per month
pathology of tension headaches
dont know mechanism
- CNS - decreased threshold of neurons - leads to misinterpretation
- PNS - increased muscle tenderness, increased number of active trigger points, forward head posture, decreased neck mobility
every one in US has episodic
3000 x 10~6 lost work days annually
clinical features tension headaches
peripheral muscle tenderness
- head, neck, shoulders
- constant worsens with HA pain
- correlates with frequency of HA and intensity of HA pain
palpation of muscles
can initiate HA
diagnostic criteria of tension headaches
bilateral head pain pain steady intensity is mild to moderate pain no aggravation of HA by normal daily activities Pain lasts 30 minutes to 7 days HA not attributed to other causes
Tx of tension headache
earlier the treatment, the better
- start with max dose of chosen therapy
- triptans, muscle relaxants, OMT
clenching teeth at night
TMJ - could cause tension headaches
migraine headaches
mechanism unknown
- vascular - dilation of vessels in brain, pain
- cortical spreading depression theory - self propagating wave of neuronal and glial depolarization in the brain
trigemino muscular theory
activation of trigeminal system, neuron that innervates the vessels of dura
aura migraine
from vessel constriction
sensitization
neurons increase response to nociceptive input
genetics
role in development in migraine
prodrome
phase before have headaches
affective or vegetative symptoms 24-48 hours before
euphoria, depression, irritability, food craving, constipation, neck stiffness
aura
in classic migraine
types of aura
visual, auditory, olfactory, verbal
any sense
most common aura
visual
-visual loss
HA stage
unilateral, throbbing, pulsatile pain, intensity increase, nausea/vomiting, chills sweats, photo/phonobia
postdrome pain
pain when move head
- exhaustion
- elation/euphoria
mild to moderate migraine
no nausea/vomiting
moderate to severe
have nausea/vomiting
cluster headaches
episodic and chronic
episodic
daily attacks for weeks with periods of remission
chronic
daily attacks with no significant periods of remission
pathogenesis of cluster headaches
unknown
- theory 1 - hypothalamic activation with secondary activation of trigeminal autonomic reflex
- 2 - neurogenic inflammation of wall of cavernous sinus obliterates venous drainage
clinical features of cluster headaches
8 times a day
unilateral
attacks of severe orbital, supraorbital, temporal pain
diagnosis of cluster headaches
at least 5 attacks
lasting 15-180 mins
one every other day for more than half time for an attack period
one or more other symptoms of cluster HA
medication overuse headaches
pathogenesis, not understood
opiods, aspirin, tylenol, butalbital, triptans, ergotamine, NSAIDs
clinical features of medication overuse HA
frequent treatment of HA pain with analgesic
-
diagnosis of medication overuse HA
more than 15 days / month
- for at least 3 months
- developed or worsened with continued use of medication
Tx of medication overuse HA
stop medication intake
-withdrawal symptoms, make HA worse
bridge therapy
treat the HA pain to get through withdrawal period, use the bridging agent not same class of drug
HA is complaint
associated with many illnesses
consider other potential causes
indications for imaging
possible with bad enough headache
CV4
cranial technique done to self for HA decrease
