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OPP 2.1 > Cephalgia > Flashcards

Cephalgia Flashcards

1
Q

types of headaches: primary

A
  • tension-type
  • migraine
  • cluster
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2
Q

types of headaches: secondary

A
  • rebound (OTC overuse)

- manifestation of other diseases

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3
Q

what should be asked in hx to help classify the HA?

A
  • birth hx
  • any OTC for pain?
  • any new meds?
  • change in social hx?
  • hx of trauma
  • surgical hx
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4
Q

tension-type headache: how long does pain usually last?

A

30 min to 7 days

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5
Q

tension-type headache: how is the pain described?

A
  • fullness, tightness, pressure in head
  • pain b/l
  • band-like, dull, tight cap feeling around head
  • tightness often found in suboccipital area
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6
Q

tentions-type headache: how is the pain rated?

A
  • mild to mod
  • non-throbbing
  • steady - not aggravated by normal daily activities
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7
Q

tension-type headache: assoc sx

A
  1. peripheral mm tenderness
    - neck and shoulders
    - constant or worsen with actual HA pain
    - correlated with frequency and intensity of HA pain
    - palpation illicit pain
  2. sleep issues
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8
Q

TTH pathogenesis

A

body’s response to stress

  • stress and mental tension
  • head and neck mvmts and postures
  • anxiety and depression
  • fatigue
  • structural abnormalities
  • viscerosomatics
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9
Q

TTH pathophysio - peripheral pain mech

A
  • tightness of pericranial myofascial tissues sends nociceptive inputs to the dorsal horn neurons
  • become sensitized - causes what is normally innocuous stimuli to be interpreted as pain
  • episodic TTH (<15 days)
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10
Q

TTH pathophysio - central pain mech

A
  • increased facilitation of cranial structures
  • decreased inhibition of pain transmission at the level of spinal dorsal horn/trigeminal nucleus
  • altered brainstem reflexes suggest abnormal limbic controlled pain systems
  • mech for chronic TTH (>15days)
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11
Q

TTH pathophysio - above tentorium membrane in pain referral pathways

A
  • pain referred by CN V

- pain perceived in front, temporal, parietal regions

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12
Q

TTH pathophysio - below tentorium membrane in pain referral pathways

A
  • pain referred by CN IX, X, and upper cervical spinal nerve roots
  • pain perceived in occipital region
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13
Q

TTH tx

A

acute/abortive

  • earlier the tx admin, the better
  • start with max dose of chosen therapy
  • NSAIDS and OMT
  • effectiveness of med for acute relief decreases with increased use
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14
Q

TTH prophylaxis

A
  • behavior mod
  • workspace adjustments
  • tx
  • exercises
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15
Q

migraine HA presentation - prodrome

A

symptoms that occur 24-48 hours before migraine:

  • euphoria
  • depression
  • irritability
  • food cravings
  • constipation
  • neck stiffness
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16
Q

migraine HA presentation: aura

A
  • seen in classic migraine
  • visual, auditory, or olfactory hallucinations (visual most common - scotomas and photopsia)
  • vertigo
  • paresthesias
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17
Q

migraine HA presentation: headache

A
  • u/l, throbbing, pulsaltile pain
  • can radiate to opp side
  • intensity increases
  • relief from lying in dark, quiet room and sleeping it off
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18
Q

migraine HA presentation: postdrome

A
  • mvmt of head causes pain transiently
  • exhausation
  • mild elation or euphoria
19
Q

migraine HA pathogenesis

A
  • initial episode occurs during puberty

- triggered by many things

20
Q

migraine HA pathophysio - genetics

A
  • epigenetics
  • more commonly passed on from mother
  • defects in voltage gated Ca2+ channel or Na-K ATPase channel
21
Q

migraine HA pathophysio - psychiatric problems

A
  • depression
  • bipolar
  • anxiety
  • insomnia
  • somatoform disorders
  • boderline personality disorder
  • narcissistic personality disorder
22
Q

migraine pathophysio - which CN causes it?

A

CN V nucleus

  • 3 branches to the face - u/l pain
  • meningeal vessels - vasoconstriction/dilation
  • dura
23
Q

migraine pathophysio - which NT is thought to be involved?

A

serotonin

- use of triptans (sertonin agonists) effective in abortive therapy

24
Q

migraine HA tx

A

acute/abortive therapies

  • mild-mod (w/o nausea or vomitting) - acetaminophen, NSAIDs, combo drugs with caffeine, OMT
  • mod-severe - triptans, sumatriptan/naproxen, ergot alkaloids, opiates, OMT
25
Q

migraine HA prophylatics therapies

A
  • surgery
  • adjusting one’s environ to avoid triggers
  • OMT
26
Q

general cluster HA - which nerve involved?

A

trigeminal autonomic cephalgia (TAC)

  • short-lasting, u/l, severe attacks primarily within V1 distrib
  • parasymp hyperactive
  • symp impaire
27
Q

cluster HA dx criteria

A
  • dx is clinical
  • severe u/l orbital, supraorbital, temporal pain
  • attack happens at around same time each day
  • pain lasts 15min-3hrs
  • ave of 8-10 wks/yr
  • hx of at least 5 attacks
28
Q

cluster HA - common symptoms

A
  • severe orbital, supraorbital, temporal pain
  • strictly u/l
  • restlessness and agitation
  • rocking or rubbing their head for relief
29
Q

cluster HA - how often does HA occur?

A

up to 8x/day

30
Q

cluster HA - other symptoms driven by which autonomic?

A

PS

  • ptosis
  • miosis
  • lacrimation
  • rhinorrhea
  • conjunctival injection
  • nasal congestion
31
Q

cluster HA - what 2 forms can a patient have?

A
  • episodic form - rhythmic attacks with periods of remission

- chronic form - no remission

32
Q

cluster HA pathophysio - theory 1

A

hypothalamic activation with secondary activation of trigeminal-autonomic reflex

33
Q

cluster HA pathophysio - theory 2

A

neurogenic inflamm of the wall of the cavernous sinus obliterates venous drainage –> injury of symp fibers traveling with internal carotid artery

34
Q

cluster HA tx

A

acute/abortive

  • 100% O2
  • opiates
  • triptans, ergots, lidocaine
  • OMT
35
Q

cluster HA preventative

A
  • glucocorticoids, lithium
  • surgery
  • occipital nerve procedures
  • deep brain stimulation
  • OMT
36
Q

rebound headache - presentation

A
  • episode of HA
  • present upon awakening
  • transient relief with subsequent doses of analgesic
  • location, severity, and type of HA vary
37
Q

rebound headache - assoc symptoms

A
  • nausea
  • asthenia
  • difficulty concentrating
  • memory problems
  • irritability
38
Q

rebound headache - dx criteria

A
  • HA present >15days/month
  • reg use or overuse of pain meds for 3 mos
  • HA dev or worsened with cont use of meds
39
Q

rebound HA - higher risk with which meds?

A
  • opioids
  • butalbital containing combo analgesics
  • aspirin/acetaminophen + caffeine combo
40
Q

rebound HA tx

A
  • withdrawn offending meds

- bridge therapy - used to get through withdrawal period

41
Q

other considerations for secondary causes of HA

A
  • flu
  • tumor/cancer
  • aneurysm
  • meningitis
  • sleep apnea
42
Q

CC of HA, what PE should be included?

A
  • CN screening
  • pronator drift
  • rhomberg tests
43
Q

what OMT tech for acute HA?

A
  • gentle OMT

- avoid HVLA and other direct tech to avoid symp stimulation

OPP 2.1 (6 decks)

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