Cephalgia Flashcards
types of headaches: primary
- tension-type
- migraine
- cluster
types of headaches: secondary
- rebound (OTC overuse)
- manifestation of other diseases
what should be asked in hx to help classify the HA?
- birth hx
- any OTC for pain?
- any new meds?
- change in social hx?
- hx of trauma
- surgical hx
tension-type headache: how long does pain usually last?
30 min to 7 days
tension-type headache: how is the pain described?
- fullness, tightness, pressure in head
- pain b/l
- band-like, dull, tight cap feeling around head
- tightness often found in suboccipital area
tentions-type headache: how is the pain rated?
- mild to mod
- non-throbbing
- steady - not aggravated by normal daily activities
tension-type headache: assoc sx
- peripheral mm tenderness
- neck and shoulders
- constant or worsen with actual HA pain
- correlated with frequency and intensity of HA pain
- palpation illicit pain - sleep issues
TTH pathogenesis
body’s response to stress
- stress and mental tension
- head and neck mvmts and postures
- anxiety and depression
- fatigue
- structural abnormalities
- viscerosomatics
TTH pathophysio - peripheral pain mech
- 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)
TTH pathophysio - central pain mech
- 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)
TTH pathophysio - above tentorium membrane in pain referral pathways
- pain referred by CN V
- pain perceived in front, temporal, parietal regions
TTH pathophysio - below tentorium membrane in pain referral pathways
- pain referred by CN IX, X, and upper cervical spinal nerve roots
- pain perceived in occipital region
TTH tx
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
TTH prophylaxis
- behavior mod
- workspace adjustments
- tx
- exercises
migraine HA presentation - prodrome
symptoms that occur 24-48 hours before migraine:
- euphoria
- depression
- irritability
- food cravings
- constipation
- neck stiffness
migraine HA presentation: aura
- seen in classic migraine
- visual, auditory, or olfactory hallucinations (visual most common - scotomas and photopsia)
- vertigo
- paresthesias
migraine HA presentation: headache
- u/l, throbbing, pulsaltile pain
- can radiate to opp side
- intensity increases
- relief from lying in dark, quiet room and sleeping it off
migraine HA presentation: postdrome
- mvmt of head causes pain transiently
- exhausation
- mild elation or euphoria
migraine HA pathogenesis
- initial episode occurs during puberty
- triggered by many things
migraine HA pathophysio - genetics
- epigenetics
- more commonly passed on from mother
- defects in voltage gated Ca2+ channel or Na-K ATPase channel
migraine HA pathophysio - psychiatric problems
- depression
- bipolar
- anxiety
- insomnia
- somatoform disorders
- boderline personality disorder
- narcissistic personality disorder
migraine pathophysio - which CN causes it?
CN V nucleus
- 3 branches to the face - u/l pain
- meningeal vessels - vasoconstriction/dilation
- dura
migraine pathophysio - which NT is thought to be involved?
serotonin
- use of triptans (sertonin agonists) effective in abortive therapy
migraine HA tx
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
migraine HA prophylatics therapies
- surgery
- adjusting one’s environ to avoid triggers
- OMT
general cluster HA - which nerve involved?
trigeminal autonomic cephalgia (TAC)
- short-lasting, u/l, severe attacks primarily within V1 distrib
- parasymp hyperactive
- symp impaire
cluster HA dx criteria
- 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
cluster HA - common symptoms
- severe orbital, supraorbital, temporal pain
- strictly u/l
- restlessness and agitation
- rocking or rubbing their head for relief
cluster HA - how often does HA occur?
up to 8x/day
cluster HA - other symptoms driven by which autonomic?
PS
- ptosis
- miosis
- lacrimation
- rhinorrhea
- conjunctival injection
- nasal congestion
cluster HA - what 2 forms can a patient have?
- episodic form - rhythmic attacks with periods of remission
- chronic form - no remission
cluster HA pathophysio - theory 1
hypothalamic activation with secondary activation of trigeminal-autonomic reflex
cluster HA pathophysio - theory 2
neurogenic inflamm of the wall of the cavernous sinus obliterates venous drainage –> injury of symp fibers traveling with internal carotid artery
cluster HA tx
acute/abortive
- 100% O2
- opiates
- triptans, ergots, lidocaine
- OMT
cluster HA preventative
- glucocorticoids, lithium
- surgery
- occipital nerve procedures
- deep brain stimulation
- OMT
rebound headache - presentation
- episode of HA
- present upon awakening
- transient relief with subsequent doses of analgesic
- location, severity, and type of HA vary
rebound headache - assoc symptoms
- nausea
- asthenia
- difficulty concentrating
- memory problems
- irritability
rebound headache - dx criteria
- HA present >15days/month
- reg use or overuse of pain meds for 3 mos
- HA dev or worsened with cont use of meds
rebound HA - higher risk with which meds?
- opioids
- butalbital containing combo analgesics
- aspirin/acetaminophen + caffeine combo
rebound HA tx
- withdrawn offending meds
- bridge therapy - used to get through withdrawal period
other considerations for secondary causes of HA
- flu
- tumor/cancer
- aneurysm
- meningitis
- sleep apnea
CC of HA, what PE should be included?
- CN screening
- pronator drift
- rhomberg tests
what OMT tech for acute HA?
- gentle OMT
- avoid HVLA and other direct tech to avoid symp stimulation
