Cephalgia: aka headache Flashcards
cephalgia
headache
tension headache
- can range from infrequent –> chronic (15+ days/mos)
CNS- decreased pain/thermal/electrical threshold of CNS, leading to misinterpretation of info by CNS and overstimulation of CNS
PNS- increased muscle tenderness, increased active trigger points, forward head posture, decreased neck mobility
Diagnostic criteria for tension headaches
- bilateral head pain
- pain is steady
- intensity is mild to moderate
- no aggravation by normal daily activity
- pain lasts 30 minutes to 7 days
- caused by stress, muscle tension, workplace envionment, posture, structure or viscerosomatics
Theories for cause of migraine headaches
- dilation of vascularity in brain –> pain; constriction from vessel resulting in aura migraine
- cortical spreading depression: self propagating wave of deplarization in brain - altering blood brain barrier permeability
- trigemino-muscular: activation of trigeminal system - neuron that innervates vessels and dura
- Sensitization- neurons increase response to nociceptice input
Genetics and Migraines
- multifactorial inheritance patterns
- epigenetics may play a role
- more commonly passed on from mom
Prodrome
first phase before migraine headache: vegetative symptoms 24-48 hours before
- have affective or vegetative symptoms: can be euophoria, depression, irritability, food cravings, constipation, neck stiffness
The Aura
second stage of migraine headache
visual - loss of portion of the visual field
auditory - hear things that aren’t there, or lose hearing
olfactory - smell things that aren’t there
verbal - change in speech
Migraine headache: HA stage
Unilateral, throbbing, pulsatile pain
Intensity increases over the course of hours
Nausea/vomiting
Photo/phonophobia
Chills/sweating
Relief: Lying in a dark, quite room, Sleeping it off
Postdrome phase
last phase of migraine headaches:
- Movement of head causes pain that is transient
- Exhaustion
- Mild elation or euphoria can be present
Where should OMT be performed on migraine headaches?
Upper thoracic spine Upper Ribs Cranial Cervical – mostly upper Including OA and AA Abdomen Sacrum
Where should OMT treat for tension headache?
Upper thoracics Ribs Cervicals – especially C1 & C2 Cranial dysfunction – this includes TMJ Lumbar Sacrum Pelvis
two types of cluster headaches
- episodic: daily attacks for weeks with periods of remission (remission periods are weeks long)
- chronic: daily attacks with no signifiant periods of remission
cluster headaches
may involve pain around one eye, along with drooping of the lid, tearing and congestion on the sam side as the pain
Pathogenesis of cluster headaches
unknown
1. hypothalamic activation with secondary activation of trigeminal-autonomic reflex
Leads to pain
2. neurogenic inflammation of the wall of the cavernous sinus obliterates venous drainage
Leads to injury of sympathetic fibers traveling with internal carotid artery
clinical features of cluster headaches
- Attacks of severe orbital/supraorbital/temporal pain
- Restlessness and agitation
- Attacks up to 8 times a day which are short lived
- Unilateral: Always on same side during a single attack
Other symptoms: Ptosis Miosis Lacrimation Rhinorrhea Conjunctival injection Nasal congestion
Diagnostic criteria of cluster headaches
- At least 5 attacks
- Severe unilateral orbital/supraorbital/temporal pain lasting 15-180 mins if untreated
- Minimum frequency: One every other day for more than ½ the time for an attack period
- One or more other symptoms of Cluster HA
- No other possible cause of pain
100% O2 is one of the best treatments for patients
Medication overuse HA
- headache present more than 15 days a month, regular use of medication for 3 mos, headache continues with use of medication
- treat through withdrawing offending medication
- can give them a “bridge therapy”
Brain tumor headahce
most often mimics TTH, but can be worse unilaterally, when bending forward
tx for tension headache
NSAIDS, tyelnol, triptans, muscle relaxants, caffeine, butalbitol, OMT
what areas of body should be treated with OMT of tension headaches?
upper thoracics, ribs, C1, C2, cranial dysfunction (TMJ), lumbar, sacrum, pelvis
tx. for migraine HA
mild to moderate (no nausea or vomiting)
- NSAIDs, tyelonl, caffeine, OMT
moderate to severe - have nausea/vomitting
- triptans, sumatriptan, ergot alkaloids, opiates, barbiturates, OMT
tx for cluster HA
oxygen, triptans, octreotide (somatostatin), lidocaine, Ergots, OMT
clinical features of medication overuse HA
- frequent treatment of HA pain with analgesic
- pain present or starts when they wake
- transient relief occurs with more doses of analgesic (thus increasing the use of pain meds)
diagnostic criteria- HA must be present for more than 15 days a month, and patients must use/overuse pain medication for at least 3 mos. HA should have developed or worsened despite continued use of medication
when to send for imaging?
- abnormal findings on neuro exam
- HA that doesn’t fit a specific pic.
- rapidly increasing HA
- worst HA ever or “thunderclap” feeling.
- frontal HA that is worse when bending forward
