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OPP II > Cephalgia - SS > Flashcards

Cephalgia - SS Flashcards

1
Q

What are the primary types of headaches?

A

–Tension-Type (TTH)
–Migraine
–Cluster

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2
Q

What are the secondary types of headaches?

A

–Rebound
•Medication (OTC) overuse
–Manifestation of other

diseases

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3
Q

What is the most common precipitating factor for TTH? What are other causes?

A
  1. Stress and mental tension
  • Head and neck movements and postures
  • Anxiety and depression
  • Fatigue
  • Structural Abnormalities
  • Viscerosomatics
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4
Q

What happens to a persons body who sits at work regularly?

A

–The upper neck bends backwards causing the suboccipital muscles to tighten
–Pectoralis minor muscle subsequently tightens
–Trapezius fibers weakened or atrophy

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5
Q

What are the seven pain sensitive structures in the head?

A
  1. •Skin and its blood supply
  2. •Muscles of the head and neck
  3. •Venous sinuses and their tributaries
  4. •Parts of the dura mater – base of the brain
  5. •Dural arteries
  6. •Intracranial arteries
  7. •Cranial nerves
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6
Q

What are the two pain mechanisms for tension type headaches?

A

Peripheral pain mechanism

Central pain mechanism

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7
Q

Describe the peripheral pain mechanism of TTHA.

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
–Central mechanism for episodic TTH (<15 days a month)

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8
Q

Describe the central pain mechanism of TTHA.

A

–Increased facilitation of cranial structures
–Decreased inhibition of pain transmission at the level of the spinal dorsal horn/trigeminal nucleus
–Altered brainstem reflexes suggest abnormal limbic controlled pain systems
–Mechanism for chronic TTH (>15 days a month)

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9
Q

What is pain above the tentorium referred by?

A

Trigeminal nerve

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10
Q

Where is pain referred by the trigeminal nerve percieved?

A

•Pain is perceived in the frontal, temporal and parietal regions of the head

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11
Q

What is pain below the tentorium referred by?

Where is it percieved?

A
  • Pain is referred by the glossopharyngeal, vagus and upper cervical spinal nerve roots
  • Pain is perceived in the occipital region
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12
Q

What types of behavior mods can help with TTHA?

A
  • Education about postural mechanics
  • Getting correct footwear
  • Tension relief exercises
  • Stress management/counseling
  • Smoking cessation
  • Medication
  • Ensuring vision is corrected if necessary
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13
Q

What workplace adjustments are helpful for TTHA?

A
  • Computer screen needs to be raised to eye level to promote good posture
  • Address chair height!
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14
Q

What are some good tx’s for TTHA?

A
  • Acupuncture
  • PT
  • OMT
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15
Q

What are the exercises that are useful for TTHA?

A
  • Scapular stabilization
  • Trapezius strengthening
  • Pectoralis minor stretches
  • Sternocleidomastoid and scalene stretches
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16
Q

What is the prodrome period? What are the symptoms?

A

–Affective or vegetative symptoms 24-48 hrs before
•Euphoria
•Depression
•Irritability
•Food cravings
•Constipation
•Neck stiffness

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17
Q

What is the Aura period? What are the common presentations?

A

–Seen in a classic migraine
–Visual, auditory, or olfactory hallucinations
•Visual is the most common
–Scotomas are blind spots in the visual field
–Photopsia are dashing lights
–Vertigo
–Paresthesias

18
Q

What are the symptoms of a migraine headache? What brings relief?

A

–U/l, throbbing, pulsatile pain
•Can radiate to the opposite side
–Intensity increases over the course of hours
–Nausea, vomiting, diarrhea
–Vertigo/dizziness
–Tremors
–Chills/sweating
–Photo/phonophobia
–Relief
•Lying in a dark room, quiet room
•Sleeping it off

19
Q

Describe the postdrome period of a migraine HA

A

–Movement of the head causes pain transiently
–Exhaustion
–Mild elation or euphoria

20
Q

What are common triggers of migraines?

A

•May be triggered by:
–Head injury or other trauma
–Emotional stress
–Hormonal stress
•Women are particularly susceptible during menses
–Fasting
–Changes in weather or temperature
–Oversleeping or undersleeping
–Physical stimuli
•Smoking, caffeine or alcohol
–Vasoactive substances in food
•Wine, cheese, cold foods
–Strong odors or lights
•The flicker speed of computers
–Neck pain

21
Q

When does the initial migraine episode usually present?

A

•Initial episode most often occurs during puberty
–But can occur at any age between 5-40 yrs

22
Q

What is the name of CN V?

A

Trigeminal nerve

23
Q

What are the projections of CN V?

A

–3 branches to the face – responsible for the u/l pain
–Meningeal vessels - responsible for vasoconstriction/dilation
–Dura

24
Q

What is the pathophys of migraines?

A

•Trigger -> sensitization of CN V nucleus
–Connection unknown

25
Q

What are cluster headaches a type of?

A

•Type of trigeminal autonomic cephalgia (TAC)

26
Q

What are some components of cluster headaches?

A
  • Diagnosis is clinical and unmistakable
  • Severe unilateral orbital/supraorbital/temporal pain
  • Attack happens at around the same time each day
  • Pain lasts 15 min – 3 hrs if untreated
  • Average of 8-10 wks/yr
  • Hx of at least 5 attacks
  • In 50% of pts its onset is nocturnal
  • One or more other symptoms of a cluster HA
  • No other possible cause of the pain
27
Q

What are the two theories behind cluster HA?

A

•Theory 1
–Hypothalamic activation with secondary activation of trigeminal-autonomic reflex
•Theory 2
–Neurogenic inflammation of the wall of the cavernous sinus obliterates venous drainage
–Leads to injury of sympathetic fibers traveling with internal carotid artery

28
Q

What do you always want to ask someone about who has cluster headaches?

A

Suicide ideation

29
Q

Why do you want to do neuroimaging for cluster headaches?

A

Higher rate of pituitary tumors associated

30
Q

What is a rebound headache also known as??

A

Medication overuse headache

31
Q

What is the diagnostic criteria for rebound headache?

A

–HA present more than 15 days a month
–Regular use or overuse of pain medication for at least 3 months
–HA developed or worsened with continued use of medication

32
Q

What are the treatments for rebound headaches?

A

•Withdrawn the offending medication
–May cause withdrawal symptoms
–HA will get worse for a period of time after removal
•Then it will get better
•Bridge therapy
–Used to get them through the withdrawal period
–Bridging agents
•Naproxen, Tizanidine + NSAID, Glucocorticoids, Ergots, Prochloperazine, Lidocaine, Valproate, Aspirin
•OMT

33
Q

If you have a chief complaint of a HA the physical exam should include what???

A

–Cranial nerve screening (II-XII)
–Pronator drift and Rhomberg tests

34
Q

What are some indications for imaging studies?

A

•Abnormal or unexplained findings on neurologic exam
•HA that doesn’t fit the clinical picture of any one HA type in particular
•HA in the setting of other diseases
–Ie. Immune deficiency, h/o malignancy, CAD, HTN
•Sudden onset of “worst HA of their lives” or “thunderclap”
–Think aneurysm in the Circle of Willis
•H/o awakening from sleep due to HA
•Rapidly increasing frequency of HAs
•Frontal HA that is worse when leaning forward
–Primarily in children

35
Q

Describe brain tumor headaches.

A

–Most often mimics TTH, but can be worse u/l, when bending forward, and/or ax. w/ nausea and vomiting
–48% of brain tumors have HA as a symptom during the course of the disease

36
Q

In HA treatment, what would we use upper thoracic and rib treatment to accomplish?

A

Balance autonomic tone

37
Q

Why do we address cervical dysfunction with OMT for HA?

A

–Eliminate cervical strain and

soft tissue tension involved in exacerbating

the pain

–Address suboccipital dysfunction
–C1 and C2 can affect the superior cervical ganglion

causing a hypersympathetic tone intracranially

38
Q

Why would we treat TMJ?

A

–Eliminate cranial strain patterns affecting the trigeminal neurovascular system

39
Q

Why treat the abdomen for HA?

A

–Diaphragmatic restriction affects the sympathetic chain from L2-T5
–Restriction in the mesenteric ganglion can contribute to hypersympathetic tone

40
Q

Why treat the lumbar, sacrum and pelvis for HA?

A

–Eliminate compensatory or contributing strain patterns from below

41
Q

Why is it important to address postural mechanics for HA?

A

–To reduce exacerbating factors
–Core strengthening, scapular stabilization, proprioceptive training

42
Q
A

OPP II (9 decks)

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