Head/Neck Flashcards
What are other common DD’s next to a HA/ Head pain?
- Upper respiratory tract infection
- Maxillary sinusitis
- TMJ dysfunction
- Anaemia
- Depression
- Dental disorders
- Visual disorders (refractive error, glaucoma)
- Exertional HA
- Trigem neuralgia
What are some serious conditions to consider when a suspected HA comes in?
- CAD
- Subarachnoid or intracranial hemorrhage
- Myocardial ischemia
- Hypertensive Crisis
- Keep in mind that interneurons link the solidary nucleus and trigeminal one
- Phaeocycotoma – tumor of the chromaffin cells
- Intra-cerebral tumor
- Meningitis
What are some other factors often missed when patients have HA’s?
- TMJ
- Refractive errors
- Glaucoma
- Dental disorder
- Trigeminal neuralgia
- Exertional – sex or exercise
- Depression
- Anemia
- Metabolic disorders- diabetes or thyroid
- Drugs
What are some drugs/chemicals that can lead to HA’s?
- Alcohol
- Caffeine
- Nicotine
- Analgesics (rebound headaches) – aspirin, codeine, paracetamol
- Antibiotics
- Combined COOP
- Vasodilators
HA Who am I:
S: unilateral
Q: pulsating quality
I: moderate to severe
R: Vision, senses and motor system
T: last minutes, recurrent
N: tingling in the hands and feet, vertigo, ringing in ears, double vision
Aggravating factors: medication, lack of sleep, bright louds, loud sounds, certain foods, hunger or dehydration
Relieving factors: medication, manual medicine.
Migraine with Aura
How are migraines with Aura diagnosed (criteria)?
- Aura symptoms: visual, sensory, speech and/or language,
- Atypical Aura symptoms: motor, brainstem, retinal
- 5 HA’s to be diagnosed
- Aura symptoms can last up to 1 hr
- Fully reversible
Suspected Aetiology of migraine with Aura
It’s believed that the migraine with visual aura is like an electrical or chemical wave that moves across the part of your brain that processes visual signals (visual cortex) and causes these visual hallucinations. Many of the same factors that trigger migraines are responsible for triggering migraines with aura, including stress, bright lights, some foods and medications, too much or too little sleep, and menstruation.
What are the three pathophysiological theories of migraines?
- Vascular dysregulation – issue to do with vasoconstriction to the brain ischemia causing the aura and vasodilation is the pounding and pulsating (old)
- Spreading cortical depression – self prorogating depolarizing wave in their brain (also gone to back burner)
- Neuronal sensitization – both peripheral and central mechanisms are likely involved with the trigeminocervical nucleus. Having issues with pain modulation pathways and nociception activation (popular theory)
What is the suspected mechanism for feeling pain in the head, scalp and face during a HA?
Convergence of the spinal trigeminal nucleus which also supplies that meningitis (tunica adventitia), scalp and face
What are some endogenous factors that can precipitate a migraine?
hormonal changes, psychosocial stress, sleep deficit or surplus, hunger, exertion
What are some exogenous factors that can precipitate a migraine?
certain kinds of food; stimulation of different sensory modalities (ie smells/perfume)
HA Who am I:
S: Unilateral pain (strictly unilateral), can be a combination or one of the following sites: orbital, supraorbital, temporal
Q: intense, never-ending
I: 8-10/10, dependant on person on pain scales, pain will be severe
R: Pain can refer to other areas of the head, in particular in pathway of the trigeminal nerve
T: Attacks from 1-8 times a day, attack itself occurs for 15-180 minutes
N: autonomic symptoms ipsilateral to pain
Cluster HA
What are some associated features of a cluster HA?
- Restless and agitated
- Ipsilateral conjunctival injection (blood vessels in the eye are dilated)
- Lacrimation (tears)
- Nasal congestion
- Rhinorrhoea (runny nose)
- Sweating – face and forehead particularly
- Miosis
- Ptosis
- Eyelid odema
HA Who am I:
• Bilateral pain
• Pressing/tightening quality
• Mild – moderate intensity
• Lasts minutes – days
• Pain doesn’t worsen with physical activity
• Photophobia or phonophobia may not be present
TTH
HA Who am I:
• side-locked pain
• provocation of typical headache by digital pressure on neck muscles and by head movement
• posterior-to-anterior radiation of pain
• Migrainous features such as nausea, vomiting and photo/phono phobia may be present, although to a generally lesser degree
• Tendency to become chronic
Cervicogenic HA
What are some extra-cranial causes of intracranial pressure?
- Fracture of the cranium
- Haemorrhage in subdural, epidural or subarachnoid space
- Infections of the meninges
- Onset of the neurological symptoms delayed- depends on pathology
What is meningitis?
Infection of the lining tissues of the brain
What are some signs and symptoms of meningitis?
- Headache -severe
- Neck pain
- Vomiting
- Drowsiness, difficult to wake
- Confusion and irritability
- Severe muscle pain
- Pale, blotchy skin- spots/ Rash
- Severe headache
- Stiff neck
- Dislike bright lights
- Convulsion/seizures
- Confusion- very big factor
- Positive brudzonki sign
- Positive kernig sign
What is cervical myelopathy?
A serious and disabling condition arising from cervical cord compression
What degenerative changes can lead to cervical myelopathy?
- Osteophyte encroachment in the central (+/- lateral) canal
- Disc calcification and loss of disc height
- Ligamentous buckling (LF) or ossification (PLL)
Clinical features present in cervical myelopathy?
Onset of symptoms is usually insidious:
•Hypersensitivity and clumsiness in the hands and feet
•“Tightness” in the legs (spasticity)
Initially subtle, but UMN signs predominate below the level of the lesion:
•Hyperreflexia, clonus, Babinski sign (sometimes asymmetrical)
•Weakness, ataxia
The clinical picture may be complicated by:
•Radiculopathy, if there is lateral canal stenosis at the level of the lesion
•Dorsal column involvement
•Low back pain, leg pain
What is a whiplash associated disorder?
An acceleration-deceleration mechanism of energy transfer to the neck
Clinical features of a whiplash associated disorder?
- Tinnitus, deafness
- Visual problems, dizziness
- TMJ pain, Dysphagia
- Depression, anxiety, sleep disturbance, memory loss
What is thoracic outlet syndrome?
Compression of brachial plexus and subclavian vessels due to entrapment at the scalenes, clavicle/1st rib and pectoralis minor muscle
