headache

Question 1

what are most headaches?

Answer 1

mixed tension type and migraine

Question 2

primary headache

Answer 2

90% of HAs
- not the result of underlying disease process

Question 3

migraine

Answer 3

unilateral throbbing HA lasting several hours
- preceded by aura & often associated with systemic sx

Question 4

tension-type HA

Answer 4

most frequent type
- bilaterally, pressing/tightening, occipital

Question 5

cluster HA

Answer 5

rare, severe vascular syndrome, cause unknown
- periorbital, occurs daily at similar timeframe for weeks only

Question 6

secondary HA

Answer 6

could be result of serious underlying dz
- rare but may require urgent diagnosis & tx
- won’t resolve until addressed
-infection, substance induced, trauma, vascular, homeostasis disorder, psych

Question 7

red flags during HPI

Answer 7

• worst HA ever
• change in regular HA pattern
• worsening over days or weeks
• thunderclap HA
• onset after age 55

Question 8

trigeminal system

Answer 8

• primary nociceptive & defensive system for face & cranium
• trigeminocervical nucleus = essential nociceptive nucleus of the head, throat & upper neck, descends to upper levels of spinal cord

Question 9

C1-C3 spinal nerves

Answer 9

C1 = sensory to suboccipital muscles
C2 = superficial posterior muscle of neck / greater occipital nerve
C3 = lies in C2-3 intervertebral foramen, longissimus & splenius

• ventral rami join with C4 to form cervical plexus

Question 10

cervicogenic HA

Answer 10

benign HA
- unilateral, radiating pain in neck or suboccipital area referring to fronto-temporal region
- pain info sent to upper cord via C1-2
- perception of pain in cutaneous region of CN V

Question 11

viscerosomatic (VSR)

Answer 11

sensory input from visceral causes activity in somatic structure
- ex: pain & mm tightness in L shoulder with onset of MI

Question 12

viscero-visceral (VVR)

Answer 12

sensory input from visceral structure causes activity in visceral organ
- distention of gut = contraction of gut mm

Question 13

somato-somatic (SSR)

Answer 13

sensory input from somatic structure causes activity in somatic structure
- defensive withdrawal actions

Question 14

somato-visceral (SVR)

Answer 14

sensory input from somatic structure causes activity in visceral organ
- somatic stim travels up cord to brainstem

Question 15

chronic sinusitis

Answer 15

pain through CN V
- sphenoidal sinus = vertex HA
- ethmoidal sinus = orbital HA
- maxillary sinus = alveolar ridge/teeth pain
* CN V = tooth pain in absence of tooth pathology
* CN IX & X = nausea
* C1-3 = TART of suboccipital mm, paraspinal mm

Question 16

intracranial space occupying lesion

Answer 16

• brain parenchyma doesn’t have pain Rs
• inc pressure from growing space occupying lesions presses on dura
• metabolic chemicals irritate dura

Question 17

roles & goals of OMT

Answer 17

1. reduce or eliminate somatic component of reflex loop
   - interrupt reflex cycle
   - improve function to reduce pain hopefully
2. restore free & balanced motion for MSK
3. improve motion of diaphragms & rib cage
4. restore balance b/n SNS & PNS
5. promote energy conservation

Question 18

useful OMT for headaches

Answer 18

1. cervical soft tissue
2. suboccipital release
3. lymphatic pumps
4. cervical MET, HVLA, CS

Question 19

cervicogenic HA tx

Answer 19

OA, AA, C2 segments
suboccipital & paraspinal mm
postural retraining, stress recognition, relaxation exercises

Question 20

chronic sinusitis tx

Answer 20

• pharm management
• address upper cervical segments, autonomics, lymphatics

Question 21

brain metastasis tx

Answer 21

no OMT until full evaluation