headache Flashcards
what are most headaches?
mixed tension type and migraine
primary headache
90% of HAs
- not the result of underlying disease process
migraine
unilateral throbbing HA lasting several hours
- preceded by aura & often associated with systemic sx
tension-type HA
most frequent type
- bilaterally, pressing/tightening, occipital
cluster HA
rare, severe vascular syndrome, cause unknown
- periorbital, occurs daily at similar timeframe for weeks only
secondary HA
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
red flags during HPI
- worst HA ever
- change in regular HA pattern
- worsening over days or weeks
- thunderclap HA
- onset after age 55
trigeminal system
- 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
C1-C3 spinal nerves
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
cervicogenic HA
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
viscerosomatic (VSR)
sensory input from visceral causes activity in somatic structure
- ex: pain & mm tightness in L shoulder with onset of MI
viscero-visceral (VVR)
sensory input from visceral structure causes activity in visceral organ
- distention of gut = contraction of gut mm
somato-somatic (SSR)
sensory input from somatic structure causes activity in somatic structure
- defensive withdrawal actions
somato-visceral (SVR)
sensory input from somatic structure causes activity in visceral organ
- somatic stim travels up cord to brainstem
chronic sinusitis
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
intracranial space occupying lesion
- brain parenchyma doesn’t have pain Rs
- inc pressure from growing space occupying lesions presses on dura
- metabolic chemicals irritate dura
roles & goals of OMT
- reduce or eliminate somatic component of reflex loop
- interrupt reflex cycle
- improve function to reduce pain hopefully - restore free & balanced motion for MSK
- improve motion of diaphragms & rib cage
- restore balance b/n SNS & PNS
- promote energy conservation
useful OMT for headaches
- cervical soft tissue
- suboccipital release
- lymphatic pumps
- cervical MET, HVLA, CS
cervicogenic HA tx
OA, AA, C2 segments
suboccipital & paraspinal mm
postural retraining, stress recognition, relaxation exercises
chronic sinusitis tx
- pharm management
- address upper cervical segments, autonomics, lymphatics
brain metastasis tx
no OMT until full evaluation
