Headache

Question 1

The second most common source of cervicogenic headaches is the ________joint.

Answer 1

Atlantoaxial (AA)

Question 2

Migraines are thought to be due to a release of ________ molecules that lead to vasodilation of intracranial arteries, which in turn triggers nociceptive fibers.

Answer 2

Pro-inflammatory

Question 3

The number one treatment for migraines is ________.

Answer 3

Avoidance of triggers

Question 4

There are a number of osteopathic considerations for the cause of migraines. They are:

________ (causes vasoconstriction and decreased cerebral blood flow)

________ (causing a nerve reflex to the trigeminal spinal nucleus)

________ (causing pressure on the dura and trigeminal neve)

________ (compromising the middle meningeal artery)

________ (causing reflex vasodilation of the internal and external carotids)

________ (causing decreased venous drainage through the jugular foramen)

Answer 4

Increased sympathetics

C1-C3 somatic dysfunction

Elevated sphenoid bone (greater wing)

Sphenosquamous compression

Temporal bone somatic dysfunction

Occipitomastoid compression

Question 5

The throbbing during a migraine is due to ________.

Answer 5

Pulsation of arteries

Question 6

One of the biggest triggers for migraines is ________.

Answer 6

Emotional stress

Question 7

The sphenopalatine ganglion (via other nerve pathways) is responsible for innervating ________ gland and the ________.

Answer 7

Lacrimal, nasal mucosa

Question 8

The anatomical locus for cervicogenic headaches is the ________ in the upper cervical spinal cord.

Answer 8

Trigeminocervical nucleus

Question 9

Chronic paroxysmal hemicrania can be differentiated from cluster headaches in that it responds absolutely to ________, whereas cluster headaches do not.

Answer 9

Indomethacin

Question 10

Tension type headaches may be due to biomechanical issues. In particular is ________, which is commonly seen in students and office workers.

Answer 10

Upper cross syndrome

Question 11

The intersection of the ________ and the ________ sensory pathways allows for bidirectional transmission of pain signals between the neck and the face/head.

Answer 11

Upper cervical, trigeminal

Question 12

The largest contribution to the sphenopalatine ganglion is the ________ root, which comes mainly from the ________ nerve.

Answer 12

Parasympathetic, greater petrosal

Question 13

The most frequent source of cervicogenic headaches is the ________ zygopophyseal joint.

Answer 13

C2/C3

Question 14

An anatomical structure that is considered in Osteopathic treatment of cluster headaches is the ________.

Answer 14

Sphenopalatine ganglion

Question 15

One of the best therapies for cluster headaches is ________ therapy.

Answer 15

Oxygen

Question 16

Due to OMT being indicated for facet-mediated pain and myofascial pain, it is very useful for treating ________ headaches.

Answer 16

Cervicogenic

Question 17

Red flags for headaches:

“Thunderclap” headache or “worst headache of my life” = ________

Acute neck pain with Horner syndrome = ________

Fever, altered mental status, and +/- nuchal rigidity = ________

Headache with focal neurologic deficit, or papilledema = ________

Headache with visual impairment, periorbital pain, or ophthalmoplegia = ________

Headache secondary to head trauma = ________

Answer 17

Subarachnoid hemorrhage

Cervical artery dissection

Meningitis/encephalitis

Increased intracranial pressure

Acute angle closure glaucoma

Epidural/subdural hematoma

Question 18

Treatments for tension-type headaches include ________ and ________, and are generally conservative.

Answer 18

Lifestyle changes, home exercises/stretching

Question 19

A nerve commonly affected in tension-type headaches is the ________.

Answer 19

Greater occipital nerve

Question 20

There is NO male predominance in ________, unlike cluster headaches.

Answer 20

Chronic paroxysmal hemicrania

Question 21

Headaches that are non-throbbing, with tightness in a “band-like” distribution around the head are classified as ________.

Answer 21

Tension-type

Question 22

Swollen or droopy eye, miosis, reddened conjunctiva, tearing, and nasal discharge/congestion are all symptoms of a ________ headache.

Answer 22

Cluster

Question 23

Unlike tension-type headaches, ________ headaches are unilateral and are typically a result of articular dysfunction.

Answer 23

Cervicogenic