Headache

Question 1

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

Answer 1

Upper cervical, trigeminal

Question 2

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

Answer 2

C2/C3

Question 3

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

Answer 3

Indomethacin

Question 4

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

Answer 4

Atlantoaxial (AA)

Question 5

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

Answer 5

Trigeminocervical nucleus

Question 6

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

Answer 6

Parasympathetic, greater petrosal

Question 7

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

Answer 7

Upper cross syndrome

Question 8

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 8

Subarachnoid hemorrhage Cervical artery dissection Meningitis/encephalitis, ICP, Acute angle closure glaucoma Epidural/subdural hematoma

Question 9

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

Answer 9

Greater occipital nerve

Question 10

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

Answer 10

Sphenopalatine ganglion

Question 11

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

Answer 11

Cervicogenic

Question 12

The throbbing during a migraine is due to ________.

Answer 12

Pulsation of arteries

Question 13

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

Answer 13

Cluster

Question 14

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

Answer 14

Tension-type

Question 15

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

Answer 15

Lifestyle changes, home exercises/stretching

Question 16

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 16

Pro-inflammatory

Question 17

The number one treatment for migraines is ________.

Answer 17

Avoidance of triggers

Question 18

One of the biggest triggers for migraines is ________.

Answer 18

Emotional stress

Question 19

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

Answer 19

Lacrimal, nasal mucosa

Question 20

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

Answer 20

Cervicogenic

Question 21

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

Answer 21

Chronic paroxysmal hemicrania

Question 22

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

Answer 22

Oxygen

Question 23

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 23

Increased sympathetics C1-C3 somatic dysfunction Elevated sphenoid bone (greater wing) Sphenosquamous compression Temporal bone somatic dysfunction Occipitomastoid compression