Headaches Flashcards

Question

Tension-type headache mechanism

Answer 1

Mechanism – muscle tension in neck, scalp or face due to stress, poor posture or overuse - Involves peripheral and central NS sensitization

Answer 2

- "pressure" or "tightness" - recurring bandlike pressing headache with some migraine features - rarely associated with nausea, phtophobia, or phonophobia - bilat, dull, non-throbbing, mild-mod pain - 82% said sx lasted less than 24hrs - 1/2 pts say stress or hunger as triggers

Answer 3

At least 10 previous headache (HA) episodes Occur on <180 days/year (for infrequent or frequent TTH) Headache duration: 30 minutes to 7 days At least 2 of the following 4 features: - Pressing or tightening (non-pulsating) quality - Mild to moderate intensity - Bilateral location - Not worsened by routine physical activity (e.g., walking stairs) Both of the following: - No nausea or vomiting - Either no photophobia and no phonophobia, or only one (not both)

Answer 4

Postural correction Ergonomic adjustments Relaxation and stress management STM, MFR, TrP release Stretching and strengthening of neck and upper back muscles

Answer 5

Severe unilateral pain due to activation of trigeminal-autonomic reflex Uncommon (< 1 in 1000) Prevalence = 6 men: 1 woman Onset = Ave age 30 y.o. (develops in the 20s)

Answer 6

smoking, alcohol use, high altitude exposure

Answer 7

Severe, brief attacks with frequent recurrence - Can occur multiple times per day Pain characteristics: - Burning, piercing, or neuralgic in nature - Often causes restlessness or agitation STRICTLY unilateral (one-sided) Attack duration: - Less than 3 hours (typically 15–180 minutes) Clustering pattern: - Occurs in bouts lasting ~1–2 months - 2/3 of patients have 1–2 clusters per year Location of pain: - Most commonly periorbital (around the eye) but also frontal and temporal areas most common sx: Ipsilateral lacrimation

Answer 8

alcohol and stress (relative insensitive feature)

Answer 9

Generally treated with pharmacologic agents PT may help with stress management Occasional use of manual therapy for relaxation and postural correction

Answer 10

Caused by chronic and excessive use of medication to treat HA MOST common 2 HA Affects up to 5% of some populations, women more than men

Answer 11

Cost effective medications Main drug classes: * Analgesics * Anti-emetics * Anti migraine medications * Prophylactic medications Simple lifestyle modifications Patient education

Answer 12

Fractures Dislocations Gross instabilities

Answer 13

Tumors Inflammatory disorders Infection Visceral referral VBI/CAI – esp. Dissection in progress.

Answer 14

Is there a Hx of head trauma? * Subdural or epidural hematoma; Fx; Upper C/S instability Was there a slow or insidious onset of a NEW HA? * Tumor; vascular event such as aneurysm Are there any neurological deficits? * Hematoma, tumor Does it occur only with exertion and is progressively worse? * Aneurysm Is there associated nuchal rigidity? * With fever = meningitis * Without fever = subarachnoid hemorrhage Is this a new temporal HA in an older person, especially if associated with vision deficit or trunk pain? - Temporal arteritis Have you ever been given new medication or discontinued use of a Rx med? * Rebound HA Have you recently stopped smoking, drinking coffee, drinking alcohol, or using “recreational” drugs? * Withdrawal Do HA’s occur after reading or has there been a change in eyeglass Rx? * Eye strain Are you exposed to toxic chemicals? * Toxins

Answer 15

Subarachnoid hemorrhage, vertebral artery dissection

Answer 16

Brain tumor, subdural hematoma

Answer 17

Worsening vascular HA’s, increasing intracranial pressure

Answer 18

drowsiness, confusion, loss of memory, focal neuro signs, fever

Answer 19

brain tumor

Answer 20

Brain tumor, subarachnoid hemorrhage

Answer 21

Presents as unilateral pain that starts in the neck. It is a common chronic and recurrent HA that usually starts after neck movement. It usually accompanies a decreased ROM of the neck

Answer 22

* Source of pain must be in the neck and perceived in the head or face * Evidence that the pain can be attributed to the neck * Pain resolves within 3 months after successful treatment of causative disorder or lesion

Answer 23

* Rare * Affects people 30-44 years * Age of onset early in 30s BUT age of seeking medical care = 49.4 years * Men and women affected equally * Pericranial muscle tenderness involved side (compared to other HA patients)

Answer 24

structures innervated by the C1-C3 spinal nerves and include the : * upper cervical synovial joints, ligaments * muscles of the sub-cranial spine * discogenic (C2-C3)

Answer 25

C1–C3 spinal nerves transmit pain to the trigeminocervical nucleus - This nucleus processes nociceptive signals from both neck and head Referred pain mechanism: - Neural connections between upper cervical nerves and trigeminal system may cause pain felt in the occiput and/or eyes Cervical disc pathology can trigger: - Aseptic inflammation - C-fiber neurotransmission - → Both contribute to exacerbation of CGH

Answer 26

neck trauma, WAD, strain, chronic spasm of scalp/neck/shoulder can increase sensitivity of the area => lower threshold for pain and result in more severe pain **Non traumatic risk factors**: DDD, DJD, poor posture, muscle imbalances

Answer 27

No specific pathology typically seen on imaging or diagnostic studies Lack of response to vasoactive migraine medications - Suggests no arterial involvement Key diagnostic clue: - Headache triggered by neck movement or external pressure on the neck Pain pattern helps differentiate from other headaches: - Unilateral pain without sideshift - initial pain in the occipital region - Does not meet criteria for other headache types (e.g., migraine, tension-type)

Answer 28

Estimates place CGH: 14-18% of chronic headaches 15-20% of recurrent headaches 70% headache sufferers complain of neck pain associated WITH their headache

Answer 29

Occiput and C1/2 hyperextend with the fattened lordosis - results in ↓craniocervical angle - results in ↑ Forward head posture (FHP) Tend to develop cervicogenic headache. - facet joints dysfunction leads to abnormal afferent information affecting the tonic neck reflex, then encourages gradual adaptation of FHP

Answer 30

compression of craniocervical structures including greater & lesser occipital nerves

Answer 31

* **Triggered by neck movements** * Pain spreading to the occipital region * Tenderness in the suboccipital tissues * Decreased cervical ROM * Unresponsiveness to typical HA medications

Answer 32

Manipulative maneuvers (e.g., spinal manipulation, mobilization) may: - Stimulate neural inhibitory systems within the spinal cord - Activate descending pain-inhibitory pathways This may help reduce pain perception and modulate central sensitization in CGH

Answer 33

Combined manual therapy/deep cervical flexor retraining Manual therapy to the cervical spine * AROM & PROM * Mobs and manipulation - Thoracic and cervical Specific retraining (strengthening)- deep neck flexors, cervical extensors, scapular stabilizers Postural education **Ergonomics Body mechanics**