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Principles VI > Headaches > Flashcards

Headaches Flashcards

1
Q

What are the different types of headaches? (8)

A

1) Vascular
2) Neurological
3) Traumatic
4) Myogenic
5) Cervicogenic
6) Miscellaneous
7) Metabolic
8) Toxic

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2
Q

What are the life threatening causes of headache? (11)

A

1) CNS Infection: Meningitis, Encephalitis
2) Brain Tumor or Abscess
3) Subarachnoid Hemorrhage
4) Subdural Hematoma
5) Epidural Hematoma
6) Temporal Arteritis
7) Stroke or TIA
8) Rx reaction
9) Allergic reactions
10) Hypo/hypertension
11) Hypo/hyperglycemia

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3
Q

What are 5 quick screening questions for serious pathologY/

A
  1. Is the headache of recent onset (< 6 months)?
  2. Is there any progression in the frequency or
    severity of the headaches?
  3. Was the onset sudden and severe?
  4. Are there any clues suggesting hard neurologic
    signs associated with the headaches?
  5. Are there any cognitive changes associated with
    the headaches (e.g., memory, confusion, personality)?
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4
Q

What is a treatment trial for a cervicogenic headache?

A

8-16 visits over 3-6 weeks

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5
Q

What will a physical exam finding of altered mental status cause consideration for?

A

Intracranial lesion (e.g., stroke, tumor)

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6
Q

What will a physical exam finding of Meningeal signs cause consideration for?

A

Meningits, stroke

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7
Q

What will a physical exam finding of positive “jolt” test cause consideration for?

A

Meningtis

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8
Q

What will a physical exam finding of focal neurologic signs cause consideration for?

A

Intracranial lesion (e.g., stroke, tumor)

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9
Q

What will a physical exam finding of a rash cause consideration for?

A

Lyme disease, Rocky Mountain spotted fever,

meningococcemia

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10
Q

What will a physical exam finding of change in vision cause consideration for?

A

Glaucoma, optic neuritis, vertebral artery dissection,
intracranial lesion, post-traumatic headache,
temporal arteritis, CVA, idiopathic intracranial
hypertension

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11
Q

What will a physical exam finding of fever cause consideration for?

A

Infection (CNS vs. systemic)

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12
Q

What will a physical exam finding of double vision cause consideration for?

A

Intracranial mass, idiopathic intracranial
hypertension, post- traumatic headache, dissecting
aneurysm

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13
Q

What will a physical exam finding of altered ptosis, miosis consideration for?

A

Carotid artery dissection

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14
Q

What will a physical exam finding of altered Horner’s Syndrome consideration for?

A

Space occupying lesion

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15
Q

What will a physical exam finding of papilledema consideration for?

A

Mass lesion, optic neuritis, pseudotumor

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16
Q

What will a physical exam finding of dilated pupil consideration for?

A

Aneurysm compressing third cranial nerve

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17
Q

What indication would warrant an emergent MRI?

A

“Thunderclap” HA with abnormal neuro

exam

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18
Q

What imaging would be done with an isolated thunderclap HA?

A

Consider referral for CT;
abrupt onset HA has +LR
2.5 for intracranial lesion

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19
Q

What imaging would be done with a New onset if high risk for intracranial
disease (e.g., HIV positive, prior CA)

A

Consider MRI or CT

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20
Q

What imaging would be done with a abnormal neuro exam (e.g.,
papilledema, unilateral loss of sensation,
weakness, hyper-reflexia)?

A

Consider MRI or CT, +LR
4.21 for intracranial
lesion

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21
Q

What imaging would be done with a with HA with fever or nuchal rigidity

A

MRI or CT

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22
Q

What imaging would be done with a with Progressively worsening HA?

A

MRI or CT

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23
Q

What imaging would be done with a with Change in character of the HA

A

Consider MRI, +LR 2.0

for intracranial lesion

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24
Q

What imaging would be done with a with Persistence despite analgesics/course of
treatment

A

X-ray or MRI or CT

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25
Q

What imaging would be done with a with Suspected intracranial lesion?

A

MRI or CT (head)

26
Q

What imaging would be done with a with Suspected subarachnoid
hemorrhage or subdural
hematoma

A

MRI or CT (head), spinal tap

27
Q

What imaging would be done with a with temporal arteritis.

A

Biopsy

28
Q

What imaging would be done with a Suspected meningeal

infection

A

MRI or CT (head), spinal tap

29
Q

What are some characteristics of a cluster headache? (5)

A

1) Severe
2) Eye symptoms
3) Strictly unilateral
4) Swarms 15 mins-3 hours,
1-8 times the same day
5) Conjunctival injection,
lacrimation, nasal
congestion, rhinorrhea,
facial sweating, miosis &
ptosis (partial Horner’s
syndrome)

30
Q

What are some characteristics of migraine headaches?(4)

A 
1) Two or more headaches in the
previous three months
2) Pulsatile, Unilateral with shifts
3) Severe enough to limit “life”
4) Two of theses are true:
- Has a headache limited your
activities for a day or more in
the last three months?
- Nauseated
- Photophobia
31
Q

What are some characteristics of tension headaches? (6)

A

1) 10 or more episodes fulfilling ALL of the following criteria:
2) Lasts from 30 minutes to 7 days
> 2 of the following characteristics:
3) Quality of pain is pressing/tightening, but not
pulsating
4) Severity is mild to moderate (inhibiting, but
not prohibiting)
5) Location is bilateral (although unilateral forms
occur)
6) Aggravating factors—no aggravation with
walking stairs or similar activities

32
Q

Which two headache conditions may overlap and have a mix of the two types of headaches?

A

tension & cervicogenic

33
Q

What are the key differentiating features suggesting CGH?

A 
1) Provocation of the headache symptoms by
mechanical pressure and/or continuous
backward tilting of the head
2) Limitation in movement of the neck
3)Non-radicular, ipsilateral diffuse
shoulder/arm pain
34
Q

What does a long duration headache favor?

A

Long duration favors CGHA

35
Q

What are some cervicogenic headache associated symptoms?

A

Autonomic reactions: (less severe than migraines)

1) Nausea
2) Vomiting
3) Ipsilateral edema & periocular flushing
4) Dizziness
5) Phonophobia OR photophobia
6) Blurred vision in ipsilateral eye
7) Difficulty swallowing

36
Q

Which headache shifts from side to side,
either during the headache
or from episode to episode?

A

Migraine

37
Q

Which headache stays on one side,
either during the headache
or from episode to episode?

A

Cervicogenic headache

38
Q

If the headache starts in the neck what is usually the cause?

A

If it starts in the neck first,
cervicogenic headache or a
myofascial pain syndrome is more likely.

39
Q

If a headache is bilateral and one side consistently hurts more than the other what type of headache is it?

A

If one side is dominant,
cervicogenic headache remains in
the differential

40
Q

What are some muscles that can refer pain in the form of a headache (6)

A

1) Upper cervical multifidus
2) Semispinalis capitus
3) Longisimus capitus
4) Splenius capitus
5) Trapezius
6) SCM

41
Q

Where does C0-1 refer pain to?

A

1) Laterally to the ear

2) Posteriorly to the occiput

42
Q

Where does C1-2& C2-3 refer pain to?

A

Suboccipitals
Jaw
Eye
Right temple

43
Q

Where does C2-3 refer pain to?

A

Above the eye and the inferior ridge of the TMJ

44
Q

What is the sphenomandibularis muscle?

A 
1) A 5th muscle of
mastication found in
1996
2) Previously thought to
be part of the
Temporalis muscle
3) Anatomical connection
from the jaw to cause
headaches
45
Q

what are some causes of sclerotogenous radiation of pain? (6)

A

1) Cervical spondylosis
- Osteoarthritis or
inflammatory
arthropathy
2) Cervical
sprain/strain
- Acute or chronic
3) Congenital
anomalies
- occipitalization, os
odontoideum
4) Occipital neuralgia
- C2 ganglion entrapped in
hypertrophic capsule of
the lateral atlantoaxial jt.
5) Third occipital
headache
6) C2-3 facet joint
- irritation, w/wo 3rd
occipital nerve entrapped
by an osteophyte

46
Q

What was most effective treatment plan for headaches?

A

Larger, concentrated doses,
9-12 treatments over 3-4
weeks, showed most benefit

47
Q

What are some treatment goals for cervicogenic headaches? (8)

A

1) Reduction of biomechanical abnormalities in the
cervical spine and restoration of normal
intersegmental joint function
2) Reduction of neuroplastic changes
3) Recovery of full active and passive cervical spine
range of motion
4) Reduced inflammation of paraspinal tissues
5) Reflex relaxation of paraspinal tissues
6) Restoration of muscular function
7)Reduction of poor postural habits
8) Reduce insults and avoid further injury

48
Q

What is the recommendation for palpation of specific pressure points and the amount of force applied?

A

Van Suijlekom (2010) recommends the palpation of specific
“pressure points” with about 3-4 kg of pressure which
may then provoke both local and spreading pain.
Doubling of the pressure may provoke the headache
presentation.

49
Q

For CGHA treatment, which areas of the cervical spine are manipulated?

A

Biomechanical

1) C2-3 rotation
2) C1
3) Cranium

50
Q

How much flexion/extension occurs at C0-1?

A

25° F/E with no coupling

51
Q

How much rotation occurs at C0-1?

A

4-8° rotation at end range

52
Q

How many facet places can be on each C1 facet?

A

Up to 3 facet planes on each C1 facet

53
Q

How is rotation and LF coupled in C0-1?

A

5° rotation coupled with opposite LF

54
Q

What happens to C0-C1 with LF?

A

5° LF slides C0 to opposite side leaving C1

“laterally translated” on LF side

55
Q

What happens at C0-C1 when it approaches end range?

A

3-4° near end range, about 15-20 degrees,

C0 joins C1 and glides laterally on C2

56
Q

What motion occurs most at C1-2?

A

Mostly rotation (40°,½ of cervical ROM)

57
Q

What happens to C1-C2 with LF?

A

LF (5°’s) couples with lateral translation

toward LF side – R LF shifts C1 to the R

58
Q

What happens to C1-C2 with flexion and rotation?

A

C1 drops down and forward onto C2 in

flexion and rotation

59
Q

What are some complicating factors of the cervical spine? (3)

A 
1) Occipitalizaion can lead to C1-C2
hypermobility or frank instability
2) Degeneration and osteophyte
formation can also complicate upper
cervical dysfunction rendering the
cervical manipulation a temporary or
palliative treatment
3) Co-morbidity issues
60
Q

How long do uncomplicated cervicogenic headaches take to respond to care?

A

Uncomplicated cervicogenic headaches

should respond to care within 3-6 weeks

61
Q

With aggressive treatment how long should it take to see 50% improvement?

A

An aggressive 2 week trial consisting of six
to seven treatments, a 50% improvement in
symptomatology is expected

Principles VI (2 decks)

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