Headaches Flashcards
Describe the two types of headaches
Primary: no known underlying pathology eg
- migraine (with and without aura)
- cluster headache
- tension-type headache (TTH)
Secondary: due to a particular condition eg vascular, tumour, or head or neck trauma CAUTION
*Headache or facial pain from disorders of cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial or cervical structure: Cervical/Cervicogenic headache
Migraine SE
¥ Pulsating ¥ Severe/excruciating ¥ 4-72 hrs duration ¥ Unilateral, +/- side-shift ¥ Aggravated by routine
+/-
nausea, vomiting, photophobia, phonophobia, aura
Migraine ICHD
¥ A. 5 attacks of B-D
¥ B. H/A 4-72 hrs
¥ C. At least 2 of following:
-unilateral
-pulsating
-moderate/severe
-aggravation by or causing avoidance of routine physical activity eg walking
¥ D. at least 1 of: -nausea/vomiting
-photophobia/phonophobia
± aura develops over 5-20 mins, lasts <60 mins
Migraine Management
¥ Respond to Triptans
¥ Limited evidence for effect of conservative rx
¥ Prophylactic medications – amitriptylines etc – side-effects++
Cluster headache SE
¥ Severe++ ¥ Unilateral ¥ 15-180min ¥ Bi-daily to 8/day ¥ Restless/agitated \+/- (at least one) ipsilateral: conjunctival injection, lacrimation (weepy eye), nasal congestion, rhinorrhoea, forehead & facial sweating, miosis, ptosis (drooped eyelid), eyelid oedema
Cluster headache ICHD
¥ A. 5 attacks of B-D
¥ B. severe unilateral, orbital, supraorbital and/or temporal pain, 15min-2 hrs if untreated
¥ C. one or more of:
-ipsilateral lacrimation
-ipsilateral nasal congestion
-ipsilateral eyelid oedema
-ipsilateral forehead and facial sweating
-ipsilateral miosis (↓pupil) and/or ptosis (↓eyelid)
-a sense of restlessness or agitation
D. Attacks from 1 every other day to 8/day
Tension-type Headache SE
¥ Pressing/tightening ¥ Mild/moderate ¥ Bilateral ¥ 30min – 7 days - nausea, vomiting \+/- photophobia, phonophobia ¥ Not agg by routine ¥ Pericranial TOP ¥ Agg by rest, eased by mmt ¥ Worst @ EOD (end of day)
Tension-type Headache ICHD
¥ A. 20 mins-7 days ¥ B. 2 or more of: -bilateral -pressing/tightening (non-pulsating) -mild-moderate -not aggravated by routine physical activity eg walking, stairs C. both of following: -no nausea or vomiting -no more than 1 of photophobia or phonophobia
Describe cervical headaches
¥ Area-any area of head esp suboccip unilat>bilat
Associated-dizzy, light-headed, visual, tinnitus
¥ Bx-mechanical trigger eg Cx movements, sustained posture
Eased-supine+/-analgesics
¥ Hx-50% relate onset to injury or past Hx of neck trauma, degenerative jt disease
0/C1 headache SE
¥ Vice-like “ache” ¥ TMJ pain ¥ Ear pain/blocked ¥ Patchy ¥ Uni/bi-lateral ¥ No neck pain below occiput
C1/2 headache SE
¥ Uni/bi-lateral ¥ Immediate SO pain ¥ May describe a ‘head-band’ of pain -Rare and most difficult to treat -Commonly associated with trauma
C2/3 headache
¥ Uni/bi-lateral, “face ache”
¥ +/- nuchal line pain
¥ Nausea, dizziness, throbbing, “migraine-type”
Most common & often associated with O/C1 dysfunction
Cervical headache OE
¥ Forward head posture, poking chin
¥ Movements-no set pattern of restriction, may need combined upper Cx
¥ Reproduce H/A=diagnostic of Cx H/A
¥ VBI may be +ive
¥ Mm-tight suboccipital E, upper traps; loss endurance-deep Cx F
¥ Palp/PAIVM’s findings in upper Cx region O-C3
Cervical headache Management
¥ Strong sustained mobs IV+ >oscillations stiff Cx
¥ Home exs:
-Stretch tight mm-suboccip E, upper traps
-Posture: generalised/localised upper Cx retraction
-Increase endurance of deep Cx Fors +isometric strengthening other neck mm
¥ Ergonomics: desk, pillow, sleep position
Check thoracic spine-mobilise if stiff
