Headaches Flashcards
What is a primary HA?
HA itself is the main medical condition. May be exarcebated by exposure to toehr factors
What is a secondary HA
HA related to an underlining medical condition.
what are the types of primary HA?
Migraines tension cluster
What is an example os a secondary type HA
TMJ eye problem cervicogenic
What are the features of a migraine with aura
Aura lasting < 60mins • High sensitivity to sound, lights, changes to vision, changes to speech. • P&N, numbness • Headache follows aura within around 60mins • Risk cerebral infarction • > risk with OCP/HRT
What are the features of a migraine no aura
• 4-72 hours • 2of • Throbbing • Unilateral • Moderate to severe pain • Worse with physical activity • 1 of • Nausea/vomiting • Photophobia/phonophobia
What are the features of a tension HA
• F>M • Can last <30mins or up to 7 days • >2 of the following • Bilateral • Non pulsatile • mild to moderate in severity • Not agg by physical activity • No nausea or vomiting. • Some sensitivity to light and sound may occur • Usually bilateral, ‘band like’
What are the features of a cluster HA
• M>F • Severe unilateral pain usually behind the eye. • Last up to 180 mins • Eye ssx • Tearing • Miosis • Ptosis • Sweating • Swelling of the eyelid • Occurs in a timing pattern up to 8x every day to 1x every second day • Severely distressing for the patient.
What are the features of a cervicogenic HA
Referral of pain from tender points in the neck • Reproduction of headache with palpation of points • Reduced Cx ROM • Usually Unilateral pain • Non throbbing
What are the HA red flags Hint “SNOOP”
Systemic symptoms (fever, weightloss) • Secondary headache risk factors(HIV, systemic cancer) • Neurologic symptoms or abnormal signs (confusion, impaired alertness, or consciousness) • Onset: sudden, abrupt, or split-second • Older: new onset and progressive headache, especially in middle-age >50 (giant cell arteritis) • Previous headache history or headache progression: first headache or different (change in attack frequency, severity, or clinical features)
Cranial Nerve examination
CN II, III, IV, VI - optic, oculomotor throclear, abducens
- Eye test
- examination of optic disc and retina using an ophthalmoscope
- pupillary reflex
- peripheral vision test
- central vision test (pen to nose and H)
CN I - olfactory
- Observe blockage and nose
- Smell test
CNV - trigeminal
- sensory testing
- sharp dull
- masseter/ temporalis contraction
CN VIII - vestibulocochlear
- whisper
- Webber
- Rhine
CNVII - facial
- Symetry
- smille
- blow cheeks
- shut eyes and try to open them
CNIX, X glossophalengeal, vagus
- gag reflex
- AHHH
CNXII hypoglossal
- push tongue against the cheek
- speech
CNXI accessory
- resist test shoulder elevation
- resist neck rotation
What is the treatment for migraines?
- HVLA
- Physical therapy effective when combined with relaxation, correct medication in migrane sufferers.
- Manual therapy more effective when used in conjunction with other interventions
What is the treatment for tension HA
- Manual therapy effective in a multimodal approach
- More effective than pharm intervention alone
- Reduction in severity and frequency, especially in short term
what is the treatment for cervicogeninc HA?
- manipulation,
- exercise therapy,
- soft- tissue
- in combination all show improvements in pain severity and frequency
What is the patient management for HA?
- Education
- Effective assessment
- Addressing modifiable risk factors and maintaining factors
- Pharmacological and/or psychological intervention if necessary
- Manual therapy indicated.
