L16 Headaches Flashcards
sinus HA distribution
pain behind forehead and cheekbones
cluster HA distribution
pain in and around one eye
tension headache distribution
pain like a band squeezing the head
migraine HA distribution
pain, nausea, visual changes typical
unilateral often
cervicogenic HA distribution
surrounding eye, cheek, top of head, back of head, SCM
what % of adults experience at least 1 HA a year?
50%
lifetime prevalance of HA
93-98%
migraine annual prevalence
10-12%
types of primary headache
migraine
tension type
trigeminal autonomic cephaligia/cluster HA
types of secondary HA
trauma/injury
intracranial disorder
substance withdrawal
infection
cervicogenic or originating from some other structure on the head
psychiatric disorder
other facial pains and neuropathies not technically HA
CN lesion
onset and population for migraines
starts at puberty
35-45 most affected
women 2x more than men
mechanism of migraines
activation of a mechanism deep in the brain producing inflammatory substances around nerves and blood vessels of the head
dysregulation of trigeminal nerve nucleus
vasculogenic, immunologic, neurogenic
s/s of migraine attack
recurrent HA
mod-severe pain intensity
unilateral, can change sides
pulsating
aggravated by physical activity
nausea
photophobia
phonophobia
lasts hours to 2-3 days
can be associated with abdominal symptoms in children
triggers of migraines
stress
foods: chocolate and cheese
missing a meal
menses/week before period
alcohol
caffeine
what childhood history is correlated with migraines?
cyclic vomiting and motion sickness
migraine with aura symptoms
1/3 of migraine pts
visual aura most common with light flashes/scotoma/hemianopsia
less than 30 min of symptoms
how can physical therapy treat migraines
serve as adjunct to meds
trigger point release
postural dysfunction
relaxation techniques
avoid triggers
tension HA occurance
episodic
<15 days per month
mechanism of tension HA
muscle tension in neck, scalp, or face from stress, posture, or overuse
population of tension HA
starts in teenage years
women 3x more than men
irregular sleep pattern
eye strain
s/s of tension type HA
pressure and tightness
bandlike HA
no nausea, light or sound sensitivity
triggered by stress or hunger
less than 24 hours
BL dull mild to mod pain, not throbbing
diagnostic criteria for tension type headache
- at least 10 days previous HA episodes in 180 days
- Ha lasting 30 min to 7 days
- 2 of the following:
tightening/non pulsating, mild-mod, BL, not aggravated by phys activity - both: no n/v, can have sound or light sensitivity but not both
PT for tension HA
posture correction
ergonomic adjustments
relaxation
stress management
STM
trigger point
strengthening
stretching
cluster HA mechanism
trigeminal autonomic reflex
cluster HA population
uncommon
6:1 men:women
average onset 30 y/o
cluster HA s/s
severe, brief symptoms with common recurrence up to multiple times daily
burning/piercing/neuralgic pain causing restlessness and agitation
unilateral only
lasting less than 3 hours
periorbital, frontal, or temporal
same sided lacrimination, rhinorrhea, miosis, ptosis
cluster HA triggers
alcohol
stress
medication overuse headache
caused by chronic excessive use of HA medication
secondary headache type
headache screening: what should be screened in a pt with a headache?
if traumatic: fracture, dislocation, instability
if non traumatic: tumor, inflammatory disorder, infection, visceral referral, VBI or CBI dissection
special questions for HA subjective
Hx of head trauma?
slow or insidious onset of new HA?
neuro deficits?
Does it occur and/or worsen with exertion?
nuchal rigidity?
tempral headache in older person with vision deficit or trunk pain?
new meds or discontinued meds?
stopped smoking, drinking caffeine, using rec drugs
HA after reading or change in glasses prescription
exposure to toxic chemicals
concerning HA presentation with need for medical referral
sudden onset of new severe HA
progressively worsening HA
onset after physical exertion, straining, coughing
onset after 50 years old
neuro/CNS dysfunction
cervicogenic HA
referred pain perceived in any region of the head with the primary nociceptive source in MSK tissues innervated by cervical nerves
unilateral, starting in neck, comes with decreased ROM
epidemiology of cervicogenic headache
age of onset 30s-40s
men:women equal
pericranial muscle tenderness on involved side
C1-C3 innervated structures like synovial joints, ligaments, subcranial muscles, discogenic
cervicogenic HA pathophys
C1-C3 nerves sending pain signals to nociceptive nucleus of the head and neck
referring pain to occpiut and eyes
inflammation and neurotransmission
risk factors for cervicogenic HA
neck trauma
WAD
strain
chronic spasm increasing area’s sensitivity
DDD/DJD
poor posture
muscle imbalance
differential of cervicogenic HA
no specific pathology on imaging
lack of response to migraine medication
headache with neck movement or pressure
UL pain without side shift
initial pain in occipital region
forward head posture and CGH
upper cervical hyperextension creating a forward head posture
facet joint dysfunction leads to abnormal afferent information on tonic neck reflexes encouraging FHP
cervicogenic headache differentiated from migraine and tension by:
triggered by neck movement
pain spreading to occipital region
tenderness in suboccipitals
decreased cervical ROM
unresponsiveness to HA meds
cervicogenic HA diagnostic cluster
decreased cervical AROM
palpable tenderness Oa to C3/4, joint dysfunction
deep cervical flexor strength impairments
these are not present in migraine or tension HA
also proposed: C1/2 tenderness, pec minor length decreased, shortening in upper trap, levator, scalenes, scm, pec major
CGH treatment
PT as first line
manips stimulating neural inhibitory systems in SC and descending inhibition
manual therapy
AROM/PROM
DNF training
postural re-ed
