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Evidence Based Managment > L2 > Flashcards

L2 Flashcards

1
Q

What are the two Headache types

A
  • Primary (usual) : migraine , Tension , Clister
  • Secondary: vascular, pathologic, cervicogenic
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2
Q

What is the history of Headache Hx (NDV PPW)

A
  • Nausea
  • Dizziness
  • Visual disturbance
  • Photophobia (sensitive to light)
  • Phonophobia (sensitive to sound)
  • When was last eye exam?
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3
Q

Causes of HEADACHES (TMT COM)

A

Tension / Stress
- Migraine
- Tumor
- Cervicogenic headache
- Occular
- Metabolic/Toxic

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4
Q

What are some Behavioral Headache Triggers?

A
  • Stress / Tension induced
  • Depression
  • Poor posture
  • Dehydration
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5
Q

What are some Environmental Headache Triggers?

A
  • Odor
  • Altitude
  • Change in Weather
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6
Q

What are some Physical Headache Triggers?

A
  • TMJ
  • Eating / Drink cold food or drinks
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7
Q

What are some Diagnostic Alarms in Headache Disorders?

A
  • Happens after 50+ yrs
  • Onset in PT w. CA or HIV
  • Papilloedema
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8
Q

Headache triggered by exertion, coughing, bending or sexual activity is possibly caused by what type pathologies?

A
  • SOL
  • Aneurysm
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9
Q

Describe some Intracranial Pressure relations to Headaches

A
  • Does NOT cause it alone
  • Increase causes Headache & displaces pain sensitive intracranial structures (BV , Meninges , CN , Spinal N)
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10
Q

What are some Clinical Eval. of Headaches?

A
  • Rule out Red Flags
  • Vitals
  • Auscultate for Bruits
  • CN exam
  • Fundoscopic exam
  • Motor eval / Dorsal columns / Cerebellar exam
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11
Q

{stat} Primary Headache account for ….

A
  • 90% of all headaches
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12
Q

What are the 3 categories of Primary Headaches?

A
  • Migraine
  • Tension type
  • Cluster
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13
Q

What are the Types of migraine?

A
  • Migraine w aura (MC)
  • Migraine w/o aura (classic)
  • Retinal migraine (opthalmic)
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14
Q

What is the criteria for Migraine w/o aura?

A
  • Lasts 4-72hrs
  • Headache has at least 2: ( Unilat / Pulses / Moderate or severe / worsens w. activity)
  • Nausea
  • Photophobia / Phonophobia
  • NOT related to Secondary headache
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15
Q

What is the criteria for Migraine w aura?

A
  • Has at least 2 attacks
  • At least 1 REVERSIBLE symptom: (Visual / sense / speech / motor / brainstem)
  • At least 3 characteristics ( Spreads gradual >5min / 2+ symp occur in succession / Symp. lasts 5 - 60 min / Unilat. / Aura followed by Headache )
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16
Q

What is an aura?

A
  • Develops 5-60 min
  • Visual Aura: See Zig-Zag lines or Flashing lights
  • Auditory aura : Unusual sounds heard
  • Olfactory aura: Smells nonpresent odors
  • Aphasia: Language problems
  • Sensory Aura: Numbness/tingling
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17
Q

What is Scintillating scotoma?

A
  • ↓ Visual acuity or flashing lights near central visual field
  • Followed by a migraine
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18
Q

What is some Medical management of Headaches that has High evidence based association?

A
  • Triptans (acute)
  • Analgesics (aspirin, acetaminophen)
  • Ibuprofen
  • Parenteral dexamethasone
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19
Q

What are Chiro management of migraines w or w/o Aura?

A
  • 1/2 x per week for 8 weeks have high evidence
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20
Q

What is the MC primary headache?

A

Tension type

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21
Q

What are some Classification of Tension type headaches?

A
  • Frequent (>10 1-14 day/month 3+month)
  • Infrequent (>10 >1day/month)
  • Episodic
  • Chronic (>15 day/month >3 month)
22
Q

What are some Characteristics of Tension headaches?

A
  • No aura
  • Bilateral
  • Tightening (“Hatband-Like)
  • Mild/moderate
  • Neck / TMJ pain
  • Frontal/temporal located
23
Q

Tension headaches do not affect/cause:

A
  • Nausea/vomiting
  • ADL
  • Suboccipital location
  • Physical activity
  • Photophobia/phonophobia
  • Lasts 30 min- 7 day
24
Q

What are some Chiro management of Tension Type Headaches?

A
  • Soft tissue/manipulation
  • Stress reduction/exercise
  • Low load Craniocervical mobilization/exercise
  • Kinesiotaping to reduce myofascial adhesions
25
Q

What causes a Cluster headache?

A
  • Referred as Neurovascular
  • Evidence supports Hypothalamus as culprit
26
Q

Trigeminal Autonomic Cephalgia can be described as:

A
  • Cluster Headache are a common form of this
27
Q

What are some Symptoms of cluster headache?

A
  • Severe
  • Unilateral (Orbital/suportibal/temporal)
  • Lasts 15-180 min
  • Occurs every other day up to 8x/day
28
Q

Cluster headaches are assoc. with the following:

A
  • Lacrimation
  • Nasal congestion
  • Rhinorrhoea
  • Forehead/facial sweating
  • Miosis
  • Ptosis
  • Eyelid edema
29
Q

What are some Chiro management of Cluster headaches?

A
  • Not clinical warranted (Lidocaine , Capsaicin , etc)
30
Q

What is the difference between Acute vs Chronic Post-traumatic headache?

A
  • acute <3 months
  • chronic >3 months
31
Q

What is Used to assess severity of Head trauma (especially in sports)?

A
  • Glasgow Coma Scale
32
Q

Describe the Glasgow coma scale:

A
  • Verbal response: 5 points
  • Eye opening: 4 points
  • Motor response : 6 points
    ** the higher the better **
33
Q

Sports concussion assessment tool referred as

A

Scat 5

34
Q

What are some example of Vascular headaches?

A
  • Stroke / TIA
  • Giant cell / Temportal Arteritis
  • Carotid / Vertebral artery pain
  • Thrombus
35
Q

What is Giant cell Arteritis?

A
  • System vasculitis
  • Throbbing over temples
  • Headache
  • Visual loss
  • Fatigue
  • Myalgia
  • Rare before age 50
  • MC in Women
36
Q

What are some Clinical features of Cervicogenic headache?

A
  • Caused by disorder of C-spine
  • Accompanied by neck pain
  • Overlap w. Tension headaches
37
Q

What happens in a Cervicogenic Headache?

A
  • Resisted passive neck movements
  • Changes in neck muscle
  • Tender neck muscles
38
Q

Radiologic exam reveals at least 1 in a Cervicogenic Headache:

A
  • Movement abnormalities (Flexion-Extension)
  • Abnormal posture
  • Fx / Tumor / RA etc
39
Q

Occipital neuralgia can be caused by:

A
  • Adjusting someone who is guarding after whiplash
40
Q

Presentation of Occipital Neuralgia:

A
  • Throbbing / Electric shock-like pain in upper neck
  • Unilateral
41
Q

Occipital neuralgia caused by a irritation or injury to:

A

Greater occipital (C2)
lesser occipital (C3)

42
Q

TMJ disorders may be due to:

A
  • Internal derangement
  • Inflammation
  • Muscle imbalance (Lateral pterygoid)
  • Hypermobility
43
Q

IN. derangement of TMJ is associated with:

A
  • Structural changes within the joint caused by direct trauma/whiplash and grinding
44
Q

Disc displacement without reduction is associated with:

A
  • More severe, disc will not reduce and causes pain and decrease ROM
  • Lock jaw
45
Q

Hypermobility of TMJ will:

A
  • Deviate AWAY from affected side
46
Q

TMJ Disorder clinical evaluation:

A
  • Posture exam
  • ROM of TMJ & C-Spine
  • CN V exam (SENSORY)
47
Q

Pain location summary:

A
  • unilateral/hemicranial- migraine/cluster
  • cluster- always unilateral around eye, temple/cheek
    bilateral-tension
  • +50% brain tumor patients have headache with ipsilateral pain
48
Q

Pain duration summary of types of headaches:

A
  • migraine 4-72hrs
  • cluster 15-180min
  • paroxysmal hemicrania 5-20 min
  • tension 30min-7days
49
Q

Brain tumor headaches are similar to:

A
  • Tension type pain presentation
50
Q

Palliative factors of headaches:

A
  • Dark room/motionless (migraine)
  • Movements (cluster)
  • Rest/sleep (tension)

Evidence Based Managment (8 decks)

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