Lecture 2 Flashcards
Types of HA
-
Tension HA = >80%
- Frequent (<15 days/month) ***
- Chronic (>15 days/month)
- Migraine = 12-16%
- Medication overuse = ~3%
- Cluster HA/trigeminal cephalgias = ~ 0.1%
What is the most common type of HA?
Is it frequent or chronic more often?
Tension HA
Frequent (>15 days/month)
Secondary causes of HA
“Worse HA of my life”
Subarachnoid hemorrage
Secondary causes of HA
“New onset of focal neurologic weakness”
Stroke
Secondary causes of HA
“Onset of HA > 50YO”
- Temporal arthritis
- Neoplasm
Secondary causes of HA
“HA + systemic symptoms”
1. Meningitis
2. Encephalitis
Secondary causes of HA
“Eye pain => HA”
acute angle glaucoma
Secondary causes of HA
“High BP => HA”
1. HTN urgency/MRGNC
2. Preeclampsia
Generally, chronic HA can be caused by…treated with…
1. Mulitple etiologies
2. Multiple modalities/treatments and altering lifestyle
When performing OLDCARTS for a patient presenting with HA, what MUST we ask?
- Location: unilateral/bilateral/ radiation
- Characterstic: type of pain
- 3. Related symptoms: photosensitivity, aura, tearing?
- 4. Temporal: same time everday?
Tension HA
- Type of pain?
- Associated symptoms?
- Etiology
- Bilateral, tight/ achy that is tender, radiates from occipital/cervical region, with NO other
- None
- Not clear, but most are cervicogenic (perceived as occuring in another part of the body than true source) bc of (+) of trigeminal cervical complex
Categorize tension HA by frequency
- Infrequent: ≤1 days/month
- Frequent: 1 - 15 days/month
- Chronic: ≥ 15 days/month
Most common causes of tension HA
- Myofascial pain referral
- Cervical facet referral
- TMJ dysfunction
Tension HA caused by myofascial pain referral
- Mainly due to what?
- Where is pain/what causes pain?
- Overuse/injury to muscles
- Trigger points (palpable muscle knots) that is discrete, focal and hyperirritable. When touching => twitch response “OUCH”, pain pattern
Treatment of Tension Headache: myofascial pain referral
- Conservative therapy:
- Ischemic compression (manual manipulation),
- PT,
- Spray and stretch with a cold analgesic topical spray and lengthen muscle,
- Dry needling
- Trigger point injections – lidocaine and steroid
- Pharmacology – muscle relaxers and NSAIDS
Tension Headache due to cervical facet referral
- Mainly due to what?
- Where is pain/what causes pain?
- Primarily due to:
- Degeneration/arthritis,
- Injury
- Overuse/poor posture
- Where is pain/what causes pain: Cervical facet joint capsule
Tension Headache due to cervical facet referral
- Symptoms?
- Treatment
- Symptoms
- Painful (even when palpating)⬇︎ ROM,
- Protective spasms with movement
- Treatment
- RICE (rest = most of the time will go away on its own) = BEST
- Convservative: Manual medicine or PT
- NSAIDS, oral steroids
- Injection of lidocaine and steroid injections with fluoroscopy,
- Radiofrequency Ablation (burn out nerve innervation to facet)
Tension type headache: TMJ (jaw pain)
- Mainly due to what?
- Where is pain/what causes pain?
- Due to:
- Malocclusion (teeth lining up),
- Disc displacement/joint degeneration,
- Myalgia
- Where is pain/what causes pain:
- Intraarticular: TMJ joint
- Extraarticular: (pterygoid muscle (inside jaw), temporalis or masseter muscle
Tension HA: TMJ pain
- Symptoms?
- Treatment?
Associated sxs –
- ⬇︎ ROM of jaw,
- Clicking, crepitus of joint
- Pain when opening/closing/chewing
Treatment:
- TMJ specific – bite splint***, passive stretching, biofeedback (CBT; jaw relaxation)
- Conservative therapy: Manual medicine, PT
- NSAIDs and muscle relaxants
- Joint or trigger point injections
- Surgery CI
What is CI in patients with tension HA due to TMJ?
surgery
Patient has a unilateral, throbbing burning pain, but can shift that occurs in multiple phases.
What type of head pain is this?
Migraine
Migraine
- Associated symptoms and which is most predictive of migraines
- Aura
- Nausea (most predictive)
- Photophobia
- Phonophobia
4 phases of migraines
- Premonitory: fatigue, irritability, depression, difficulty speaking/reading/sleeping
- Aura (some migraines don’t have this): visual problems + numbness and tingling
- Headache: unilateral throbbing burning pain + photophobia/phonophobia + N/V
- Postdrome: fatigue, cant concentrate and depressed
PAHP
4 MC triggers for migraines (in order)
- Emotional stress = MC (80%)
- Hormones (MC in females)
- Irregular sleep
- Diet
Caffeine and alcohol, smells, changes in weather, dehydration
5 factor model for migraines
- Biomechinical
- Resp/criculation
- Metabolic
- Behavioral
- biomechanical (manipulation decreases number of days, acupuncture can be a prophylaxis),
- resp/circulatory (stay hydrated),
- metabolic (don’t skip meals)
- behavioral (meditation, biofeedback, avoid triggers)
How can we decrease the number of HA days in migraines and what can be a prophylaxis?
- Decrease number of HA days => manipulation
- Prophylaxis => acupuncture
When should we think of medication overuse/rebound as the cause of HAs?
- Chronic pain medication use >15 days/month for 3 months
- Headache recurring around the same time every day
- Always relieved with taking medication
Tx for meds as cause of HA?
Stop taking drug and bridge with different medication
MC HA of trigmenial autonomica cephalgia family
Cluster HA
Cluster HA
- Mainly due to what?
- Where is pain/what causes pain?
- of trigmeninal autonomic => Severe, debilitating HA on one side of head (unilateral) that occurs in brief cycles
- Sweating, swelling of eye, tears, stuffy/runny nose
Treatment of CLuster HA
- O2
- Triptans/ Ergotamine
- Intranasal lidocaine
- Verapamil
Management of HA
avoid triggers
- How can we prevent tension HA?
- What is the most important behaviorial intervention for tension HA?
- SSRI, tricyclics
- Smoking cessation bc nictoine is correlated to # of HA
