Lecture 9: Osteopathic Approach to Head Pain Flashcards
What nerves should be considered for head pain of anterior 2/3 vs. posterior 1/3?
- Anterior 2/3 –> Trigeminal n.
- Posterior 1/3 –> Lesser Occipital (C1-3), Recurrent branches of IX and X
Relevant sympathetic spinal levels associated with head pain?
T1-T4
Mean age of onset for tension HA?
Peak prevalence?
- MAO = 25-30 yo
- Peak prevalence = 30-39 yo
Anxiety and depression often associated w/ what type of headache?
Chronic tension-type HA
Peripheral pain mechanisms are more likely important for what type of tension HA?
Episodic tension-type HA
Central pain mechanisms are more likely involved in what type of tension HA?
Chronic tension-type HA
What are the clinical features (signs/sx’s) of Tension-type HA’s?
- Bilateral
- Mild to moderate intensity
- Pressure or tightening quality (nonpulsating)
- Absence of N/V
- Not aggravated by routine physical activity
How long can Episodic Tension HA’s last?
30 minutes to 7 days
Chronic Tension HA’s are defined as having episodes for how long (days/months)?
≥ 15 days/month on average for ≥ 3 months
What is the most common abnormal PE finding for Tension HA’s?
Pericranial muscle tenderness - tends to be mostly scalp
How to treat the neurological component (5-models) of a tension-type HA?
- Analgesics and NSAIDs = 1st line
- Combination analgesics w/ caffeine = 2nd line
- Metaclopramide
3 focuses for the Metabolic component (5-models) in tx of Tension-HA?
- Sleep hygiene
- Hormonal influences - menstrual
- Hydration
Using the 5-models what component should be addressed first in the treatment of Migraine, Cervicogenic, and Tension HA’s?
- Respiratory/circulatory
- Address lymphatics first to reduce irritants from inflammatory milieu
Using the 5-models approach what should be addressed via the neurological component for Migraine, Cervicogenic, and Tension HA’s?
- Address counterstrain points anteriorly and posteriorly in the cervicals, upper thoracics, upper ribs, and UE’s
- Use cranial to address other contributing SD’s
Which treatment technique for SD’s has been shown to be an effective method for treating tension HA?
MFR
How does a menstrual migraine differ than a normal one?
Typically w/o aura and more severe
Using the 5-models approach what should be addressed via the Biomechanical component for Tension HA’s?
- Address myofascial SD’s
- Address joint SD’s w/ cranial, MET, Still’s, HVLA, or FPR
What are 2 likely risk factors for Migraines?
- Medication overuse
- MS
What is the mnemonic used for Migraine Diagnosis?
- POUND
- Pulsating
- Duration 4-72 hOurs
- Unilateral
- Nausea or vomiting
- Disabling
*4/5 criteria met has + likelihood ration 24 for definitive possible migraine
Differential Diagnoses for Migraines?
- Tension HA or Cluster HA
- Cervical spine dz –> greater occipital neuralgia
- Acute cervical strain –> Whiplash
- Intracranial mass or Meningitis or Subarachnoid hemorrhage or TIA
- Sinusitis
- Cavernous sinus thrombosis
- Optic neuritis or Acute Glaucoma
- SLE
- TMD
- Epilepsy
What is pathognomonic for migraine w/ aura?
Spreading oligemia (reduced blood volume) in brain
Migraine w/o aura seems to be associated with what messenger molecules?
- NO
- 5-HT
- CGRP
Using the 5-models how do you treat the Biomechanical components of Migraines?
Address joint SD with Cranial, MET, Still’s, HVLA or FPR
Cervicogenic HA is caused by disorder of what?
Cervical spine and its component bony, joint, and/or soft tissue elements
*Usually NOT associated w/ neck pain
Involvement of which cervical facet is the most frequent source of Cervivogenic HA?
- C2-C3 = most frequent
- AA is probably 2nd
Facet pain from C5-C6 and C6-C7 may contribute to what type of relfex resulting in TrP pain referral to the head?
Somato-somatic reflex
For diagnosis of Cervicogenic HA, evidence of causation by at least two of the following 4 items must be met?
- Developed in temporal relation to the onset of cervical disorder/lesion
- Significantly improved or resolved w/ improvement in or resolution of cervical disorder/lesion
- Cervical ROM is reduced AND HA is made significantly worse by provocative maneuvers
- Abolished following diagnostic blockade of a cervical structure or its nerve supply
What are 5 differential diagnoses for Cervicogenic HA?
- Migraine - POUND
- Tension HA
- C2 neuralgia
- Neck-tongue syndrome
- Occipital Neuralgia
If the pain associated with a HA is myofascial what category does it best fit under?
Tension HA
What are the common signs/sx’s of C2 neuralgia?
- Paroxysmal sharp or shock-like pain centered in occipital region
- Ipsilateral eye lacrimation and conjunctival injection are common
What is Neck-tongue syndrome?
Onset typicall when?
- Rapid head turning causes subluxation of the posterior AA joint and C2 spinal root compression
- Sx = neck pain, may be asscociated w/ ipsilateral tongue sensory sx’s
- Onset typically during childhood or adolescence
Using the 5-model approach how should the Biomechanical component of Cervicogenic HA’s be treated?
- Address joint SD w/ MET, Stills, or FPR
- HVLA may irritate facilitated segments!
