[Lecture] Head Pain, TMJ, Migraines [Chou]

Question 1

What is the differential diagnosis for headaches?

(From most common to least)

Answer 1

Tension type headache (80%)

Migraine (15%)

Medication overuse (3%)

Cluster/Trigeminal (0.1%)

Question 2

What are examples of secondary causes of headache?

Answer 2

Subarachnoid hemorrhage - “Worst headache of life”

Stroke - (New onset focal neurologic weakness)

Meningitis/Encephalitis

Acute angle glaucoma - (Acute eye pain)

Hypertensive/preeclampsia - (High blood pressure)

Question 3

THIS WILL BE A TEST QUESTION SO HELP ME

If you have a secondary cause of headache (subarachnoid hemorrhage, stroke, meningitis etc…), what is the NEXT BEST STEP to treating patient?

Answer 3

Send to the ED

Question 4

What questions do you need to focus on during your HISTORY that will help you determine the type of headache your patient has?

Answer 4

Location: Unilateral vs. bilateral? Radiation?

Characteristics: Type of pain

Related symptoms: Photosensitivity? Aura? Tearing?

Temporal: Same time everyday?

Question 5

Describe the characteristics of a TENSION type headache

Answer 5

Pain pattern : Bilateral tight/Achy pain

Radiation from the occipital/cervical region

Question 6

What is THE defining characteristic of trigger points? (in comparison to tender points)

Answer 6

Trigger points RADIATE

Question 7

What are examples of conservative therapies for treating tension type headaches?

Answer 7

Manual manipulation : ischemia compression

Physical thearpy

Spray and stretch (lengthen muscle, cold analgesic topical spray)

Dry needling

Question 8

What are used in trigger point injections for tension type headache treatment?

Answer 8

Lidocaine and steroid

Question 9

What type of pharmacologic interventions can you use to treat tension type headaches?

Answer 9

Muscle relaxers

NSAIDS

Question 10

5 Models Treatment

Biomechanical

What do you want to think about?

Answer 10

Conservative therapies first!!!

(Splint, stretching, spray & stretch, dry needling, OMT, PT)

Or

Injections/radiofrequency ablation if conservative doesnt work

Question 11

5 Models Treatment

Neurologic

What do you want to think about?

Answer 11

Pharmacology!

Muscle relaxors

Preventative : SSRI, Tricyclics ***

Question 12

5 Models Treatment

Behavioral

What do you want to think about?

BTW THIS WILL BE A TEST QUESTION

Answer 12

***Smoking cessation*** (nicotine correlated to # headache days)

RICE

Prevent overuse

Biofeedback (CBT)

Question 13

What are the three common causes of tension type headaches?

Answer 13

Myofascial Pain Referral

Cervical Facet Referral

Tamporal Mandibular Joint Dysfunction (TMJ)

Question 14

What muscles are usually involved in TMJ?

Answer 14

Pterygoid muscle

Temporalis muscle

Masseter muscle

Question 15

What is the most effective TMJ specific treatment?

Answer 15

Bite splint

Question 16

Descibe the characteristics of a migraine

Answer 16

Pain pattern: Unilateral throbbing burning pain, has multiple phases

Associated sxs: Aura, nausea, photophobia, phonophobia

Question 17

What is the most common migraine triggers? Top 5 in order

Answer 17

Emotional stress (80%)

Hormones (65%)

Irregular sleep (50%)

Diet (50%

Caffeine and Alcohol

Question 18

What are some less common migraine triggers? (4)

Answer 18

Changes in weather

Dehydration

Smells

Medications

Question 19

What is the major 5 model treatment consideration for migraine management?

**TEST QUESTION

Answer 19

Behavioral

AVOID TRIGGERS

Question 20

What is considered chronic pain medication use?

Answer 20

>15 days/month for 3 months

Question 21

How do you help treat a patient with medication overuse?

Answer 21

Stop offending medication

Bridge the patient to another med to break the cycle

Question 22

What is the classic presentation of a cluster headache?

Answer 22

Sweating, swelling, tearing, runny nose

“Its like there is sand in my eye”