[Lecture] Head Pain, TMJ, Migraines [Chou] Flashcards
What is the differential diagnosis for headaches?
(From most common to least)
Tension type headache (80%)
Migraine (15%)
Medication overuse (3%)
Cluster/Trigeminal (0.1%)
What are examples of secondary causes of headache?
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)
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?
Send to the ED
What questions do you need to focus on during your HISTORY that will help you determine the type of headache your patient has?
Location: Unilateral vs. bilateral? Radiation?
Characteristics: Type of pain
Related symptoms: Photosensitivity? Aura? Tearing?
Temporal: Same time everyday?
Describe the characteristics of a TENSION type headache
Pain pattern : Bilateral tight/Achy pain
Radiation from the occipital/cervical region
What is THE defining characteristic of trigger points? (in comparison to tender points)
Trigger points RADIATE
What are examples of conservative therapies for treating tension type headaches?
Manual manipulation : ischemia compression
Physical thearpy
Spray and stretch (lengthen muscle, cold analgesic topical spray)
Dry needling
What are used in trigger point injections for tension type headache treatment?
Lidocaine and steroid
What type of pharmacologic interventions can you use to treat tension type headaches?
Muscle relaxers
NSAIDS
5 Models Treatment
Biomechanical
What do you want to think about?
Conservative therapies first!!!
(Splint, stretching, spray & stretch, dry needling, OMT, PT)
Or
Injections/radiofrequency ablation if conservative doesnt work
5 Models Treatment
Neurologic
What do you want to think about?
Pharmacology!
Muscle relaxors
Preventative : SSRI, Tricyclics ***
5 Models Treatment
Behavioral
What do you want to think about?
BTW THIS WILL BE A TEST QUESTION
***Smoking cessation*** (nicotine correlated to # headache days)
RICE
Prevent overuse
Biofeedback (CBT)
What are the three common causes of tension type headaches?
Myofascial Pain Referral
Cervical Facet Referral
Tamporal Mandibular Joint Dysfunction (TMJ)
What muscles are usually involved in TMJ?
Pterygoid muscle
Temporalis muscle
Masseter muscle
What is the most effective TMJ specific treatment?
Bite splint
Descibe the characteristics of a migraine
Pain pattern: Unilateral throbbing burning pain, has multiple phases
Associated sxs: Aura, nausea, photophobia, phonophobia
What is the most common migraine triggers? Top 5 in order
Emotional stress (80%)
Hormones (65%)
Irregular sleep (50%)
Diet (50%
Caffeine and Alcohol
What are some less common migraine triggers? (4)
Changes in weather
Dehydration
Smells
Medications
What is the major 5 model treatment consideration for migraine management?
**TEST QUESTION
Behavioral
AVOID TRIGGERS
What is considered chronic pain medication use?
>15 days/month for 3 months
How do you help treat a patient with medication overuse?
Stop offending medication
Bridge the patient to another med to break the cycle
What is the classic presentation of a cluster headache?
Sweating, swelling, tearing, runny nose
“Its like there is sand in my eye”
