Management of Headaches and TMJ

Question 1

If you have ruled out headache red flags, what is the next aim?

Answer 1

Reproduce patients pain/symptoms

Question 1

What things should be considered when examining headaches?

Answer 1

Cranial nerve exam
Blood pressure
Cervical flexion - rotation test
Temperature

Question 2

When considering what structures may be pain causative, what questions should be asked?

Answer 2

What structures are lengthened, shortened, under increased load, restricted, hypermobile, etc. How would you use your examination to find out?

Question 3

What factors must be considered for environmental factors of headaches?

Answer 3

Patterns
HA relating to time, place, medication, activity, hormonal, etc.

Question 4

What options are for pharmacological treatment of HA?

Answer 4

Paracetamol - TTH
NSAIDs - migraine, TTH, CGH

Question 5

What medications make no difference to TTH headaches?

Answer 5

Triptans

Question 6

What pharamcological treatment options can be used for migraine?

Answer 6

Triptans
Best taken as migraine begins - early or later seems less effective

Question 7

What is the mechanism of triptans for migraines?

Answer 7

Vasoconstriction

Question 8

What are the side effects of triptans for migraines?

Answer 8

Nausea
Vomiting
Flushing
Dizziness

Question 9

What are preventer medications for migraines?

Answer 9

Cardiovascular drugs
Beta blockers
ACE inhibitors
Antidepressants
Anti-epileptics

Question 10

What manual therapy is beneficial for migraines?

Answer 10

SMT for chronic migraines
Physical therapy when combined with relaxation, correct medication in migraine sufferers
Manual therapy more effective when used in conjunction with other interventions

Question 11

What manual therapy is beneficial for TTH?

Answer 11

Effective multimodal approach
More effective than pharm intervention alone
Reduction in severity and frequency, esp in short term

Question 12

What manual therapy is beneficial for cervicogenic?

Answer 12

Manipulation
Exercise therapy soft-tissue in combination all show improvements in pain severity and frequency

Question 13

What is conservative treatment of TMD?

Answer 13

Patient education and reassurance
Jaw rest
A soft diet
Warm compress over the region of pain and passive stretching exercises
Behavioural modifications
May need to refer to GP or dentist

Question 14

What may improve ROM but not pain at the TMD?

Answer 14

Stretching, manual therapy and jaw exercises

Question 15

What behavioural modifications are good for TMD?

Answer 15

Including improving sleep hygiene, stress reduction and elimination of parafunctional habits such as teeth clenching and grinding are important

Question 16

HA management tips/tricks

Answer 16

Have empathy
Stress relief
Sleep health
Address postural/compensatory pattern
General exercise advice
Outcome measures to measure

Question 17

What are good stress relief tips for HA management?

Answer 17

Breathing exercises/meditation
Psychological intervention - referral

Question 18

What are sleep tips for HA?

Answer 18

Turn off technology
Go to bed and wake at the same time daily

Question 19

What is the general exercise advice?

Answer 19

30 min x 3 a week moderate exercise