migraines + physiotherapy management Flashcards
what are red flags associated with migraines?
-new headache that is abrupt and severe, constant or progressive, worse at night, during pregnancy etc
-associated with new neurological signs or symptoms, nausea + vomiting, systemic symptoms eg fever, weight loss etc
-history of trauma, cancer, HIV, aneurysm etc
what are primary headache disorders?
-tension type headache
-trigeminal autonomic cephalgias (headache with other autonomic symptoms)
what are primary vs secondary headache?
-primary: headaches that are not caused by another medical condition eg tension type, clusters etc
-secondary: headaches caused by other diseases, ie the headache is a symptom eg head or neck trauma, infection etc
what are secondary headache types?
-head or neck trauma
-cranial or cervical vasculature disorder
-substance or withdrawal
-infection
-psychriatric disorder
what are primary and secondary headache disorders reviewed by physiotherapy ?
-primary headache disorders: migraine without aura and tension type headaches (episodic or chronic)
-secondary: headache attributed to disorder of the neck eg cervicogenic headache o or a headache related to head or neck trauma eg whiplash
what are examples of muscles which cab refer pain to the head?
-suboccipital muscles
-SCM
-traps
-splenius capitus
-semispinalus capitus
what is migraine?
-disorder of the central nervous system resulting in pain and wide variety of neurological symptoms
-may have aura, dizziness, weakness, throbbing headache, nausea, sensitivity to lights, noise , odors etc
(note once the neuro symptoms are not new etc not a red flag)
what are examples of migraine triggers?
- hormonal - ovulation, menopause, pregnancy etc
- sleep - too much, too little etc
- stress - significant events, everyday life stresses eg work
- food/drink - skipping meals, chocolate, cheese, alcohol
- other - overuse of acute medication, weather changes, cervical spend
what is aura?
Aura is a set of neurological symptoms that happen before or during a migraine headache. they usually resolve quickly (<60 mins)
eg visual symptoms, speech, weakness
-15-20 % of migraine patients
what is the diagnostic criteria for migraine without aura?
A. at least 5 attacks fulfilling criteria B-D
B. headaches lasting 4-72 hours
C. headaches that has at least 2 of the following characteristics eg unilateral location, pulsating quality, moderate to severe pain, aggravated by or causing avoidance of routine physical activity
D. during the headache - N+V, photophobia
e. not attributed to another disorder
describe the association between migraine and neck pain
-neck pain is a more common feature than nausea
-76% of people with migraine get neck pain
-physios can help with identifying whether the neck pain is a symptom is maybe a cause of it
in terms of a subjective Hx of a patient with a migraine, what do you need to include for the presenting complaint
-initial onset - time since, age
-progression - is it worsening, trauma, pregnancy?
-previous Rx- pharmacological dose and effect
-frequency: days per month
-intensity- VAS
-duration of headache
-any associated symptoms
-migraine trigger
-location eg unilateral or bilateral
-quality - burning, stabbing, throbbing, pressing etc
-behaviour - eggs/ eases etc
what are examples of different symptoms that can be associated with migraines?
-visual eg photophobia, blurred
-aural - tinnitus, sensitivity to sound
-vestibular- dizziness, imbalance
-sensory- sensory loss to limbs or face
-autonomic - tearing and redness of eye, stuffy nose
-GI- N+V
what’s important to know about medications with headaches?
-preventative therapy
-acute therapy
-corticosteroids
-anti-coagulants eg warfarin
-HTN medication
what’s important to note about PMHx with headaches?
-HTN
-cholesterol
-smoking Hx
-hyperlipidemia
-diabetes
-increased BMI
these can increase the risk of artherosclerosis and can impact arteries
-previous Ca Hx
-immunosuppressed
-ligamentous instability eg AK, RA
-connective tissue disorders
what are examples of investigations that can be used for migraines?
-CT brain
-MRI brain
-MR angiography
-MRI of cervical spine
-xray
what do we need to know about fam Hx with headaches?
-is there a family history of headache or migraine
-strokes in family
-vascular disease
what is recommended for physiotherapy management for migraines?
-manual therapy + exercise + pain neuroscience education
-lifestyle management - trigger management, sleep hygiene, regular exercise, stress management
is spinal manipulation alone for migraine?
very little evidence
-there is a risk of adverse events
what is effective for cervicogenic headaches?
both exercise + manual therapy are effective!!
in terms of neck pain and migraine, what 3 groups is it classified into?
-pain free on palpation of upper cervical spine
-local pain only
-pain referred to the head during sustained pressure
what are some sleep hygiene tips that could be useful to educate a patient about?
-regular wake up and sleep pattern
-avoid napping during the day
-avoid stimulants close to bedtime
-avoid TV and phone in bed
-ensure sleep environment is pleasant and relaxing
