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PTMMD > Neck P! with Headaches > Flashcards

Neck P! with Headaches Flashcards

1
Q

What is the proposed underlying cause of neck pain with headaches?

A

Starts with neck pain, leads to headache

Cervicogenic Headaches (CGH)
- Disorder of the cervical spine and its component bony, disk, and/or soft tissue element

Cervical Spine Impairments
- Upper Cervical spine (C0/C1, C1/C2, C2/C3) facet joint impairments
- Muscle impairments including myofascial trigger points

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2
Q

Differential Diagnosis for Headaches should include other impairment-based diagnoses. What are those different diagnosis?

A

Cervicogenic headaches can produce Migraines

Primary Headaches
- Migraine without aura
- Migraine with aura
- Frequent episodic tension-type
- Chronic tension-type
- Cluster headache (Trigeminal autonomic cephalgia)

Neuromusculoskeletal
- Neck P! with Movement coordination Impairment (WAD)
- Temporomandibular Disorders

SCM can have same pain referral, retro-orbital (behind and around the eye)

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3
Q

What system, structure, pain mechanism, and phase of healing are unique to this patient presentation?

A

System
- Musculoskeletal

Structure
- Zygopophyseal joint, muscle (myofascial trigger points)

Pain Mechanism
- Nociceptive

Phase of healing
- None

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4
Q

What are common subjective reports for Neck pain with headaches?

A
  • Noncontinuous Unilateral neck and associated (referred) headache
  • Unilateral headache with onset preceded by neck pain
  • Headache aggravated by neck movements or sustained positions
  • Symptoms progress occipital to frontal in a ram’s horn distribution (retro-orbital)
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5
Q

What are the Aggravating and Easing Factors for Neck Pain with Headaches?

A

Same as Mobility

Aggravating
- Dull ache with sustained positions
- Symptoms reproduced with active movements

Easing
- Frequent change in positions
- Progressive cervical spine movement

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6
Q

What is the 24 hours pain behavior with Neck Pain with Headaches?

A

Morning
- Rarely morning pain unless neck maintained in an awkward positions

Noon to evening
- Symptoms may vary throughout the day depending on the patients activities, may have increased pain with sustained positions or specific movements

Night
- Symptoms may disturb depending on sleep positions, severity and irritability

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7
Q

When conducting Movement and provocation examinations for Neck P! with Headache, what will you see when the patient performs AROM?

A
  • Cervical ROM limitations and symptom provocation
  • Symptom provocation with the addition of overpressure and/or combined motions
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8
Q

When conducting Movement and provocation examinations for Neck P! with Headache, what is commonly seen when you are performing PIVM?

A
  • Hypomobility of the involved segment(s) (C0/C1, C1/C2, C2/C3) with local and/or somatic referred symptom reproduction
  • Symptom reproduction with the manual examination
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9
Q

With patients with Neck Pain with Headache, the special test you do should include the Flexion-Rotation Test. When doing this test, what would you find with this impairment?

A
  • C1/C2 spinal segment mobility
  • 10° reduction of side to side ROM (considered +)
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10
Q

When conducting Muscle Performance examinations for Neck P! with Headaches, what will find with Muscle Length Testing and what muscles will you MLT?

A
  • We will find limited length of the cervicothoracic musculature
  • Upper Trap., Levator Scapulae, Scalenes, Suboccipitals, SMC, Pec Minor/Major
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11
Q

When conducting Muscle Performance examinations for Neck P! with Headaches, what will you find with Muscle Palpations and what muscles will you Palpate?

A
  • Active and Latent trigger myofascial trigger points of the cervicothoracic musculature
  • Upper Trap., SCM, Suboccipitals, temporalis, splenius capitis and cervicis, Semispinalis capititis
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12
Q

When conducting Muscle Performance examinations for Neck P! with Headaches, what muscles will you test when checking Muscle Strength, Endurance and Coordination?

A
  • Longus Capitus and Longus Colli
  • Cervical Multifidus
  • Middle and Lower Trap
  • Rhomboids and Serratus Anterior
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13
Q

What is the Clinical Course and Prognosis for Neck P! with Headache?

A
  • Acute Idiopathic neck pain has variable recovery with slowing of progress noted at 6-12 weeks from onset
  • Chronic non-specific, atraumatic neck pain may be stable or fluctuating with periods of improvements and worsening
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14
Q

What are factors that may impact prognosis for Neck P! with Headache?

A
  • Older Age
  • Prior history of musculoskeletal disorder
  • Prior health
  • Regular exercise
  • History of previous neck pain
  • Sick leave
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15
Q

What are the factors the may impact new onset or recurrence, with patients with Neck P! with headache?

A
  • Female gender
  • History of previous neck pain
  • Older age
  • High demand jobs
  • History of smoking
  • Low social support
  • History of previous LBP
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16
Q

A patient with Neck P! with headache, how would they present when they are in the Acute stage?

A
  • Severity and Irritability are often high
  • Pain at rest or with initial to mid-range spinal movements: before tissue stretch
  • Pain control is often the intervention goal at this stage
17
Q

A patient with Neck P! with headache, how would they present when they are in the Subacute stage?

A
  • Severity and Irritability are often moderate
  • Pain experiences with mid-range motions that worsens with end-range spinal movements: at tissue resistance
  • Movement control is often the intervention goal at this step
18
Q

A patient with Neck P! with headache, how would they present when they are in the Chronic stage?

A
  • Severity and Irritability are often low
  • Pain that worsens with sustained end-range spinal movements or positions overpressure: Overpressure into tissue resistance
  • Functional optimization is often the intervention goal at this stage
19
Q

With Neck P! with headache, what are the recommended interventions in the Acute Stage?

A

Exercise
- C1/C2 self sustained natural apophyseal glide (SNAG)
{OA, AA, and Scap-Thoracic}

20
Q

With Neck P! with headache, what are the recommended interventions in the Subacute Stage?

A

Exercise
- C1/C2 self sustained natural apophyseal glide (SNAG)

Manual Therapy
- Cervical mobilization and manipulation

21
Q

With Neck P! with headache, what are the recommended interventions in the Chronic Stage?

A

Exercise
- Combined cervicoscapulothoracic exercise including endurance, neuromuscular re-education with/or without biofeedback, stretching, and strengthening elements

Manual Therapy
- Cervicothoracic manipulation and mobilization

22
Q

When should we consider interprofessional or Intraprofessional referral and what are other treatment options?

A

Imaging
- In the absence of Red Flag signs and for those classified as low risk, imaging is not indicated

Medications/Injections
- NSAIDs
- Facet joint injection
- Radiofrequency ablation

PTMMD (33 decks)

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