OA to Head Pain (w/ TMJ)

Question 1

Primary cause of headaches DDx:

Answer 1

tension type headache (>80%)
Migraine (12-16%)
Medication overuse (~3%)
Cluster headache/trigeminal cephalgias (~0.1%)- RARE

Question 2

frequent subtype of tension headache (part of tension-type):

Answer 2

<15 days/month

Question 3

chronic subtype of tension headache (part of tension-type):

Answer 3

> 15 days/month

Question 4

Secondary causes of headache:

Answer 4

SAH, stroke, temporal arthritis, neoplasm, meningitis, encephalitis, acute angle glaucoma, HTN urgency/emergency, preeclampsia

Question 5

Worst headache of their life from___

Answer 5

SAH

Question 6

cause of new onset focal neurologic weakness w/ HA

Answer 6

stroke

Question 7

cause of onset HAs @ >50 y/o

Answer 7

temporal arthritis, neoplasm

Question 8

cause of associated system symptoms with headache

Answer 8

meningitis, encephalitis

Question 9

cause of acute eye pain w/ headache

Answer 9

acute angle glaucoma

Question 10

cause of HA w/ High BP

Answer 10

hypertensive emergency/urgency, preeclampsia

Question 11

if a pt presents with a secondary cause of HA, what should you do?

Answer 11

SEND THEM TO EMERGENCY ROOM

Question 12

What is impt in the history of a person presenting w/ HA?

Answer 12

pain pattern: location- unilateral vs. bilat? radiation; characteristic- type of pain; photosensitivity? aura?tearing? is it same time everyday?

Question 13

What is the pain pattern of tension type headaches?

Answer 13

bilateral tight/achy pain (tenderness, radiation from occipital/cervical region); usually no assoc symptoms

Question 14

What is the treatment of tension type headaches from myofascial pain referral?

Answer 14

conservative therapy:

• manual manipulation (ischemic compression)
• PT
• spray and stretch (lengthen muscle + cold analgesic topical spary)
• dry needling

trigger point injections: lidocaine + steroid

pharmacology: muscle relaxers, NSAIDS

Question 15

common causes of tension type headache (general):

Answer 15

• myofascial pain referral
• cervical facet referral
• temporal mandibular joint (TMJ) dysfunction

note: etiology isnt clear

Question 16

treatment for cervical facet referral

Answer 16

RICE; rest

conservative: manual meds, physical therapy
pharm: NSAIDs, oral steroids
injection: lidocation + steroid guided by fluoroscopy; radio-frequency ablation- burn out nerve innervation of facet (more aggressive)

Question 17

primary cause of TMJ:

Answer 17

malocclusion (teeth lining up problem)

disc displacement/joint degeneration

myalgia

Question 18

what generates most of the pain in TMJ?

Answer 18

muscles (extra-articular: pterygoid, temporalis, masseter)

other: intra-articular = tmj joint

Question 19

assoc syx with TMJ

Answer 19

decreased ROM of jaw, clicking, crepitus of joint, pain w/ opening/closing/chewing

Question 20

treatment of TMJ tension type HA

Answer 20

TMJ specific: bite splint, biofeedback (CBT), passive stretching

conservative: manual medicine, PT
pharm: NSAIDs, muscle relaxants

joint or trigger point injection

surgery= generally CONTRAINDICATED!

Question 21

5 models of treatment to tension type headaches - Biomechanical

Answer 21

consider risk/benefit!!!

conservative: splint, stretching, spray and stretch, dry needling; omt/pt

injections/radiofrequency ablation

Question 22

5 models of treatment of tension type headaches- metabolic

Answer 22

pharmacology (inflammatory)–> nsaids, steroids

Question 23

5 models of treatment of tension type headaches- neurologic

Answer 23

pharm: muscle relaxants

prevantative = SSRIs, tricyclics

Question 24

5 models of treatment of tension type headaches- behavioral** HY

Answer 24

RICE, prevent overuse, biofeedback (CBT), SMOKING CESSATION (nicotine correlated to #HA days)**

Question 25

What is the pain pattern for migraines?

Answer 25

unilateral throbbing burning pain (initially but may shift); has multiple phases

Question 26

Assoc symptoms with migraines+ whats most impt?

Answer 26

aura nausea (most predictive) photophobia phonophobia

Question 27

Phases of migraines:

Answer 27

premonitory--> aura--> HA--> postdrome

Question 28

Common migraine triggers:

Answer 28

``` emotional stress (80%) hormones (65%; female: male 3:1) irregular sleep (50%) diet (50%) caffeine + alcohol changes in weather dehydration smells medications ```

Question 29

basic migraine pathophysiology

Answer 29

has to do with wave of depolarization--> neuro depression there is a genetic influence to headaches as depolarizes--> nociception and SENSITIZATION (decreasing pain threshold) of trigeminocervical pain

Question 30

migraine 5 model treatment- biomechanical:

Answer 30

manipulation (decreases number of migraine days) + acupuncture (evidence of some prophylaxis)

Question 31

migraine 5 model treatment- respiratory circulatory:

Answer 31

stay hydrated

Question 32

migraine 5 model treatment- metabolic:

Answer 32

dont skip meals

Question 33

migraine 5 model treatment- neurologic:

Answer 33

abortive: triptans, ergots prophylaxis: propranolol, amitryptiline, topiramate anti seizure meds

Question 34

migraine 5 model treatment- behavioral***:

Answer 34

mindfulness/meditation; yoga/tai chi; biofeedback ***AVOID TRIGGERS***

Question 35

chronic pain medication use

Answer 35

>15 days/ months for 3 months

Question 36

medication overuse/rebound associated symptoms:

Answer 36

HA recurring around same time every day and are always relieved with taking meds

Question 37

treatment for medication overuse/rebound treatment:

Answer 37

education ***STOP OFFENDING MEDICATION (can bridge w/ different med)

Question 38

the most common of the trigeminal autonomic cephalgias =

Answer 38

cluster headache

Question 39

pain pattern of a cluster headache

Answer 39

unilateral; brief cycles (almost like bursts); same time everyday assoc symptoms= AUTONOMIC (sweating, yelling, tearing, stuffy/runny nose; redness) TREAT W/ OXYGEN!

Question 40

treatment for cluster HAs

Answer 40

oxygen!! (+ others but this most impt)

Question 41

5 model approach to head pain- biomechanics

Answer 41

KNOW specific modalities for specific etiologies of head pain KNOW which headaches respond to conservative modalities (OMM,PT)

Question 42

5 model approach to head pain- neuro

Answer 42

general abortive + prophylactic treatments

Question 43

5 model approach to head pain- behavioral

Answer 43

known common triggers + behavior modifications; know behavior interventions that decrease number of HA days