OA to Head Pain (w/ TMJ) Flashcards
Primary cause of headaches DDx:
tension type headache (>80%)
Migraine (12-16%)
Medication overuse (~3%)
Cluster headache/trigeminal cephalgias (~0.1%)- RARE
frequent subtype of tension headache (part of tension-type):
<15 days/month
chronic subtype of tension headache (part of tension-type):
> 15 days/month
Secondary causes of headache:
SAH, stroke, temporal arthritis, neoplasm, meningitis, encephalitis, acute angle glaucoma, HTN urgency/emergency, preeclampsia
Worst headache of their life from___
SAH
cause of new onset focal neurologic weakness w/ HA
stroke
cause of onset HAs @ >50 y/o
temporal arthritis, neoplasm
cause of associated system symptoms with headache
meningitis, encephalitis
cause of acute eye pain w/ headache
acute angle glaucoma
cause of HA w/ High BP
hypertensive emergency/urgency, preeclampsia
if a pt presents with a secondary cause of HA, what should you do?
SEND THEM TO EMERGENCY ROOM
What is impt in the history of a person presenting w/ HA?
pain pattern: location- unilateral vs. bilat? radiation; characteristic- type of pain; photosensitivity? aura?tearing? is it same time everyday?
What is the pain pattern of tension type headaches?
bilateral tight/achy pain (tenderness, radiation from occipital/cervical region); usually no assoc symptoms
What is the treatment of tension type headaches from myofascial pain referral?
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
common causes of tension type headache (general):
- myofascial pain referral
- cervical facet referral
- temporal mandibular joint (TMJ) dysfunction
note: etiology isnt clear
treatment for cervical facet referral
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)
primary cause of TMJ:
malocclusion (teeth lining up problem)
disc displacement/joint degeneration
myalgia
what generates most of the pain in TMJ?
muscles (extra-articular: pterygoid, temporalis, masseter)
other: intra-articular = tmj joint
assoc syx with TMJ
decreased ROM of jaw, clicking, crepitus of joint, pain w/ opening/closing/chewing
treatment of TMJ tension type HA
TMJ specific: bite splint, biofeedback (CBT), passive stretching
conservative: manual medicine, PT
pharm: NSAIDs, muscle relaxants
joint or trigger point injection
surgery= generally CONTRAINDICATED!
5 models of treatment to tension type headaches - Biomechanical
consider risk/benefit!!!
conservative: splint, stretching, spray and stretch, dry needling; omt/pt
injections/radiofrequency ablation
5 models of treatment of tension type headaches- metabolic
pharmacology (inflammatory)–> nsaids, steroids
5 models of treatment of tension type headaches- neurologic
pharm: muscle relaxants
prevantative = SSRIs, tricyclics
5 models of treatment of tension type headaches- behavioral** HY
RICE, prevent overuse, biofeedback (CBT), SMOKING CESSATION (nicotine correlated to #HA days)**
What is the pain pattern for migraines?
unilateral throbbing burning pain (initially but may shift); has multiple phases
Assoc symptoms with migraines+ whats most impt?
aura
nausea (most predictive)
photophobia
phonophobia
Phases of migraines:
premonitory–> aura–> HA–> postdrome
Common migraine triggers:
emotional stress (80%) hormones (65%; female: male 3:1) irregular sleep (50%) diet (50%) caffeine + alcohol changes in weather dehydration smells medications
basic migraine pathophysiology
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
migraine 5 model treatment- biomechanical:
manipulation (decreases number of migraine days) + acupuncture (evidence of some prophylaxis)
migraine 5 model treatment- respiratory circulatory:
stay hydrated
migraine 5 model treatment- metabolic:
dont skip meals
migraine 5 model treatment- neurologic:
abortive: triptans, ergots
prophylaxis: propranolol, amitryptiline, topiramate
anti seizure meds
migraine 5 model treatment- behavioral***:
mindfulness/meditation; yoga/tai chi; biofeedback
AVOID TRIGGERS
chronic pain medication use
> 15 days/ months for 3 months
medication overuse/rebound associated symptoms:
HA recurring around same time every day and are always relieved with taking meds
treatment for medication overuse/rebound treatment:
education
***STOP OFFENDING MEDICATION (can bridge w/ different med)
the most common of the trigeminal autonomic cephalgias =
cluster headache
pain pattern of a cluster headache
unilateral; brief cycles (almost like bursts); same time everyday
assoc symptoms= AUTONOMIC (sweating, yelling, tearing, stuffy/runny nose; redness)
TREAT W/ OXYGEN!
treatment for cluster HAs
oxygen!! (+ others but this most impt)
5 model approach to head pain- biomechanics
KNOW specific modalities for specific etiologies of head pain
KNOW which headaches respond to conservative modalities (OMM,PT)
5 model approach to head pain- neuro
general abortive + prophylactic treatments
5 model approach to head pain- behavioral
known common triggers + behavior modifications; know behavior interventions that decrease number of HA days
