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OS lV Exam 1 > OA to Head Pain (w/ TMJ) > Flashcards

OA to Head Pain (w/ TMJ) Flashcards

1
Q

Primary cause of headaches DDx:

A

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

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2
Q

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

A

<15 days/month

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3
Q

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

A

> 15 days/month

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4
Q

Secondary causes of headache:

A

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

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5
Q

Worst headache of their life from___

A

SAH

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6
Q

cause of new onset focal neurologic weakness w/ HA

A

stroke

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7
Q

cause of onset HAs @ >50 y/o

A

temporal arthritis, neoplasm

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8
Q

cause of associated system symptoms with headache

A

meningitis, encephalitis

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9
Q

cause of acute eye pain w/ headache

A

acute angle glaucoma

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10
Q

cause of HA w/ High BP

A

hypertensive emergency/urgency, preeclampsia

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11
Q

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

A

SEND THEM TO EMERGENCY ROOM

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12
Q

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

A

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

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13
Q

What is the pain pattern of tension type headaches?

A

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

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14
Q

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

A

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

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15
Q

common causes of tension type headache (general):

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

note: etiology isnt clear

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16
Q

treatment for cervical facet referral

A

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)

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17
Q

primary cause of TMJ:

A

malocclusion (teeth lining up problem)

disc displacement/joint degeneration

myalgia

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18
Q

what generates most of the pain in TMJ?

A

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

other: intra-articular = tmj joint

19
Q

assoc syx with TMJ

A

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

20
Q

treatment of TMJ tension type HA

A

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

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

joint or trigger point injection

surgery= generally CONTRAINDICATED!

21
Q

5 models of treatment to tension type headaches - Biomechanical

A

consider risk/benefit!!!

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

injections/radiofrequency ablation

22
Q

5 models of treatment of tension type headaches- metabolic

A

pharmacology (inflammatory)–> nsaids, steroids

23
Q

5 models of treatment of tension type headaches- neurologic

A

pharm: muscle relaxants

prevantative = SSRIs, tricyclics

24
Q

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

A

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

25
Q

What is the pain pattern for migraines?

A

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

26
Q

Assoc symptoms with migraines+ whats most impt?

A

aura
nausea (most predictive)
photophobia
phonophobia

27
Q

Phases of migraines:

A

premonitory–> aura–> HA–> postdrome

28
Q

Common migraine triggers:

A 
emotional stress (80%)
hormones (65%; female: male 3:1)
irregular sleep (50%)
diet (50%)
caffeine + alcohol
changes in weather
dehydration
smells
medications
29
Q

basic migraine pathophysiology

A

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

30
Q

migraine 5 model treatment- biomechanical:

A

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

31
Q

migraine 5 model treatment- respiratory circulatory:

A

stay hydrated

32
Q

migraine 5 model treatment- metabolic:

A

dont skip meals

33
Q

migraine 5 model treatment- neurologic:

A

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

34
Q

migraine 5 model treatment- behavioral***:

A

mindfulness/meditation; yoga/tai chi; biofeedback

AVOID TRIGGERS

35
Q

chronic pain medication use

A

> 15 days/ months for 3 months

36
Q

medication overuse/rebound associated symptoms:

A

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

37
Q

treatment for medication overuse/rebound treatment:

A

education

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

38
Q

the most common of the trigeminal autonomic cephalgias =

A

cluster headache

39
Q

pain pattern of a cluster headache

A

unilateral; brief cycles (almost like bursts); same time everyday

assoc symptoms= AUTONOMIC (sweating, yelling, tearing, stuffy/runny nose; redness)

TREAT W/ OXYGEN!

40
Q

treatment for cluster HAs

A

oxygen!! (+ others but this most impt)

41
Q

5 model approach to head pain- biomechanics

A

KNOW specific modalities for specific etiologies of head pain

KNOW which headaches respond to conservative modalities (OMM,PT)

42
Q

5 model approach to head pain- neuro

A

general abortive + prophylactic treatments

43
Q

5 model approach to head pain- behavioral

A

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

OS lV Exam 1 (4 decks)

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