Osteopathic Approach to Head Pain Flashcards
PE components in osteopathic approach to head pain
HEENT
Neuro (including muscle strength, CNs, DTRs)
OSE (flexion, extension, traction, and compression of cervical spine)
Psychological disposition
Special tests as indicated
Areas of possible TART or lymphatic findings in PE for head pain
Cranial Cervical Upper thoracic Upper ribs Upper extremities Sacrum Posture/leg length
Osteopathic considerations in terms of location of head pain as well as possible sympathetic involvement
Anterior 2/3 = trigeminal n.
Posterior 1/3 = lesser occipital (C1-3), recurrent branches of IX and X
Sympathetics: T1-4
Epidemiology of tension headache
Mean age at onset 25-30
Peak prevalence at age 30-39
Female to male ratio 5:4
30-78% mean lifetime prevalence of tension type headache globally
Risk factors for tension headache and associated conditions
Likely: Stress, mental tension, emotional disturbance
Possible: poor self-rated health, inability to relax after work, sleeping few hours per night
Associated: anxiety, depression, migraine +/- aura, medication overuse headache
Tension HA causes
Uncertain cause; susceptibility influenced by genetic factors in epidemiological and twin studies
Tension HA pathogenesis proposed
Active myofascial trigger points in head, neck, and shoulder
Episodic tension-type headache: peripheral pain mechanisms likely more important
Chronic tension type headache: central pain mechanisms more likely involved
Clinical features of tension type HA
Bilateral, mild to moderate intensity, pressing or tightening quality (nonpulsating)
Not aggravated by routine physical activity
No N/V; may have photophobia or phonophobia but not both
May increase in frequency or duration over time
Difference between episodic tension HA and chronic tension HA
Episodic: HA can last 30 minutes to 7 days; infrequent with less than 10 episodes occurring on less than 1 day per month over the course of a year; or can be frequent with greater than 10 episodes on 1-14 days per month for greater than 3 months; often develops into chronic type
Chronic: episodes on more than 15 days per month on average for more than 3 months; may be continuous and unremitting, pts with chronic type more likely to seek care
Most common abnormal HEENT finding with tension headache
Pericranial muscle tenderness — tends to be mostly the scalp
Can also have dysfunction of frontal, temporal, masseter, pterygoid, SCM, splenius, and trapezius mm. (More likely with episodic than chronic)
General 5 models for tension HA tx
Behavioral: identify triggers, encourage following prescriptions, biofeedback, CBT and relaxation, counseling
Neurologic: analgesics and NSAIDs, caffiene, metaclopramide
Biomechanical: PT and acupuncture, OMT/manual therapy level 2, intra-oral appliance
Metabolic: sleep hygiene, hormonal influences, hydration
Respiratory-circulatory: hydration
5 models OMT for tension headache
Biomechanical: address myofascial SDs, address joint SDs with cranial, MET, Still’s, HVLA, or FPR
Resp/circ: address lymphatics first to reduce irritants from inflammatory milieu
Neuro: address counterstrain points in cervicals, upper thoracics, upper ribs, and upper extremities; use cranial to address other SDs
Metabolic: improvement is d/t other approaches
Behavioral: exercise Rx to support tx of SDs contributing symptoms
One study showed that _______ (osteopathic technique) is more effective than control intervention for tension HA
MFR
Epidemiology of migraine
Currently about 15% of adults; 21% of US females and 10% of US males
Most common in american indian or alaska native > white > black or african american > hispanic or latino > native hawaiian or pacific islander > asian
Risk factors for migraine
Analgesic overuse (defined as daily or almost daily for over 1 month)
MS
Possibly oral contraceptives
