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ECOS IV Midterm > Primary Headache > Flashcards

Primary Headache Flashcards

1
Q

What are the primary causes of headaches?

A
  • Tension type headache
  • Migraine
  • Medication overuse
  • Cluster headache/trigeminal cephalgias
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2
Q

What are some secondary causes of headaches?

A
  • Worst headache of life –> subarachnoid hemorrhage
  • New onset focal neurologic weakness –> Stroke
  • Onset of headache at >50 years old –> temporal arteritis or neoplasm
  • Acute eye pain –> acute eye pain
  • High blood pressure –> hypertensive urgency or emergency or preeclampsia
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3
Q

What is needed to be done in the PE during a neurologic exam?

A
  • Rule out emergent conditions
  • Alert and oriented
  • CN exam
  • Extremity neurologic exam
  • Cerebellar exam
  • Walking gait
  • Special tests
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4
Q

What is the pain pattern of a tension type headache?

A
  • Bilateral tight/achy pain

- Band like

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5
Q

Where does the pain radiate in tension type headaches?

A
  • Radiation from occipital/cervical region
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6
Q

What are the different categories of tension type headaches?

A
  • Infrequent: <1 day per month
  • Frequent or episodic: 1-15 days/month
  • Chronic: 15 days/month
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7
Q

What are some common causes of tension type headache?

A
  • Myofascial pain referral
  • Cervical facet referral
  • TMJ dysfunction
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8
Q

How does myofascial pain referral cause tension type headaches?

A
  • Trigger point is the pain generator
  • Due to dysfunctional muscles
  • Discrete, focal, hyperirritable
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9
Q

What is a trigger point?

A
  • Palpable nodule “knot” in muscle

- Palpation –> twitch response which is visible and reproduces pain pattern

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10
Q

What is myofascial pain referral primarily due to?

A
  • Acute trauma
  • Chronic strain/overuse
  • Sedentary lifestyles
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11
Q

What is the difference between trigger points and tender points?

A
  • Trigger point
    1. Has characteristic pain pattern
    2. Only in taut band of muscle tissue
    3. Elicits pain pattern and twitch response when pressed
  • Tender point
    1. No pain pattern
    2. In muscles, tendons, ligaments, and fascia –> no taut band
    3. No radiating pattern or twitch response when pressed
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12
Q

What are some conservative therapies for myofascial pain referral?

A
  • Manual manipulation like ischemia compression
  • PT
  • Spray and stretch
  • Dry needling
  • Trigger point injections with lidocaine and steroids
  • Pharm: OTC analgesics, NSAIDS, antidepressants, muscle relaxants, BOTOX
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13
Q

What are tension type headache caused by cervical facet referral primarily due to?

A
  • Degeneration/arthritis
  • Injury
  • Overuse/poor posture
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14
Q

What is the pain generator in cervical facet referral?

A
  • Cervical facet joint capsule
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15
Q

What are some associated symptoms with cervical facet referral?

A
  • Palpation of joint reproduces symptoms

- Protective muscle spasms during ROM with painful loss of ROM

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16
Q

What is the treatment for cervical facet referral causing tension headaches?

A
  • RICE
  • Conservative –> manual medicine, PT
  • NSAIDs and steroids
  • Injection with lidocaine and steroids
  • Radiofrequency ablation
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17
Q

How does TMJD cause tension headaches?

A
  • Internal: malocclusion, bruxism, excessive opening

- External: trauma and displacement to joint/disc

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18
Q

What are the pain generators of TMJD?

A
  • Myofascial pain due to guarding/overuse
  • Joint capsule pain
  • Disc dislocation
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19
Q

What are some associated symptoms with TMJD?

A
  • Decreased ROM of jaw
  • Clicking, crepitus of joint (pop can be joint displacing)
  • Pain with opening/closing/chewing
  • Jaw deviation
  • Pain in the morning due to nocturnal bruxism
20
Q

What are some treatment options for TMJD?

A
  • TMJ specific –> bite splint, biofeedback, passive stretching
  • Conservative –> manual medicine, PT
  • Pharm –> NSAIDs or muscle relaxants
  • Joint or trigger point injection
  • Surgery generally contraindicated
21
Q

What is done in the biomechanical treatment for tension headaches?

A
  • Splint, stretching, spray and stretch, dry needling
  • OMT, PT
  • Injections/radiofrequency ablation
22
Q

What are some metabolic treatments for tension headaches?

A
  • Pharm –> NSAIDs and steroids
23
Q

What are some neurologic treatments for tension headaches?

A
  • Pharm –> muscle relaxers

- Preventative –> SSRIs or tricyclics

24
Q

What are some behavioral treatments for tensions headaches?

A
  • RICE
  • Prevent overuse
  • Biofeedback (CBT)
  • Smoking cessation (nicotine use correlates with headache)
25
Q

What are some behavioral etiologies of tension headaches?

A
  • Postural overuse –> anterior carry of neck or reverse lordosis of cervical spine due to long hours of studying
  • Arms raised overuse causing dysfunction between shoulder blades (hairdressers or factory workers)
26
Q

Who are migraines most often seen in?

A
  • Females more than males
  • Most common in 30-39
  • Genetic basis
27
Q

What are some clinical features of migraines?

A
  • Recurrent attacks

- Multiple phases –> prodrome, aura, migraine headache, postdrome

28
Q

What are some associated symptoms of migraines?

A
  • Unilateral throbbing burning pain
  • Aura
  • Nausea
  • Photophobia
  • Phonophobia
29
Q

What is seen in the prodrome phase of migraines?

A
  • Fatigue
  • Irritability
  • Depression or euphoria
  • Food cravings
  • Constipation
  • Neck stiffness
30
Q

When does the prodrome phase of migraines present?

A
  • 24-48 hours prior to onset
31
Q

What is the aura phase of migraines?

A
  • <1 hour of focal neurologic symptoms
  • Visual, sensory, language, or motor disturbances
  • Numbness and tingling
32
Q

What is seen in the postdrome of migraines?

A
  • Fatigue
  • Inability to concentrate
  • Depressed mood
33
Q

What are some common triggers of migraines?

A
  • Emotional stress
  • Hormones
  • Irregular sleep
  • Diet
  • Caffeine and alcohol
  • Changes in weather
  • Dehydration
  • Smells
  • Medications
34
Q

What are some biomechanical treatments for migraines?

A
  • Manipulation to decrease number of migraine days

- Acupuncture

35
Q

What are some respiratory/circulatory treatments for migraines?

A
  • Stay hydrated
36
Q

What are some metabolic treatments for migraines?

A
  • Don’t skip meals
37
Q

What are some neurologic treatments for migraines?

A
  • Abortive: triptans, ergots
  • Prophylaxis: propranolol, amitriptyline, topiramate, BOTOX
  • Anti-seizure meds
38
Q

What are some behavioral treatments for migraines?

A
  • Mindfulness/meditation
  • Yoga/Tai chi
  • Biofeedback
  • Avoid triggers
39
Q

What is the pain generator in medication overuse/rebound?

A
  • Chemical dependence on medication
40
Q

What are the associated symptoms of medication overuse/rebound?

A
  • Headache recurring around the same time every day

- Always relieved by taking medication

41
Q

What treatment can help medication overuse/rebound headaches?

A
  • Education is key

- Stop offending medication and can bridge cessation with other/different meds

42
Q

What is the pain pattern of trigeminal cephalalgia/cluster headache?

A
  • Unilateral severe, sharp, and stabbing pain around the eye

- Cycles during a cluster period

43
Q

What are some associated symptoms of trigeminal cephalgia/cluster headaches?

A
  • Autonomic symptoms
44
Q

What are some treatment options for trigeminal cephalgias/cluster headaches?

A
  • O2
  • Triptans
  • Ergotamine
  • Intranasal lidocaine
  • Verapamil is used prophylactically
45
Q

What is the respiratory/circulatory treatment for cluster headaches?

A
  • O2 is aborative

ECOS IV Midterm (8 decks)

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