Primary Headache Flashcards
What are the primary causes of headaches?
- Tension type headache
- Migraine
- Medication overuse
- Cluster headache/trigeminal cephalgias
What are some secondary causes of headaches?
- 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
What is needed to be done in the PE during a neurologic exam?
- Rule out emergent conditions
- Alert and oriented
- CN exam
- Extremity neurologic exam
- Cerebellar exam
- Walking gait
- Special tests
What is the pain pattern of a tension type headache?
- Bilateral tight/achy pain
- Band like
Where does the pain radiate in tension type headaches?
- Radiation from occipital/cervical region
What are the different categories of tension type headaches?
- Infrequent: <1 day per month
- Frequent or episodic: 1-15 days/month
- Chronic: 15 days/month
What are some common causes of tension type headache?
- Myofascial pain referral
- Cervical facet referral
- TMJ dysfunction
How does myofascial pain referral cause tension type headaches?
- Trigger point is the pain generator
- Due to dysfunctional muscles
- Discrete, focal, hyperirritable
What is a trigger point?
- Palpable nodule “knot” in muscle
- Palpation –> twitch response which is visible and reproduces pain pattern
What is myofascial pain referral primarily due to?
- Acute trauma
- Chronic strain/overuse
- Sedentary lifestyles
What is the difference between trigger points and tender points?
- 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
What are some conservative therapies for myofascial pain referral?
- 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
What are tension type headache caused by cervical facet referral primarily due to?
- Degeneration/arthritis
- Injury
- Overuse/poor posture
What is the pain generator in cervical facet referral?
- Cervical facet joint capsule
What are some associated symptoms with cervical facet referral?
- Palpation of joint reproduces symptoms
- Protective muscle spasms during ROM with painful loss of ROM
What is the treatment for cervical facet referral causing tension headaches?
- RICE
- Conservative –> manual medicine, PT
- NSAIDs and steroids
- Injection with lidocaine and steroids
- Radiofrequency ablation
How does TMJD cause tension headaches?
- Internal: malocclusion, bruxism, excessive opening
- External: trauma and displacement to joint/disc
What are the pain generators of TMJD?
- Myofascial pain due to guarding/overuse
- Joint capsule pain
- Disc dislocation
What are some associated symptoms with TMJD?
- 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
What are some treatment options for TMJD?
- TMJ specific –> bite splint, biofeedback, passive stretching
- Conservative –> manual medicine, PT
- Pharm –> NSAIDs or muscle relaxants
- Joint or trigger point injection
- Surgery generally contraindicated
What is done in the biomechanical treatment for tension headaches?
- Splint, stretching, spray and stretch, dry needling
- OMT, PT
- Injections/radiofrequency ablation
What are some metabolic treatments for tension headaches?
- Pharm –> NSAIDs and steroids
What are some neurologic treatments for tension headaches?
- Pharm –> muscle relaxers
- Preventative –> SSRIs or tricyclics
What are some behavioral treatments for tensions headaches?
- RICE
- Prevent overuse
- Biofeedback (CBT)
- Smoking cessation (nicotine use correlates with headache)
What are some behavioral etiologies of tension headaches?
- 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)
Who are migraines most often seen in?
- Females more than males
- Most common in 30-39
- Genetic basis
What are some clinical features of migraines?
- Recurrent attacks
- Multiple phases –> prodrome, aura, migraine headache, postdrome
What are some associated symptoms of migraines?
- Unilateral throbbing burning pain
- Aura
- Nausea
- Photophobia
- Phonophobia
What is seen in the prodrome phase of migraines?
- Fatigue
- Irritability
- Depression or euphoria
- Food cravings
- Constipation
- Neck stiffness
When does the prodrome phase of migraines present?
- 24-48 hours prior to onset
What is the aura phase of migraines?
- <1 hour of focal neurologic symptoms
- Visual, sensory, language, or motor disturbances
- Numbness and tingling
What is seen in the postdrome of migraines?
- Fatigue
- Inability to concentrate
- Depressed mood
What are some common triggers of migraines?
- Emotional stress
- Hormones
- Irregular sleep
- Diet
- Caffeine and alcohol
- Changes in weather
- Dehydration
- Smells
- Medications
What are some biomechanical treatments for migraines?
- Manipulation to decrease number of migraine days
- Acupuncture
What are some respiratory/circulatory treatments for migraines?
- Stay hydrated
What are some metabolic treatments for migraines?
- Don’t skip meals
What are some neurologic treatments for migraines?
- Abortive: triptans, ergots
- Prophylaxis: propranolol, amitriptyline, topiramate, BOTOX
- Anti-seizure meds
What are some behavioral treatments for migraines?
- Mindfulness/meditation
- Yoga/Tai chi
- Biofeedback
- Avoid triggers
What is the pain generator in medication overuse/rebound?
- Chemical dependence on medication
What are the associated symptoms of medication overuse/rebound?
- Headache recurring around the same time every day
- Always relieved by taking medication
What treatment can help medication overuse/rebound headaches?
- Education is key
- Stop offending medication and can bridge cessation with other/different meds
What is the pain pattern of trigeminal cephalalgia/cluster headache?
- Unilateral severe, sharp, and stabbing pain around the eye
- Cycles during a cluster period
What are some associated symptoms of trigeminal cephalgia/cluster headaches?
- Autonomic symptoms
What are some treatment options for trigeminal cephalgias/cluster headaches?
- O2
- Triptans
- Ergotamine
- Intranasal lidocaine
- Verapamil is used prophylactically
What is the respiratory/circulatory treatment for cluster headaches?
- O2 is aborative
