Primary/Secondary Headache Disorders Flashcards
Primary headaches
have a path-mechanical process not caused by other disease or disorders
secondary headaches
HA caused by other disorders
which types of headaches are primary headaches
migraine and tension type headaches
SNOOP4
- Systemic
- Neurological
- Onset sudden
- Onset after 50 yo
- Pattern change
- Progressive
- Precipitate valsalva
- postural aggravation
- papilledema
red flag history
- history of mechanical trauma
- recent respiratory or GI infection
- Neurological or ischemic symptoms
Red Flag Screening Tests
- Neurological or ischemic signs and symptoms including balance deficit
- Jolt accentuation of HA is a new and less recognized examination –> assesses meningeal irritation
- Lhermitte’s sign
- Vertebral artery test
What is a positive jolt accentuation of HA test?
positive if headache is exacerbated by rotating the head horizontally two or three times per second
Horner’s Syndrome Key Features
- decreased pupil size, ptosis, and decreased sweating on affected side of the face
Migraine Chart
- 4-72 hours
- Unilateral
- Pulsating
- Moderate to severe
- Aggravated by routine PA
- nausea, vomiting, or both
- Photophobia, Phonophobia, or both
- Neck pain is common but does not precede the headache
tension-type Headache Characteristics
- 30 mins to 7 days
- Bilateral
- Pressing or tightening: non-pulsating
- Mild to Moderate
- Not aggravated by routine PA
- No nausea or vomiting
- Either phonophobia or photophobia but not both
- myofacial trigger points commonly present in the pericranial region and C spine
cervicogenic headache characteristics
- variable duration
- unilateral
- dull ache
- mild to moderate
- not aggravated by routine PA
- no nausea or vomiting
- typically no phonophobia or photophobia but in some cases there can be one or the other (not both)
What causes tension type headache?
- peripheral sensitization of nociceptors in myofascial tissue
- increased muscle tenderness (contributory but not necessarily causatory)
chronic TTH
- Occurs > 15 days/month for > 3 months; altered pain sensitivity and central pain modulation
Diagnostic criteria for TTH
A. > 10 episodes fulfilling B-D
B. HA lasting 30 mins to 7 days
C. At least two: bilateral, pressing or tightening (non-pulsating), mild or moderate, not aggravated by routine PA
D. No nausea or vomiting, not greater than 1 photophobia or phonophobia
E. Not better accounted for by something else
Acute management of TTH
analgesic medication or analgesic plus caffeine, muscle relaxers
Preventative management of TTH
tricyclic antidepressants, beta blockers, Divalproex sodium
TrP injections for TTH
typically uses lidocaine and bupivacaine
manual therapy for TTH
- trust and non-thrust spinal mobilization and manipulation
- mobilization with movement
- STM/IASTM
- Dry needling
- etc
exercise and education for TTH
- posture and ergonomic adjustment
- stretching
- postural strengthening
- neural mobilization exercises
what is/what causes migraine headaches?
- stimulation of peripheral afferents in the trigeminocervical complex
- pathophysiology is complex and unclear but may have genetic abnormalities that increase CNS excitability
things included in trigeminocervical complex
all branches of CNV, posterior dura, C1 and C2 dermatomes
Premonitory: 2-48 hours before migraine
neck pain, fatigue, yawning, impaired concentration, mood changes, food cravings, increased urinary frequency, irritability, nausea and difficulty sleeping