Topic 4 - Headaches Flashcards
What are the 3 main classifications of headaches?
1) Vascular
2) Inflammatory
3) Musculoskeletal
What are 2 types of vascular headaches?
1) Migraine
2) Cluster HA
What are 4 causes/types of inflammatory headaches?
1) Tumour
2) Disease of Eye/Nose/Throat
3) Sinus HA
4) Head Trauma
What are 3 causes/types of musculoskeletal headaches?
1) Tension HA
2) Cervicogenic HA
3) TMJ Dysfunction
When the headache is the primary concern and not the result of an underlying pathology.
Primary Headache
When the headache is the result of a complication to a primary pathological process. This may arise from head/neck trauma, cranial/cervical vascular disorder or non-vascular inter-cranial disorders.
Secondary Headache
T/F - Drug use or withdrawal may cause primary headaches.
False - Drug use or withdrawal may cause SECONDARY headaches.
T/F - Any especially painful headache is considered a migraine.
False - NOT ALL especially painful headaches are considered migraines.
A type of vascular headache that is thought to be caused by vasoconstriction followed by rapid vasodilation with some evidence that there may be some neurological dysfunction involved.
Migraine
T/F - There is a greater prevalence of migraines among females.
True
T/F - Migraines are debilitating and can often interrupt work or ADLs.
True
What are the 2 types of migraines?
1) With Aura (15%)
2) Without Aura (85%)
Any sensory hallucination such as lights in the eyes/visual disturbances, ringing in the ears or tingling in the limbs or face.
Aura
Symptoms/characteristics of a ________ include:
- Pulsating/throbbing unilateral pain (can last 1-2 days)
- Accompanied by photophobia, visual disturbances, phonophobia, nausea & vomiting
- Aggravated by physical activity
- Wanting to lie down in a dark quiet space
- Occurence is occasional, not daily (up to 1-2 per week)
- Sometimes preceded by an aura
- Prodromal symptom (e.g. fatigue, irritability) hours to days before onset of pain (only for type with aura)
Migraine
Treatment for a ________ includes:
- Avoiding triggers
- Prophylactic or abortive drugs (e.g. Imitrex, Fiorinal, Miranal, narcotic analgesics)
Migraine
T/F - OTC drugs are often enough to treat migraines.
False - OTC drugs are often NOT enough to treat migraines.
Triggers for a ________ include:
- Monosodium glutamate (MSG)
- Tannic foods (e.g. old cheese, red wine, chocolate)
- Coffee
- Citrus fruits
- Sleep loss/too much sleep
- Stress/stress letdown
- Hormonal levels
Migraine
A type of vascular headache described as an unrelenting collection of headaches of varying duration. They are infrequent and affect males more than females.
Cluster Headache
_______ headaches occur over weeks to months followed by periods of remission, which could be months to years.
Cluster
Cluster headaches may spontaneously ____ and the mechanism is _______.
Stop
Unknown
T/F -Cluster headaches are often confused with dental or sinus problems.
True
Symptoms/characteristics of a _______ headaches include:
- Severe, unrelenting, unilateral pain
- Location varies
- Rapid onset that builds to a peak in 10-15 minutes
- Lasts 15 -180 minutes
- No aura
Cluster
_______ headaches are often associated with:
- Conjunctival redness
- Lacrimation
- Nasal congestion
- Visual impairment
- Ptosis
- Palpebral edema
- Forehead/facial perspiration
Cluster
Treatment for cluster headaches include __________, either OTC or prescription.
Analgesics
A type of headache associated with low blood sugar and can be an issue for diabetics. Decreased blood glucose means less fuel for the brain.
Hypoglycemic Headache
Treatment for a ____________ headache includes:
- Eating smaller meals more frequently
- Eating more complex carbohydrates (slow food)
- Avoid processed carbohydrates that will cause blood sugar to spike and crash
- If you are diabetic, inject the appropriate amount of insulin
Hypoglycemic
A type of headache that may result from overmedicating, either by taking excessive doses or taking medications when not needed. It is idiopathic and may occur in those suffering from migraines, tension headaches or chronic daily headaches.
Drug Rebound Headache
With a ____ _______ headache, increasing dosages of the medication are needed to control the headache. This is known as a ________ feedback loop.
Drug Rebound
Positive
_______ _____ headaches are considered a syndrome (not a diagnosis) with a number of sub-categories. They are categorized by the patient having a headache for 15+ days/month, for at least 3 months.
Chronic Daily
T/F - Chronic daily headaches can only be primary headaches that can be debilitating and interfere with ADLs.
False - Chronic daily headaches can be primary OR SECONDARY headaches that can be debilitating and interfere with ADLs.
A type of inflammatory headache in which pain occurs in the sinus region, often the infraorbital region and upper teeth. It tends to worsen with forward bending or lying down.
Sinus Headache
T/F - Positioning in prone may be painful for someone with a sinus headache.
True
_____ headaches are caused by sinus congestion and mucosal inflammation.
Sinus
Treatment for a _____ headaches includes:
- Decongestant medications, contrast compresses, nasal irrigation & steams
- Antibiotics may be used if congestion is related to a bacterial infection
- Acupressure points can help with drainage
Sinus
A type of musculoskeletal headache as a result of joint dysfunction in the cervical spine. Facet irritation of ___-___ can refer pain to the back of the head.
Cervicogenic Headache
C2-C3
A ____________ headache will present secondarily to neck/shoulder pain and treating the cervical impairment should decrease headache pain.
Cervicogenic
A type of musculoskeletal headache as a result of compression of surrounding structures (e.g. nerves, vasculature) due to increased muscle resting tension and/or trigger points.
Tension Headache
Some characteristics of _______ headaches include:
- Will present secondarily to neck/shoulder pain & tightness
- Most common type of headache
- Increased prevalence in females
- Severity and duration varies between individuals
- Can be frequent, episodic & chronic
- If caused by trigger points, pain will be in a typical referral pattern
Tension
T/F - Massage therapists are not very effective in treating headaches of musculoskeletal origin.
False - Massage therapists CAN BE very effective in treating headaches of musculoskeletal origin.
T/F - A combination of tension and cervicogenic headaches is common.
True
Some potential causes of _______________ headaches include:
- Soft tissue injury (e.g. trauma, whiplash)
- Overloaded musculature (e.g. faulty/dysfunctional posture)
- Emotional tension
- Greater occipital nerve irritation/impingement
- Inflammation of joints & nerves of upper c-spine (e.g. CN V, VII, IX, X - sensation to face, forehead, orbit, TMJ)
- Vascular compression
- Cervical/thoracic joint mobility issues
Musculoskeletal
With musculoskeletal headaches, pain leads to muscle ___________, which leads to decreased ___________ and back to pain. As a result, there is soft tissue dysfunction and potential soft tissue and joint impairments.
Contraction
Circulation
History and signs/symptoms of ________ headaches include:
- Unilateral/bilateral headaches (one side is often predominant)
- Pain in neck/suboccipital region that spreads into the head
- Intensity can fluctuate between mild, moderate or severe
- Precipitated by sustained neck postures or movements
- May be precipitated by stress
- May be related to trauma, degenerative disc disease or sedentary lifestyle & postural stresses
- More prevalent in females
- No familial tendency
- Pain/altered sensation in face/TMJ region
Cervical
Some ___ _____ for headaches include:
- Patient states that this is either the first or worst headache they have ever experienced
- Reports sharp pain or spikes in intensity
- Change in personality/behaviour
- Headache worse with coughing/straining
- Neurological signs/symptoms
- Loss of consciousness, nose bleed
- Headache post head trauma
Red Flags
A referral to a _________ is indicated if the patient complains of any red flags, as the headache is probably not of _______________ origin.
Physician
Musculoskeletal
Musculoskeletal impairments that may cause ________ headaches include:
- Joint impairments in the upper c-spine (e.g. pain, motion restriction)
- Poor joint alignment & biomechanics (distributes load inefficiently)
- Poor muscle endurance & overloading due to muscles being placed in a shortened/lengthened position
- Poor shoulder girdle/scapular mobility related with muscular imbalance (e.g. weak serratus anterior = overworked trapezius to upwardly rotate scapula)
Cervical
With head forward posture, muscles of the _________ neck will need to work much harder to control _______ of the distal c-spine.
Posterior
Flexion
Musculoskeletal impairments that may cause ________ headaches include:
- Impaired lumbar posture with related muscle imbalances
- Impaired thoracic mobility
- Impaired neural tissue from pressure/inflammation in the upper cervical/craniovertebral region
- Increased muscle resting tension
- Trigger points
Cervical
Some trigger points referring into the ____ include:
- Sternocleidomastoid
- Upper trapezius
- Levator scapula
- Suboccipitals
- Temporalis
- Splenius cervicis
- Splenius capitis
- Digastric
- Frontalis
Head
Some goals when treating ________ headaches include:
- Decrease/eliminate trigger points
- Decrease/eliminate associated myofascial restrictions
- Reduce/eliminate spasm (depending on cause)
- Reduce unnecessary muscle tension
- Normalize joint mobility in the cervical spine
- Normalize posture/muscle imbalances at thoracic/lumbar spine
Cervical
When it comes to prescribing therapeutic exercise for cervical headaches, strengthening the deep neck _______ and stretching the neck _________ would be a goal.
Flexors
Extensors
What are the 5 motions of the temporomandibular joint?
1) Depression
2) Elevation
3) Protrusion
4) Retraction
5) Lateral Deviation
Signs and symptoms of _________________ _____ dysfunction include:
- Pain in the TMJ region that is affected by movement (e.g. chronic toothache, blocked ears)
- Joint noise during movement (e.g. clicking)
- Restrictions/limitations with jaw movement
Temporomandibular Joint
Potential sources of pain with _________________ _____ dysfunction include:
- Local pain in TMJ in the richly vascularized and highly innervated retrodiscal pad
- Pain from muscle spasm/myofascial pain (e.g. masseter, medial/lateral pterygoid)
- Trigger points in muscles of c-spine can refer into TMJ region
Temporomandibular Joint
Possible causes of _________________ _____ dysfunction include:
- Poor oral hygiene
- Gum chewing
- Heavy kissing
- Grinding teeth excessively (e.g. bruxism)
- Smoking
- Inflammatory conditions (e.g. rheumatoid arthritis)
- Open mouth breathing
- Emotional stress
- Faulty joint mechanics
- Postural dysfunction
Temporomandibular Joint
T/F - Temporomandibular joint dysfunction has no link to neck pain.
False - Temporomandibular joint dysfunction IS OFTEN linked to neck pain.
Patients with neck pain respond by _______, which may lead to muscle or TMJ pain.
Bruxing
Head forward posture results in __________ of the mandible, which places the anterior throat muscles in a __________ position. There is increased activity in muscles that close the jaw to counter the mandibular depression caused by _________ muscles.
Retraction
Lengthened
Digastric
Extension of the upper cervical spine places muscles and soft tissue in the suboccipital region in a _________ position. This can lead to increased MRT, trigger points and _________.
Shortened
Adhesions
The nerves and ______ in the upper cervical region can become __________ or irritated, which is linked to neck pain.
Joints
Compressed
Some goals when treating _________________ _____ dysfunction include:
- Decrease unnecessary MRT, adhesions and TrPs
- Decrease/eliminate spasm of facial/jaw muscles
- Normalize c-spine posture
- Normalize joint movement at TMJ
- Correct muscle imbalances in c-spine, t-spine & l-spine
- Patient education on relaxation techniques
Temporomandibular Joint
Some trigger points referring into the _________________ joint include:
- Masseter
- Digastric
- Temporalis
- Lateral pterygoid
- Medial pterygoid
Temporomandibular
