WAD & Headache - Exam 2

Question 1

Alar ligamentous tears:
– runs from?
– weaker than?
– unique S&S?

Answer 1

– dens up and lateral to foramen magnum
– transverse ligament
– splinting, particularly with SB due to immediate tension on ligament. Possible cord S&S due to loss of dens stability

Question 2

Transverse ligament tears:
– stronger than?
– keeps dens from moving ___ & contacting ___
– unique S&S?

Answer 2

– dens
– keeps dens from moving posterior and contacting cord
– splinting and likely cord S&S with forward nodding

Question 3

what is a rim lesion?

Answer 3

horizontal tear of anterior annulus close to end plate - think of ligament rupture

Question 4

rim lesion is often misdiagnosed as?

Answer 4

rare anterior disc herniation

Question 5

what is the cause of rim lesion?

Answer 5

excessive hyperextension

Question 6

unique S&S of rim lesion

Answer 6

splinting, particularly with extension due to tension on torn anterior annulus
pain with compression (end plate) and distraction (annulus)

Question 7

what are symptoms of WAD?

Answer 7

• trauma with acute neck and interscapular referred P!
• potential trigeminocervical nucleus (TCN) symptoms

Question 8

what would you notice in a scan for WAD?
– observation:
– ROM:
– resisted/MMT:
– neuro:
– stress tests:

Answer 8

– likely splinting
– limited with empty and painful end feels in several if not all directions
– weak and painful in several directions
– + findings, including cord or cranial n involvement
– + for involved tissue

Question 9

what would a biomechanical exam show with immobilization/disuse?

Answer 9

joint hypomobility with accessory motion
fibrotic scarring

• excessive scarring –> hypomobile

Question 10

what would a biomechanical exam show if no prolonged immobilization or fibrotic scarring?

Answer 10

hypermobility due to laxity

Question 11

what is trigeminocervical nucleus (TCN)?
-___________ may develop
-location?
-the interaction of?

Answer 11

nociplastic P! may develop
located at C2, 3
interaction of sensory nerve fibers of trigeminal nerve and upper cervical spinal nerves

Question 12

in TCN, what areas experience symptoms from inflammation and/or sensitization?

Answer 12

head, face and neck

Question 13

describe the symptoms at each of the 8 areas TCN causes symptoms
1 - mandibular n.
2. ophthalmic n.
3. maxillary n.
4. CV region (C1-3 spinal n.)
5. head (C1-3 spinal n)
6. face (C1-3 spinal n)
7. jaw (C1-3 spinal n)

Answer 13

1 - tongue - altered taste/tingling
- ear - P!/tinnitus/hypersensitivity to sound
2. eye - P!/conjunctivitis without red eye/visual deficits
3. tooth ache/P!
4. upper cervical P!
5. headache aka cervicogenic HA
dizziness aka cervicogenic dizziness
paresthesia’s
6. p!/paresthesia’s
7. TMJ P!

Question 14

TCN also receives sensory input from what nerve? where is its nucleus?

Answer 14

vagus N
C3, 4

Question 15

What does the vagus nerve promote with TCN? (3)
What symptoms of parasympathetic system dysfunction? (6)

Answer 15

calmness, relaxation, digestion

irregular HR, lack of sweating, dyspnea, nausea, indigestion, GI S&S
——coordination can be influenced too

Question 16

general Rx for WAD:

Answer 16

1 - POLICED (soft collar)
2 - improve joint mechanics and stabilize
- cervical & thoracic JM/manipulation
- deep neck flexor and scapular stabilizer exercises
- if nociplastic P!: body awareness and stabilization exercises
– 90 minute sessions, 2x/wk, 10-16 weeks

Question 17

if a younger individual with a low disability at baseline presents with WAD, what is their prognosis?

Answer 17

~50% P! free at 6 months and 8/10 fully recovered

Question 18

true or false. following MVA, 50% report symptoms of WAD up to 2 years

Answer 18

true

Question 19

HA with other suspicious S&S (dizziness) require what type of referral?

all other HA - perform what?

Answer 19

urgent or even emergency

perform MSK scan and biomechanical exam

Question 20

primary HA are due to what? what are the 3 types of primary HA?

Answer 20

due to HA condition itself

tension, migraine, cluster

Question 21

what are secondary HA due to? what is the type?

Answer 21

another source
cervicogenic

Question 22

symptoms of tension headaches?

Answer 22

BAND
bilateral band-like tightness
anxiety/stress etiology
no migraine S&S - milder
dull pressure

Question 23

tension HA:
- prevalence:
- cause:

Answer 23

• ~40% of HAs
• anxiety/stress can have associated muscle tension

Question 24

what would a PT do for a tension HA?

Answer 24

address anxiety/stress
moderate quality evidence for MET plus biofeedback
oscillations or manipulations (tension doesn’t like prolonged tension)

Question 25

what are symptoms of a migraine?

Answer 25

POUNDS
pulsating
out of commission (mod-severe P! up to 3 days)
unilateral
N&V
dromes - constitutional S&S
sensational auras with visual and/or auditory sensitivity

Question 26

migraine:
- prevalence
- cause:

Answer 26

• 10-15% of headaches
• temporal artery vasodilation
  trigeminal n. nociplastic P! with CV dysfunction

Question 27

what would a PT do for a migraine?

Answer 27

address CV dysfunction
vasoconstriction of temporal arteries - caffeine
increase water intake - 1.5 L/day
2-3 mg melatonin prior to bedtime
nociplastic P! MET

Question 28

what are symptoms for a cluster HA?

Answer 28

CRUSHING
comes and goes
retro-orbital and temporal regions
unilateral
sudden and severe P!
horners syndrome
intense
grumpy

Question 29

how common are cluster headaches?

Answer 29

not common
< 1% of HA

Question 30

cervicogenic headaches:
- prevalence:
- pathophysiology:

Answer 30

• 15-20%
• C2 and/or C3 joint dysfunction due to trigeminal cervical influence

Question 31

what are symptoms of cervicogenic headaches?

Answer 31

unilateral
starting in neck/occipital region, progressing to fronto-ocular region
provoked by neck motion (movement of spine)
mild to mod pain
non-throbbing/pulsating

Question 32

what are signs of a cervicogenic headache?

Answer 32

limited and painful A/PROM
possible + combined motion
possible + neuro hypersensitivity
C2 and C3 joint dysfunction
- hypo and/or hypermobility: + linear stress test
+ cervical flexion rotation test
+ TTP (tenderness to palpation) in O-C3 region

Question 33

what should a PT do to treat cervicogenic headaches?

Answer 33

address cervical dysfunction – address what we find
dry needling - not recommended as stand alone Rx, use with MT and exercise