Week 5 & 6 Flashcards
Are females or males more likely to suffer from headaches?
females
How common is neck pain in migraine?
~75-80% of cases report neck pain accompanying migraine
What are the three types of headaches?
migraine, tension-type headache (TTH) and cervicogenic headache
Contrast primary vs secondary headaches.
primary (i.e. migraine or tension-type) may have no particular cause
secondary (i.e. cervicogenic) is secondary to musculoskeletal dysfunction
True or false, all headaches can be worsened with medication overuse.
True
What is the population incidence of cervicogenic headache?
0.8-2.2% (less common than migraine or TTH)
Where does TTH commonly present headache/pain?
forehead
Where does migraine commonly present headache/pain?
unilaterally (+/- neck)
Where does cervicogenic headache present headache/pain?
unilateral, back and top of the head (+ ipsilateral neck)
Can any of the three types of headache be diagnosed with imaging or bloods?
No- all are diagnosed using a criteria on clinical presentation
What is the diagnostic criteria for migraine?
+/- aura preceding ~5-60 minutes
headache lasting 4-72 hours
at least 2:
unilateral (but can change sides)
pulsating quality
moderate to severe intensity
aggravated by physical activity
at least 1:
vomiting or nausea
photophobia/phonophobia
What is the difference between episodic and chronic migraine?
episodic= <15 per month
chronic= >15 per month, 7 of which are ‘true’ migraine
What are the 5 stages of migraine?
- early warning symptoms (i.e. mood change)
- aura
- headache +/- nausea, vomiting, sensitivity to light, sound, smell
- resoluation
- recovery (feeling drained or energetic ~24 hours)
What is the hypothesised cause of migraines?
potentially certain parts of the brain being hypersensitive to particular stimuli i.e. emotion, sensory or sudden change in the internal or external environment
What are some common triggers for migraines?
dietary (i.e. missed or delayed meals, caffiene withdrawal, wine, bee, spirites, chocolate, citrus, aged cheese, MSG, dehydration)
environmental (i.e. blight/flickering lights, strong smells, travel, altitude, weather changes, loud sounds)
hormonal (i.e. menstruation, ovulation, oral contraceptives, pregnancy, hormone replacement therapy, menopause)
physical/emotional (i.e. sleep, viral infection/cold, back or neck pain, stress, arguments, relaxation after stress)
What is the diagnostic criteria for TTH?
headache lasting 30 minutes to 7 days
at least 2:
pressing/tightening/non-pulsating quality
bilateral, bandlike headache
mild to moderate intensity, not aggravated by physical activity
both:
no nausea or vomiting
no more than one photophobia or phonophobia
What causes TTH?
not sure
some triggers include emotional tension, anxiety, tiredness or stress
genetics may have a role
What is the diagnostic criteria for cervicogenic headache?
unilateral without side-shift
associated with ipsilateral neck pain
pain starts in the neck
no pulsating
aggravated by neck movement
restricted neck ROM
eliminated by cervical diagnostic block
possible nausea, phono/photophobia
What 3 msk dysfunctions are commonly seen in cervicogenic headache?
reduced ROM (esp. cervical rotation and extension)
segmental joint dysfunction in upper 3 segments (i.e. pain, hypomobility, local muscle spasm)
altered muscle behaviour in the CCFT (increased superficial muscle activity)
Name some red flags in headache patients.
severe & sudden onset
subacute headache progressively worsening
neurological signs or changes in consciousness
1st ever headache
recent trauma
general malaise
Two main arteries that supply the brain.
vertebral arteries (supply 20%)
carotid arteries (supply 80%)
What is cervical arterial dissection (CAD)?
dissection of a vertebral or carotid artery causing a change in blood flow and potential formation of a clot, leading to stroke
incidence 2.97 per 100,000
CAD is an important cause of stroke in what population?
young people <45 years (~25%)
Has CAD been linked with neck manipulation?
yes- whether causative or missed diagnosis though unsure
How can we recognise CAD?
acute onset of new, unusual pain
moderate-severe pain
transient neurological features (i.e. balance/gait, speech, visual disturbance)
age <55 years
Horner’s syndrome
spontaneous nystagmus (particularly bi-directional)
What is horner’s syndrome?
Horner’s syndrome:
ptosis (unilateral eyelid droop)
miosis (unequal pupils)
facial droop
Why are neck afferents important for everyday function?
they provide information to the brainstem to integrate with other sensory information
allow us to know head position in relation to body
inform postural control
eye/trunk head coordination
sensory matching
What sensorimotor dysfunction could we see with neck pain?
altered proprioception (joint position and movement sense)
altered eye movement control (smooth pursuit & gaze stability)
altered eye/head and trunk/head coordination
altered standing balance (static & dynamic)
What causes abnormal afferent input in neck disorders?
direct damage from trauma
functional impairment in muscles
morphological changes in muscle
inflammation
altered muscle activity
pain
sympathetic nervous system i.e. stress
Are sensorimotor control impairments more common in traumatic or idiopathic neck disorders?
traumatic- however could still be present with idiopathic as well
Describe cervicogenic dizziness.
episodic, vague unsteadiness with a close temporal relationship with neck pain
What is vertebrobasilar insufficiency (VBI)?
insufficient blood flow through the vertebral artery to the hindbrain
Where are the potential sites of tension on the vertebral artery that may cause VBI?
1st part- muscle compression (anterior/medial scalenes)
2nd part- vertebral bodies (disc, z joints, canals, think degenerative conditions)
3rd part- C1/2 rotation causes kinking of the contralateral artery
What are the causes of VBI?
atherosclerosis
head position
Bow-Hunters syndrome (rare)
post-traumatic headache/dizziness
What are the common signs of VBI?
5 D’s (dizziness, diplopia, dysarthria/dysphasia, drop attacks, dysphagia)
3 N’s (nausea, nystagmus, numbness)
