Week 5: Headaches Flashcards
4 main types of headaches
Migraine
Tension type heache
Cervicogenic headache
Medication overuse headache
Features of a migraine
Typically unilateral, aggravated by physical activity and has accompanying neck pain
Features of a tension type headache
Featureless headache characterised by nothing more than a pain in the head
Cause unknown
Band like pain - bilateral
Features of cervicogenic headache
Headache results from cervical spine (referred pain)
Headache associated with cervical stiffness and mostly unilateral
C0-C3 ROM rotation
60% of all rotation
C0-C3 ROM flexion-extension
33% of all flexion-extension
Features of medication overuse headache
Chronic headache associated with more than 3 months’ overuse of analgesics in people with pre-existing primary headache
No cause or pathogenesis
Are medication overuse headaches more common in men or women
Women (4:1)
Red flag list for headaches
Rapid onset of symptoms
Thunderclap headache
Neurological signs
Prominent neck pain with or without fever
Age >50
Worsening with positional changes
History of migraine
Distinguishing features for migraine
Neurological symptoms
Unilateral
Sensitivity to light and sound
Nausea/dizziness
Moderate to severe pain
aggravated by physical activity
Distinguishing features for tension type headache
Band like pain around forehead
Nothing more than pain in the head
Bilateral
No nausea
No aggravation
No trigger
non-episodic
Distinguishing features for Cervicogenic headache
Mostly unilateral
Associated with activities at the neck
Aggravated by head movements
What is the cervical flexion rotation test good for?
Good for ruling in and out cervicogenic headaches
What difference indicates cervicogenic headache for the cervical flexion rotation test
15 degrees differences in usual 45 degree rotation
10 degree difference between sides
What muscle deficit is associated with cervicogenic headache
Weakness in deep neck flexors
Strength difference for migraine and cervicogenic headache
Migraine: normal strength
Cervicogenic headache: weakness in deep neck flexors
Examination to diagnose cervicogenic headache
Reduced active ROM
Flexion rotation test
Is acupuncture useful for migraine?
moderately beneficial for prevention and treatment
Treatment for migraine
Acutely: use medication
Preventive:
- medication
- behavioural techniques (relaxation, CBT)
- Complementary medicine (yoga, mindfulness)
- lifestyle (eating, sleeping, smoking)
- Acupuncture/exercise
Is manual therapy effective for tension type headaches
Reasonably - found to reduce number of headaches per day
Tension type headaches treatment
Acutely: paracetamol
Treatment:
- behavioural techniques (relaxation training, CBT)
- TENS
- Joint mobilisation + exercises
Cervicogenic headaches treatment
Correct posture (lumbopelvic extension, avoid thoracic kyphosis, traps more horizontal)
Exercise combined with manual therapy (STM of scalenes + traps and central PAs)
How does work environment affect patient with headaches
Looking down at laptop (head going into craniocervical extension and lower cervical flexion - craned neck)
hands out in front - scapula protraction and anterior tilt
Lumbopelvic flexion in bad seat
Posture things to address for neck pain
Weak cervical flexors cannot maintain neutral cervical posture. This causes craniocervical extension (craned neck)
Correct lumbopelvic posture (neutral posture)
Correct thoracic posture (neutral and avoid kyphosis)
Address scapula posture - want posterior tilt and upward rotation
What scapula position may cause headache
Anterior tilt and downward rotation
Treatment for cervicogenic headache
Advice/Education: change position, posture, ergonomic set up, regular breaks to get up and move at work, posture cues
motor control exercises (get out of forward head control)
Manual therapy - sub occipital massage, PAs, PAIVM to cervical spine
Exercises: bow and arrows, chin retractions, deep neck flexor strength, cervical extensors, axio-scap musculature
