Week 5: Headaches

Question 1

4 main types of headaches

Answer 1

Migraine
Tension type heache
Cervicogenic headache
Medication overuse headache

Question 2

Features of a migraine

Answer 2

Typically unilateral, aggravated by physical activity and has accompanying neck pain

Question 3

Features of a tension type headache

Answer 3

Featureless headache characterised by nothing more than a pain in the head
Cause unknown
Band like pain - bilateral

Question 4

Features of cervicogenic headache

Answer 4

Headache results from cervical spine (referred pain)

Headache associated with cervical stiffness and mostly unilateral

Question 5

C0-C3 ROM rotation

Answer 5

60% of all rotation

Question 6

C0-C3 ROM flexion-extension

Answer 6

33% of all flexion-extension

Question 7

Features of medication overuse headache

Answer 7

Chronic headache associated with more than 3 months’ overuse of analgesics in people with pre-existing primary headache
No cause or pathogenesis

Question 8

Are medication overuse headaches more common in men or women

Answer 8

Women (4:1)

Question 9

Red flag list for headaches

Answer 9

Rapid onset of symptoms
Thunderclap headache
Neurological signs
Prominent neck pain with or without fever
Age >50
Worsening with positional changes
History of migraine

Question 10

Distinguishing features for migraine

Answer 10

Neurological symptoms
Unilateral
Sensitivity to light and sound
Nausea/dizziness
Moderate to severe pain
aggravated by physical activity

Question 11

Distinguishing features for tension type headache

Answer 11

Band like pain around forehead
Nothing more than pain in the head
Bilateral
No nausea
No aggravation
No trigger
non-episodic

Question 12

Distinguishing features for Cervicogenic headache

Answer 12

Mostly unilateral
Associated with activities at the neck
Aggravated by head movements

Question 13

What is the cervical flexion rotation test good for?

Answer 13

Good for ruling in and out cervicogenic headaches

Question 14

What difference indicates cervicogenic headache for the cervical flexion rotation test

Answer 14

15 degrees differences in usual 45 degree rotation

10 degree difference between sides

Question 15

What muscle deficit is associated with cervicogenic headache

Answer 15

Weakness in deep neck flexors

Question 16

Strength difference for migraine and cervicogenic headache

Answer 16

Migraine: normal strength
Cervicogenic headache: weakness in deep neck flexors

Question 17

Examination to diagnose cervicogenic headache

Answer 17

Reduced active ROM
Flexion rotation test

Question 18

Is acupuncture useful for migraine?

Answer 18

moderately beneficial for prevention and treatment

Question 19

Treatment for migraine

Answer 19

Acutely: use medication
Preventive:
- medication
- behavioural techniques (relaxation, CBT)
- Complementary medicine (yoga, mindfulness)
- lifestyle (eating, sleeping, smoking)
- Acupuncture/exercise

Question 20

Is manual therapy effective for tension type headaches

Answer 20

Reasonably - found to reduce number of headaches per day

Question 21

Tension type headaches treatment

Answer 21

Acutely: paracetamol
Treatment:
- behavioural techniques (relaxation training, CBT)
- TENS
- Joint mobilisation + exercises

Question 22

Cervicogenic headaches treatment

Answer 22

Correct posture (lumbopelvic extension, avoid thoracic kyphosis, traps more horizontal)

Exercise combined with manual therapy (STM of scalenes + traps and central PAs)

Question 23

How does work environment affect patient with headaches

Answer 23

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

Question 24

Posture things to address for neck pain

Answer 24

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

Question 25

What scapula position may cause headache

Answer 25

Anterior tilt and downward rotation

Question 26

Treatment for cervicogenic headache

Answer 26

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