1
Q
What are the two Headache types
A
- Primary (usual) : migraine , Tension , Clister
- Secondary: vascular, pathologic, cervicogenic
2
Q
What is the history of Headache Hx (NDV PPW)
A
- Nausea
- Dizziness
- Visual disturbance
- Photophobia (sensitive to light)
- Phonophobia (sensitive to sound)
- When was last eye exam?
3
Q
Causes of HEADACHES (TMT COM)
A
Tension / Stress
- Migraine
- Tumor
- Cervicogenic headache
- Occular
- Metabolic/Toxic
4
Q
What are some Behavioral Headache Triggers?
A
- Stress / Tension induced
- Depression
- Poor posture
- Dehydration
5
Q
What are some Environmental Headache Triggers?
A
- Odor
- Altitude
- Change in Weather
6
Q
What are some Physical Headache Triggers?
A
- TMJ
- Eating / Drink cold food or drinks
7
Q
What are some Diagnostic Alarms in Headache Disorders?
A
- Happens after 50+ yrs
- Onset in PT w. CA or HIV
- Papilloedema
8
Q
Headache triggered by exertion, coughing, bending or sexual activity is possibly caused by what type pathologies?
A
- SOL
- Aneurysm
9
Q
Describe some Intracranial Pressure relations to Headaches
A
- Does NOT cause it alone
- Increase causes Headache & displaces pain sensitive intracranial structures (BV , Meninges , CN , Spinal N)
10
Q
What are some Clinical Eval. of Headaches?
A
- Rule out Red Flags
- Vitals
- Auscultate for Bruits
- CN exam
- Fundoscopic exam
- Motor eval / Dorsal columns / Cerebellar exam
11
Q
{stat} Primary Headache account for ….
A
- 90% of all headaches
12
Q
What are the 3 categories of Primary Headaches?
A
- Migraine
- Tension type
- Cluster
13
Q
What are the Types of migraine?
A
- Migraine w aura (MC)
- Migraine w/o aura (classic)
- Retinal migraine (opthalmic)
14
Q
What is the criteria for Migraine w/o aura?
A
- Lasts 4-72hrs
- Headache has at least 2: ( Unilat / Pulses / Moderate or severe / worsens w. activity)
- Nausea
- Photophobia / Phonophobia
- NOT related to Secondary headache
15
Q
What is the criteria for Migraine w aura?
A
- Has at least 2 attacks
- At least 1 REVERSIBLE symptom: (Visual / sense / speech / motor / brainstem)
- At least 3 characteristics ( Spreads gradual >5min / 2+ symp occur in succession / Symp. lasts 5 - 60 min / Unilat. / Aura followed by Headache )
16
Q
What is an aura?
A
- Develops 5-60 min
- Visual Aura: See Zig-Zag lines or Flashing lights
- Auditory aura : Unusual sounds heard
- Olfactory aura: Smells nonpresent odors
- Aphasia: Language problems
- Sensory Aura: Numbness/tingling
17
Q
What is Scintillating scotoma?
A
- ↓ Visual acuity or flashing lights near central visual field
- Followed by a migraine
18
Q
What is some Medical management of Headaches that has High evidence based association?
A
- Triptans (acute)
- Analgesics (aspirin, acetaminophen)
- Ibuprofen
- Parenteral dexamethasone
19
Q
What are Chiro management of migraines w or w/o Aura?
A
- 1/2 x per week for 8 weeks have high evidence
20
Q
What is the MC primary headache?
A
Tension type
21
Q
What are some Classification of Tension type headaches?
A
- Frequent (>10 1-14 day/month 3+month)
- Infrequent (>10 >1day/month)
- Episodic
- Chronic (>15 day/month >3 month)
22
Q
What are some Characteristics of Tension headaches?
A
- No aura
- Bilateral
- Tightening (“Hatband-Like)
- Mild/moderate
- Neck / TMJ pain
- Frontal/temporal located
23
Q
Tension headaches do not affect/cause:
A
- Nausea/vomiting
- ADL
- Suboccipital location
- Physical activity
- Photophobia/phonophobia
- Lasts 30 min- 7 day
24
Q
What are some Chiro management of Tension Type Headaches?
A
- Soft tissue/manipulation
- Stress reduction/exercise
- Low load Craniocervical mobilization/exercise
- Kinesiotaping to reduce myofascial adhesions
25
What causes a Cluster headache?
- Referred as Neurovascular
- Evidence supports Hypothalamus as culprit
26
Trigeminal Autonomic Cephalgia can be described as:
- Cluster Headache are a common form of this
27
What are some Symptoms of cluster headache?
- Severe
- Unilateral (Orbital/suportibal/temporal)
- Lasts 15-180 min
- Occurs every other day up to 8x/day
28
Cluster headaches are assoc. with the following:
- Lacrimation
- Nasal congestion
- Rhinorrhoea
- Forehead/facial sweating
- Miosis
- Ptosis
- Eyelid edema
29
What are some Chiro management of Cluster headaches?
- Not clinical warranted (Lidocaine , Capsaicin , etc)
30
What is the difference between Acute vs Chronic Post-traumatic headache?
- acute <3 months
- chronic >3 months
31
What is Used to assess severity of Head trauma (especially in sports)?
- Glasgow Coma Scale
32
Describe the Glasgow coma scale:
- Verbal response: 5 points
- Eye opening: 4 points
- Motor response : 6 points
** the higher the better **
33
Sports concussion assessment tool referred as
Scat 5
34
What are some example of Vascular headaches?
- Stroke / TIA
- Giant cell / Temportal Arteritis
- Carotid / Vertebral artery pain
- Thrombus
35
What is Giant cell Arteritis?
- System vasculitis
- Throbbing over temples
- Headache
- Visual loss
- Fatigue
- Myalgia
- Rare before age 50
- MC in Women
36
What are some Clinical features of Cervicogenic headache?
- Caused by disorder of C-spine
- Accompanied by neck pain
- Overlap w. Tension headaches
37
What happens in a Cervicogenic Headache?
- Resisted passive neck movements
- Changes in neck muscle
- Tender neck muscles
38
Radiologic exam reveals at least 1 in a Cervicogenic Headache:
- Movement abnormalities (Flexion-Extension)
- Abnormal posture
- Fx / Tumor / RA etc
39
Occipital neuralgia can be caused by:
- Adjusting someone who is guarding after whiplash
40
Presentation of Occipital Neuralgia:
- Throbbing / Electric shock-like pain in upper neck
- Unilateral
41
Occipital neuralgia caused by a irritation or injury to:
Greater occipital (C2)
lesser occipital (C3)
42
TMJ disorders may be due to:
- Internal derangement
- Inflammation
- Muscle imbalance (Lateral pterygoid)
- Hypermobility
43
IN. derangement of TMJ is associated with:
- Structural changes within the joint caused by direct trauma/whiplash and grinding
44
Disc displacement without reduction is associated with:
- More severe, disc will not reduce and causes pain and decrease ROM
- Lock jaw
45
Hypermobility of TMJ will:
- Deviate AWAY from affected side
46
TMJ Disorder clinical evaluation:
- Posture exam
- ROM of TMJ & C-Spine
- CN V exam (SENSORY)
47
Pain location summary:
- unilateral/hemicranial- migraine/cluster
- cluster- always unilateral around eye, temple/cheek
bilateral-tension
- +50% brain tumor patients have headache with ipsilateral pain
48
Pain duration summary of types of headaches:
- migraine 4-72hrs
- cluster 15-180min
- paroxysmal hemicrania 5-20 min
- tension 30min-7days
49
Brain tumor headaches are similar to:
- Tension type pain presentation
50
Palliative factors of headaches:
- Dark room/motionless (migraine)
- Movements (cluster)
- Rest/sleep (tension)
Evidence Based Managment
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