OS 4 Midterm > Lecture 2 > Flashcards

Lecture 2 Flashcards

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1
Q

Types of HA

A
  1. Tension HA = >80%
    1. Frequent (<15 days/month) ***
    2. Chronic (>15 days/month)
  2. Migraine = 12-16%
  3. Medication overuse = ~3%
  4. Cluster HA/trigeminal cephalgias = ~ 0.1%
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2
Q

What is the most common type of HA?

Is it frequent or chronic more often?

A

Tension HA

Frequent (>15 days/month)

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3
Q

Secondary causes of HA

“Worse HA of my life”

A

Subarachnoid hemorrage

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4
Q

Secondary causes of HA

“New onset of focal neurologic weakness”

A

Stroke

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5
Q

Secondary causes of HA

“Onset of HA > 50YO”

A
  1. Temporal arthritis
  2. Neoplasm
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6
Q

Secondary causes of HA

“HA + systemic symptoms”

A

1. Meningitis

2. Encephalitis

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7
Q

Secondary causes of HA

“Eye pain => HA”

A

acute angle glaucoma

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8
Q

Secondary causes of HA

“High BP => HA”

A

1. HTN urgency/MRGNC

2. Preeclampsia

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9
Q

Generally, chronic HA can be caused by…treated with…

A

1. Mulitple etiologies

2. Multiple modalities/treatments and altering lifestyle

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10
Q

When performing OLDCARTS for a patient presenting with HA, what MUST we ask?

A
    1. Location: unilateral/bilateral/ radiation
    1. Characterstic: type of pain
  • 3. Related symptoms: photosensitivity, aura, tearing?
  • 4. Temporal: same time everday?
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11
Q

Tension HA

  1. Type of pain?
  2. Associated symptoms?
  3. Etiology
A
  1. Bilateral, tight/ achy that is tender, radiates from occipital/cervical region, with NO other
  2. None
  3. Not clear, but most are cervicogenic (perceived as occuring in another part of the body than true source) bc of (+) of trigeminal cervical complex
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12
Q

Categorize tension HA by frequency

A
  1. Infrequent: ≤1 days/month
  2. Frequent: 1 - 15 days/month
  3. Chronic: ≥ 15 days/month
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13
Q

Most common causes of tension HA

A
  1. Myofascial pain referral
  2. Cervical facet referral
  3. TMJ dysfunction
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14
Q

Tension HA caused by myofascial pain referral

  • Mainly due to what?
  • Where is pain/what causes pain?
A
  1. Overuse/injury to muscles
  2. Trigger points (palpable muscle knots) that is discrete, focal and hyperirritable. When touching => twitch response “OUCH”, pain pattern
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15
Q

Treatment of Tension Headache: myofascial pain referral

A
  1. Conservative therapy:
    1. Ischemic compression (manual manipulation),
    2. PT,
    3. Spray and stretch with a cold analgesic topical spray and lengthen muscle,
    4. Dry needling
  2. Trigger point injections – lidocaine and steroid
  3. Pharmacology – muscle relaxers and NSAIDS
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16
Q

Tension Headache due to cervical facet referral

  • Mainly due to what?
  • Where is pain/what causes pain?
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A
  • Primarily due to:
    1. Degeneration/arthritis,
    2. Injury
    3. Overuse/poor posture
  • Where is pain/what causes pain: Cervical facet joint capsule
17
Q

Tension Headache due to cervical facet referral

  • Symptoms?
  • Treatment
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A
  1. Symptoms
    1. Painful (even when palpating)⬇︎ ROM,
    2. Protective spasms with movement
  2. Treatment
    1. RICE (rest = most of the time will go away on its own) = BEST
    2. Convservative: Manual medicine or PT
    3. NSAIDS, oral steroids
    4. Injection of lidocaine and steroid injections with fluoroscopy,
    5. Radiofrequency Ablation (burn out nerve innervation to facet)
18
Q

Tension type headache: TMJ (jaw pain)

  • Mainly due to what?
  • Where is pain/what causes pain?
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A
  • Due to:
    1. Malocclusion (teeth lining up),
    2. Disc displacement/joint degeneration,
    3. Myalgia
  • Where is pain/what causes pain:
    1. Intraarticular: TMJ joint
    2. Extraarticular: (pterygoid muscle (inside jaw), temporalis or masseter muscle
19
Q

Tension HA: TMJ pain

  1. Symptoms?
  2. Treatment?
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A

Associated sxs –

  1. ⬇︎ ROM of jaw,
  2. Clicking, crepitus of joint
  3. Pain when opening/closing/chewing

Treatment:

  1. TMJ specific – bite splint***, passive stretching, biofeedback (CBT; jaw relaxation)
  2. Conservative therapy: Manual medicine, PT
  3. NSAIDs and muscle relaxants
  4. Joint or trigger point injections
  5. Surgery CI
20
Q

What is CI in patients with tension HA due to TMJ?

21
Q

Patient has a unilateral, throbbing burning pain, but can shift that occurs in multiple phases.

What type of head pain is this?

22
Q

Migraine

  • Associated symptoms and which is most predictive of migraines
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A
  1. Aura
  2. Nausea (most predictive)
  3. Photophobia
  4. Phonophobia
23
Q

4 phases of migraines

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A
  1. Premonitory: fatigue, irritability, depression, difficulty speaking/reading/sleeping
  2. Aura (some migraines don’t have this): visual problems + numbness and tingling
  3. Headache: unilateral throbbing burning pain + photophobia/phonophobia + N/V
  4. Postdrome: fatigue, cant concentrate and depressed

PAHP

24
Q

4 MC triggers for migraines (in order)

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A
  1. Emotional stress = MC (80%)
  2. Hormones (MC in females)
  3. Irregular sleep
  4. Diet

Caffeine and alcohol, smells, changes in weather, dehydration

25
**5 factor model for migraines** * Biomechinical * Resp/criculation * Metabolic * Behavioral
1. _biomechanical_ (**manipulation** decreases number of days, **acupuncture** can be a prophylaxis), 2. _resp/circulatory_ (stay hydrated), 3. _metabolic_ (don’t skip meals) 4. _behavioral_ (meditation, biofeedback, avoid triggers)
26
How can we decrease the number of HA days in **migraines** and what can be a prophylaxis?
1. Decrease number of HA days =\> **manipulation** 2. Prophylaxis =\> **acupuncture**
27
When should we think of medication overuse/rebound as the cause of HAs?
1. **Chronic pain medication** use \>15 days/month for 3 months 2. Headache recurring around the **same time every day** 3. Always **relieved with taking medication**
28
Tx for meds as cause of HA?
**Stop taking drug** and **bridge with different medication**
29
MC HA of trigmenial autonomica cephalgia family
Cluster HA
30
**Cluster HA** 1. Mainly due to what? 2. Where is pain/what causes pain?
1. + of trigmeninal autonomic =\> **Severe**, **debilitating** **HA** on one side of head (**unilateral**) that occurs in **brief cycles** 2. Sweating, swelling of eye, tears, stuffy/runny nose
31
Treatment of **CLuster HA**
1. **O2** 2. **Triptans/ Ergotamine** 3. **Intranasal lidocaine** 4. **Verapamil**
32
Management of HA
avoid triggers
33
1. How can we **prevent** t**ension HA?** 2. What is the most important **behaviorial intervention** for **tension HA?**
1. **SSRI, tricyclics** 2. **Smoking cessation** bc nictoine is correlated to # of HA
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