10. Osteopathic Approach to Head Pain, Migraines, TMJ

Question 1

What are the top causes of headache?

Answer 1

1. Tension (frequent and chronic)
2. Migraine
3. Medication Overuse
4. Cluster headache/Trigeminal cephalgias (rare)

Question 2

Secondary Causes of Headache

1) Red flag: worst headache of your life
2) Red flag: new onset focal neuro weakness
3) Red flag: new onset headaches at >50 yo
4) Red flag: acute eye pain
5) Associated Systemic Sx
6) High BP

Answer 2

1) Subarachnoid hemorrhage
2) Stroke
3) Temporal Arteritis or Neoplasm
4) Acute Angle Glaucoma
5) Meningitis/Encephalitis
6) HTN Emergency

Question 3

What aspect of the physical exam should you do if a patient comes in with headache?

Answer 3

Neurological exam

Question 4

How are Tension HA characterized?

• Pain Pattern
• Radiation

Answer 4

• Bilateral Tight, Achy, Band

- Radiation from occipital/cervical region

Question 5

What are some common of referred pain causing tension type headaches?

Answer 5

Myofascial pain referral
Cervical facet referral
TMJ

Question 6

How is Trigger Point Characterized?

Answer 6

Characteristic Pain Pattern
ONLY in muscle
Radiating Pain
Taut Band of Tissue
Twitch Response

Question 7

How is Tender point characterized?

Answer 7

NO characteristic pain pattern
Located in muscle, tendon, ligament, etc
NO Radiating Pain
NO Taut Band
NO Twitch Response

Question 8

How do you treat tension type headaches

Answer 8

conservative treatment mainly

Can do muscle relaxers, NSAIDs, Lidocaine

Question 9

What causes cervical facet referral pain? (Tension HA)

Where is pain generated?

Answer 9

Degeneration
Injury
Overuse

Over the cervical facet joint capsule

Question 10

Which cause of tension type headache has

Decreased ROM of jaw
Clicking and popping of jaw
Jaw deviation with pain of jaw in the morning?

Answer 10

TMJD

Tension Type HA

Question 11

What should you do when considering the biomechanical approach for treatment Tension HA?

What are the biomechanical Treatments?

What are the metabolic approach?

Behavioral and why?

Answer 11

Consider risk/benefit

(Conservative Tx)

• Splint
• OMT
• Injections

metabolic: Pharmacology-NSAID/Steroids

Behavioral: Smoking Cessation (Increased Nicotine=Increased HA)

Question 12

What are the characteristics of Migraine?

Answer 12

Unilateral Throbbing Pain
Aura
Nausea**
Photo/Phonophobia

Question 13

What are the four most common triggers of migraines?

Answer 13

• Emotional stress
• Hormones (females mostly)
• Irregular sleep
• diet

Question 14

Migraine 5 Models

Answer 14

Biomechanical: Manipulation
Resp/Circ: Hydration
Metabolic: Don't Skip Meals
*Neuro: Abortive-Triptans
Behavioral: Avoid Triggers**

Question 15

What is used for prophylaxis of migraines?

Answer 15

Propranolol, amitripyline, topiramate

Question 16

What’s the best behavioral treatment for migraines?

Answer 16

Avoid triggers

Question 17

What type of headache is associated with a headache recurring around the same time every day and is always relieved with taking medication?

Answer 17

Medication overuse/Rebound

Question 18

What type of medication causes overuse/rebound headaches?

For how long?

Answer 18

Chronic pain meds

>15 days/month for 3 months

Question 19

How do you treat medication overuse/rebound treatment?

What kind of model approach is this?

Answer 19

Stop the offending meds

BEHAVIORAL

Question 20

What type of headache is associated with 
Unilateral stabbing pain around the eye
Autonomic symptoms
--Sweating
--Swelling
--Tearing
--Stuffy/Runny Nose

Answer 20

Cluster headaches/Trigeminal autonomic cephalgias

Question 21

How do you treat cluster headaches?

• Resp/Circl
• Neuro

Answer 21

Oxygen and triptans

Resp/Circ: O2
Neuro: Prophylaxis: Verapamil

Question 22

What is used for prophylaxis of cluster headaches?

Answer 22

Verapamil (CCBs)