Exam 2 Week 4

Question 1

headache prevalence, migraine, tension HA and costs

Answer 1

93-98% have HA
each day 16%
migraine: 10-12% annually 
tension: 38% annually 
$13 billion (work days and impairment)

Question 2

what are cervicogenic headaches attributed to, and what affects them

Answer 2

abnormalities of the C-spine.

cervical movement

Question 3

what is the primary pain pattern of a cervicogenic HA

Answer 3

occipital, and radiating into the head and face. 70% HA sufferers complain of neck pain with their HA too.

Question 4

what is the estimate of cervicogenic HAs

Answer 4

1 in 5 of the population

Question 5

what seems to be the basis for the pain pattern of a cervicogenic HA

Answer 5

trigeminocervical nucleus.

afferents from CN 5 and Spinal nerves C1-C3.

Question 6

how can we tell a migraine from a sinus from a tension from a cluster HA

Answer 6

migraine: one sided, lasts hours to days, and throbbing
sinus: widespread, until you treat it and dull
tension: widespread, hours, and dull
cluster: one sided, minutes to hours and sharp (like an ice cream HA)

Question 7

what are some possible signs of intracranial pathology

Answer 7

sudden onset of severe HA, increasing intensity, persistent unilateral, HA that wake them up at night, stiff neck (sign of meningitis), systemic symptoms (weight loss, fever, malaise), neuro signs and symptoms.

Question 8

what must we be mindful of (red flag) when we are seeing patients with HA’s.

Answer 8

2/100,000 with internal carotid dissection
1/100,000 vertebral artery dissection.

most present with head the neck pain.
BIG complaint: HA like never before

Question 9

are the pain distributions for the internal carotid and vertebral arteries very helpful

Answer 9

no, overlap

Question 10

when someone comes in with a HA, what is concerning, about their history

Answer 10

pain in the head and neck, unlike anything I’ve had ever before

Question 11

what in a patients past medical history are you looking for when treating someone you suspect has an artery dissection

Answer 11

atherosclerosis risk factors, for potential damage
stroke, diabetes, smoker, MI, angina, TIA, CVA, PVD family history
HTN

Question 12

when examining for cervical artery dysfunction with cervicogenic HA, what are you looking for

Answer 12

5 D’s and 3 N’s
dizziness, drop attacks, diplopia, dysarthria, dysphagia,
ataxia
nausea, numbness, nystagmus.

Question 13

what are other red flags for cervical artery dysfunction

Answer 13

taste changes, face sensation, visual changes, facial numbness, tinnitus, gait changes, horsiness, vomiting, member or motor loss

Question 14

what is the gold standard for diagnosis of cervicogenic HA

Answer 14

a greater occipital nerve block, which can abolish the pain for up to 30 days.

Question 15

what are some subjective things with cervicogenic HA

Answer 15

pain in the area, posterior head and neck, unilateral, with shoulder and arm pain. Provoked with sustained and awkward positions, and increasing frequency of short lasting HA attacks.

Question 16

what objective things are demonstrated with cervicogenic HA’s.

Answer 16

neck movement or sustained movements, trigger options, abnormal joint mobility testing, +CFRT, poor neck flexor endurance tests

Question 17

what is the cervical flexion rotation test (CFRT)

Answer 17

looking for a significant difference in C1-2 ROM, have the neck flexed, and turn the head side to side. Positive if less then 32 degrees.

Question 18

what is the cranial cervical flexor test (CCFT)

Answer 18

purpose is to assess deep cervical flexor strength. you have the patient lay supine, and flex their cervical spine, by doing a chin tuck. make sure there is no SCM activity (not too much). the bladder under the neck should be able to generate 26-30mmHg of pressure for 10 seconds without compensation.

Question 19

what is the neck muscle endurance test

Answer 19

assess deep cervical flexion strength. tuck their chin, and hold your head up, and raise head off table 2.5 cm. see how long they can hold it. normal is more then 38 seconds.

Question 20

what is the diagnostic cluster or cervicogenic HA

Answer 20

• decreased AROM cervical extension
• palpably painful somewhere from OA-C3-4 joint dysfunctions
• deep cervical flexor strength impairments with CCFT (cranio-cervical flexion test)
• NOT USUALLY PRESENT WITH MIGRAINE HA

Question 21

whats another diagnostic cluster for cervicogenic HA

Answer 21

palpably painful C1-2 joint dysfunctions, and pec minor length shortened.

Question 22

people with cervicogenic HA have muscle tightness in…

Answer 22

upper trap, levator, scalenes, SCM, pec major and minor

Question 23

what was found, with cervicogenic HA, with the CCFT?

Answer 23

cervicogenic group had significantly greater activation of the superficial neck flexors, like the SCM.

Question 24

treatment for cervicogenic HA, as found by research and evidence

Answer 24

neck exercises, low endurance training, and spinal manipulation, are effective for short and long term.

Question 25

is there evidence favoring spinal manipulation for cervicogenic HA

Answer 25

yes, its effective in the short term, when compared to manage, placebo and spinal manip, or mob.

Question 26

CPG for acute, subacute, chronic neck pain with HA

Answer 26

acute: active mobility exercises, self SNAG subacute: cervical manip and mob and self SNAG chronic: cervicothoracic mobilization, shoulder girdle and neck stretching, strengthening and endurance.

Question 27

Jull et all in 2002 had four groups, exercise, MT, MT and THEREX and control, what was the outcome

Answer 27

MT and THEREX had greater improvement/more of a reduction in HA. less HA days per week, and shorter duration.

Question 28

what is the NNT for cervicogenic HA

Answer 28

for every 2 patients referred to PT, 1 additional patient would achieve at least a 50% reduction in symptoms. for every 3-4 patients, 1 additional patient would achieve at least a 100% reduction in symptoms.

Question 29

what was the result of the RCT of self mobilizations, like the SNAG

Answer 29

there was a significant decrease in the headache severity index at 4 weeks, and 12 months follow up. They did much better

Question 30

how is cervicogenic HA diagnosed what are some objective findings.

Answer 30

decreased AROM cervical extension palpably painful OQ- C3-4 joint dysfunctions. deep cervical flexor strength impairments with CCFT

Question 31

what is the evidence suggested treatment for people with cervicogenic HA

Answer 31

combined MT and deep cervical flexor retraining. MT to the c-spine. specific training of the DNF, extensors, scapular stabilizers and postural education.

Question 32

we must always monitor, assess, treat and reassess. what is a good asterisk sign to do your test retest?

Answer 32

cervical flexion and rotation.