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Principles VI > Headaches > Flashcards

Headaches Flashcards

1
Q

What are the different types of headaches? (8)

A

1) Vascular
2) Neurological
3) Traumatic
4) Myogenic
5) Cervicogenic
6) Miscellaneous
7) Metabolic
8) Toxic

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2
Q

What are the life threatening causes of headache? (11)

A

1) CNS Infection: Meningitis, Encephalitis
2) Brain Tumor or Abscess
3) Subarachnoid Hemorrhage
4) Subdural Hematoma
5) Epidural Hematoma
6) Temporal Arteritis
7) Stroke or TIA
8) Rx reaction
9) Allergic reactions
10) Hypo/hypertension
11) Hypo/hyperglycemia

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3
Q

What are 5 quick screening questions for serious pathologY/

A
  1. Is the headache of recent onset (< 6 months)?
  2. Is there any progression in the frequency or
    severity of the headaches?
  3. Was the onset sudden and severe?
  4. Are there any clues suggesting hard neurologic
    signs associated with the headaches?
  5. Are there any cognitive changes associated with
    the headaches (e.g., memory, confusion, personality)?
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4
Q

What is a treatment trial for a cervicogenic headache?

A

8-16 visits over 3-6 weeks

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5
Q

What will a physical exam finding of altered mental status cause consideration for?

A

Intracranial lesion (e.g., stroke, tumor)

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6
Q

What will a physical exam finding of Meningeal signs cause consideration for?

A

Meningits, stroke

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7
Q

What will a physical exam finding of positive “jolt” test cause consideration for?

A

Meningtis

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8
Q

What will a physical exam finding of focal neurologic signs cause consideration for?

A

Intracranial lesion (e.g., stroke, tumor)

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9
Q

What will a physical exam finding of a rash cause consideration for?

A

Lyme disease, Rocky Mountain spotted fever,

meningococcemia

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10
Q

What will a physical exam finding of change in vision cause consideration for?

A

Glaucoma, optic neuritis, vertebral artery dissection,
intracranial lesion, post-traumatic headache,
temporal arteritis, CVA, idiopathic intracranial
hypertension

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11
Q

What will a physical exam finding of fever cause consideration for?

A

Infection (CNS vs. systemic)

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12
Q

What will a physical exam finding of double vision cause consideration for?

A

Intracranial mass, idiopathic intracranial
hypertension, post- traumatic headache, dissecting
aneurysm

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13
Q

What will a physical exam finding of altered ptosis, miosis consideration for?

A

Carotid artery dissection

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14
Q

What will a physical exam finding of altered Horner’s Syndrome consideration for?

A

Space occupying lesion

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15
Q

What will a physical exam finding of papilledema consideration for?

A

Mass lesion, optic neuritis, pseudotumor

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16
Q

What will a physical exam finding of dilated pupil consideration for?

A

Aneurysm compressing third cranial nerve

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17
Q

What indication would warrant an emergent MRI?

A

“Thunderclap” HA with abnormal neuro

exam

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18
Q

What imaging would be done with an isolated thunderclap HA?

A

Consider referral for CT;
abrupt onset HA has +LR
2.5 for intracranial lesion

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19
Q

What imaging would be done with a New onset if high risk for intracranial
disease (e.g., HIV positive, prior CA)

A

Consider MRI or CT

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20
Q

What imaging would be done with a abnormal neuro exam (e.g.,
papilledema, unilateral loss of sensation,
weakness, hyper-reflexia)?

A

Consider MRI or CT, +LR
4.21 for intracranial
lesion

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21
Q

What imaging would be done with a with HA with fever or nuchal rigidity

A

MRI or CT

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22
Q

What imaging would be done with a with Progressively worsening HA?

A

MRI or CT

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23
Q

What imaging would be done with a with Change in character of the HA

A

Consider MRI, +LR 2.0

for intracranial lesion

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24
Q

What imaging would be done with a with Persistence despite analgesics/course of
treatment

A

X-ray or MRI or CT

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25
What imaging would be done with a with Suspected intracranial lesion?
MRI or CT (head)
26
What imaging would be done with a with Suspected subarachnoid hemorrhage or subdural hematoma
MRI or CT (head), spinal tap
27
What imaging would be done with a with temporal arteritis.
Biopsy
28
What imaging would be done with a Suspected meningeal | infection
MRI or CT (head), spinal tap
29
What are some characteristics of a cluster headache? (5)
1) Severe 2) Eye symptoms 3) Strictly unilateral 4) Swarms 15 mins-3 hours, 1-8 times the same day 5) Conjunctival injection, lacrimation, nasal congestion, rhinorrhea, facial sweating, miosis & ptosis (partial Horner’s syndrome)
30
What are some characteristics of migraine headaches?(4)
``` 1) Two or more headaches in the previous three months 2) Pulsatile, Unilateral with shifts 3) Severe enough to limit “life” 4) Two of theses are true: - Has a headache limited your activities for a day or more in the last three months? - Nauseated - Photophobia ```
31
What are some characteristics of tension headaches? (6)
1) 10 or more episodes fulfilling ALL of the following criteria: 2) Lasts from 30 minutes to 7 days > 2 of the following characteristics: 3) Quality of pain is pressing/tightening, but not pulsating 4) Severity is mild to moderate (inhibiting, but not prohibiting) 5) Location is bilateral (although unilateral forms occur) 6) Aggravating factors—no aggravation with walking stairs or similar activities
32
Which two headache conditions may overlap and have a mix of the two types of headaches?
tension & cervicogenic
33
What are the key differentiating features suggesting CGH?
``` 1) Provocation of the headache symptoms by mechanical pressure and/or continuous backward tilting of the head 2) Limitation in movement of the neck 3)Non-radicular, ipsilateral diffuse shoulder/arm pain ```
34
What does a long duration headache favor?
Long duration favors CGHA
35
What are some cervicogenic headache associated symptoms?
Autonomic reactions: (less severe than migraines) 1) Nausea 2) Vomiting 3) Ipsilateral edema & periocular flushing 4) Dizziness 5) Phonophobia OR photophobia 6) Blurred vision in ipsilateral eye 7) Difficulty swallowing
36
Which headache shifts from side to side, either during the headache or from episode to episode?
Migraine
37
Which headache stays on one side, either during the headache or from episode to episode?
Cervicogenic headache
38
If the headache starts in the neck what is usually the cause?
If it starts in the neck first, cervicogenic headache or a myofascial pain syndrome is more likely.
39
If a headache is bilateral and one side consistently hurts more than the other what type of headache is it?
If one side is dominant, cervicogenic headache remains in the differential
40
What are some muscles that can refer pain in the form of a headache (6)
1) Upper cervical multifidus 2) Semispinalis capitus 3) Longisimus capitus 4) Splenius capitus 5) Trapezius 6) SCM
41
Where does C0-1 refer pain to?
1) Laterally to the ear | 2) Posteriorly to the occiput
42
Where does C1-2& C2-3 refer pain to?
Suboccipitals Jaw Eye Right temple
43
Where does C2-3 refer pain to?
Above the eye and the inferior ridge of the TMJ
44
What is the sphenomandibularis muscle?
``` 1) A 5th muscle of mastication found in 1996 2) Previously thought to be part of the Temporalis muscle 3) Anatomical connection from the jaw to cause headaches ```
45
what are some causes of sclerotogenous radiation of pain? (6)
1) Cervical spondylosis - Osteoarthritis or inflammatory arthropathy 2) Cervical sprain/strain - Acute or chronic 3) Congenital anomalies - occipitalization, os odontoideum 4) Occipital neuralgia - C2 ganglion entrapped in hypertrophic capsule of the lateral atlantoaxial jt. 5) Third occipital headache 6) C2-3 facet joint - irritation, w/wo 3rd occipital nerve entrapped by an osteophyte
46
What was most effective treatment plan for headaches?
Larger, concentrated doses, 9-12 treatments over 3-4 weeks, showed most benefit
47
What are some treatment goals for cervicogenic headaches? (8)
1) Reduction of biomechanical abnormalities in the cervical spine and restoration of normal intersegmental joint function 2) Reduction of neuroplastic changes 3) Recovery of full active and passive cervical spine range of motion 4) Reduced inflammation of paraspinal tissues 5) Reflex relaxation of paraspinal tissues 6) Restoration of muscular function 7)Reduction of poor postural habits 8) Reduce insults and avoid further injury
48
What is the recommendation for palpation of specific pressure points and the amount of force applied?
Van Suijlekom (2010) recommends the palpation of specific “pressure points” with about 3-4 kg of pressure which may then provoke both local and spreading pain. Doubling of the pressure may provoke the headache presentation.
49
For CGHA treatment, which areas of the cervical spine are manipulated?
Biomechanical 1) C2-3 rotation 2) C1 3) Cranium
50
How much flexion/extension occurs at C0-1?
25° F/E with no coupling
51
How much rotation occurs at C0-1?
4-8° rotation at end range
52
How many facet places can be on each C1 facet?
Up to 3 facet planes on each C1 facet
53
How is rotation and LF coupled in C0-1?
5° rotation coupled with opposite LF
54
What happens to C0-C1 with LF?
5° LF slides C0 to opposite side leaving C1 | “laterally translated” on LF side
55
What happens at C0-C1 when it approaches end range?
3-4° near end range, about 15-20 degrees, | C0 joins C1 and glides laterally on C2
56
What motion occurs most at C1-2?
Mostly rotation (40°,½ of cervical ROM)
57
What happens to C1-C2 with LF?
LF (5°’s) couples with lateral translation | toward LF side – R LF shifts C1 to the R
58
What happens to C1-C2 with flexion and rotation?
C1 drops down and forward onto C2 in | flexion and rotation
59
What are some complicating factors of the cervical spine? (3)
``` 1) Occipitalizaion can lead to C1-C2 hypermobility or frank instability 2) Degeneration and osteophyte formation can also complicate upper cervical dysfunction rendering the cervical manipulation a temporary or palliative treatment 3) Co-morbidity issues ```
60
How long do uncomplicated cervicogenic headaches take to respond to care?
Uncomplicated cervicogenic headaches | should respond to care within 3-6 weeks
61
With aggressive treatment how long should it take to see 50% improvement?
An aggressive 2 week trial consisting of six to seven treatments, a 50% improvement in symptomatology is expected

Principles VI (2 decks)

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