L16 Headaches

Question 1

sinus HA distribution

Answer 1

pain behind forehead and cheekbones

Question 2

cluster HA distribution

Answer 2

pain in and around one eye

Question 3

tension headache distribution

Answer 3

pain like a band squeezing the head

Question 4

migraine HA distribution

Answer 4

pain, nausea, visual changes typical
unilateral often

Question 5

cervicogenic HA distribution

Answer 5

surrounding eye, cheek, top of head, back of head, SCM

Question 6

what % of adults experience at least 1 HA a year?

Answer 6

50%

Question 7

lifetime prevalance of HA

Answer 7

93-98%

Question 8

migraine annual prevalence

Answer 8

10-12%

Question 9

types of primary headache

Answer 9

migraine
tension type
trigeminal autonomic cephaligia/cluster HA

Question 10

types of secondary HA

Answer 10

trauma/injury
intracranial disorder
substance withdrawal
infection
cervicogenic or originating from some other structure on the head
psychiatric disorder

Question 11

other facial pains and neuropathies not technically HA

Answer 11

CN lesion

Question 12

onset and population for migraines

Answer 12

starts at puberty
35-45 most affected
women 2x more than men

Question 13

mechanism of migraines

Answer 13

activation of a mechanism deep in the brain producing inflammatory substances around nerves and blood vessels of the head
dysregulation of trigeminal nerve nucleus
vasculogenic, immunologic, neurogenic

Question 14

s/s of migraine attack

Answer 14

recurrent HA
mod-severe pain intensity
unilateral, can change sides
pulsating
aggravated by physical activity
nausea
photophobia
phonophobia
lasts hours to 2-3 days
can be associated with abdominal symptoms in children

Question 15

triggers of migraines

Answer 15

stress
foods: chocolate and cheese
missing a meal
menses/week before period
alcohol
caffeine

Question 16

what childhood history is correlated with migraines?

Answer 16

cyclic vomiting and motion sickness

Question 17

migraine with aura symptoms

Answer 17

1/3 of migraine pts
visual aura most common with light flashes/scotoma/hemianopsia
less than 30 min of symptoms

Question 18

how can physical therapy treat migraines

Answer 18

serve as adjunct to meds
trigger point release
postural dysfunction
relaxation techniques
avoid triggers

Question 19

tension HA occurance

Answer 19

episodic
<15 days per month

Question 20

mechanism of tension HA

Answer 20

muscle tension in neck, scalp, or face from stress, posture, or overuse

Question 21

population of tension HA

Answer 21

starts in teenage years
women 3x more than men
irregular sleep pattern
eye strain

Question 22

s/s of tension type HA

Answer 22

pressure and tightness
bandlike HA
no nausea, light or sound sensitivity
triggered by stress or hunger
less than 24 hours
BL dull mild to mod pain, not throbbing

Question 23

diagnostic criteria for tension type headache

Answer 23

1. at least 10 days previous HA episodes in 180 days
2. Ha lasting 30 min to 7 days
3. 2 of the following:
   tightening/non pulsating, mild-mod, BL, not aggravated by phys activity
4. both: no n/v, can have sound or light sensitivity but not both

Question 24

PT for tension HA

Answer 24

posture correction
ergonomic adjustments
relaxation
stress management
STM
trigger point
strengthening
stretching

Question 25

cluster HA mechanism

Answer 25

trigeminal autonomic reflex

Question 26

cluster HA population

Answer 26

uncommon 6:1 men:women average onset 30 y/o

Question 27

cluster HA s/s

Answer 27

severe, brief symptoms with common recurrence up to multiple times daily burning/piercing/neuralgic pain causing restlessness and agitation unilateral only lasting less than 3 hours periorbital, frontal, or temporal same sided lacrimination, rhinorrhea, miosis, ptosis

Question 28

cluster HA triggers

Answer 28

alcohol stress

Question 29

medication overuse headache

Answer 29

caused by chronic excessive use of HA medication secondary headache type

Question 30

headache screening: what should be screened in a pt with a headache?

Answer 30

if traumatic: fracture, dislocation, instability if non traumatic: tumor, inflammatory disorder, infection, visceral referral, VBI or CBI dissection

Question 31

special questions for HA subjective

Answer 31

Hx of head trauma? slow or insidious onset of new HA? neuro deficits? Does it occur and/or worsen with exertion? nuchal rigidity? tempral headache in older person with vision deficit or trunk pain? new meds or discontinued meds? stopped smoking, drinking caffeine, using rec drugs HA after reading or change in glasses prescription exposure to toxic chemicals

Question 32

concerning HA presentation with need for medical referral

Answer 32

sudden onset of new severe HA progressively worsening HA onset after physical exertion, straining, coughing onset after 50 years old neuro/CNS dysfunction

Question 33

cervicogenic HA

Answer 33

referred pain perceived in any region of the head with the primary nociceptive source in MSK tissues innervated by cervical nerves unilateral, starting in neck, comes with decreased ROM

Question 34

epidemiology of cervicogenic headache

Answer 34

age of onset 30s-40s men:women equal pericranial muscle tenderness on involved side C1-C3 innervated structures like synovial joints, ligaments, subcranial muscles, discogenic

Question 35

cervicogenic HA pathophys

Answer 35

C1-C3 nerves sending pain signals to nociceptive nucleus of the head and neck referring pain to occpiut and eyes inflammation and neurotransmission

Question 36

risk factors for cervicogenic HA

Answer 36

neck trauma WAD strain chronic spasm increasing area's sensitivity DDD/DJD poor posture muscle imbalance

Question 37

differential of cervicogenic HA

Answer 37

no specific pathology on imaging lack of response to migraine medication headache with neck movement or pressure UL pain without side shift initial pain in occipital region

Question 38

forward head posture and CGH

Answer 38

upper cervical hyperextension creating a forward head posture facet joint dysfunction leads to abnormal afferent information on tonic neck reflexes encouraging FHP

Question 39

cervicogenic headache differentiated from migraine and tension by:

Answer 39

triggered by neck movement pain spreading to occipital region tenderness in suboccipitals decreased cervical ROM unresponsiveness to HA meds

Question 40

cervicogenic HA diagnostic cluster

Answer 40

decreased cervical AROM palpable tenderness Oa to C3/4, joint dysfunction deep cervical flexor strength impairments these are not present in migraine or tension HA also proposed: C1/2 tenderness, pec minor length decreased, shortening in upper trap, levator, scalenes, scm, pec major

Question 41

CGH treatment

Answer 41

PT as first line manips stimulating neural inhibitory systems in SC and descending inhibition manual therapy AROM/PROM DNF training postural re-ed