Lecture 8: Upper Cervical Spine and Headaches Flashcards
(47 cards)
What are some important subjective questions to ask someone about HA during an eval?
onset, duration, area of pain, frequency, quality of pain, aggravating factors, relieving factors, meds, PMH, family history
What is prominent motion at AO joint?
the nod, flexion and extension
What is prominent motion at AA joint?
rotation
What is important to remember about nerves c1-c3?
joint dysfunction at upper cervical spine can cause nerve root irritation and referred pain to head and neck
Where does nerve root c1 exit?
posterior arch broad groove for the VA artery and sub occipital nerve
Where does nerve root c2 exit?
behind superior articular process
Where does nerve root c3 exit?
anterior to inferior articular process
What will pain feel like to patient if it is coming from the joint receptors?
dull and achy
What will pain feel like to patient if it is coming from the nerve itself?
sharp, superficial
What grey matter nucleus is primarily responsible for HA?
Trigeminocervical nucleus- nociceptive of the head, throat and upper neck
all afferents from CN 5,7,9,10 and c1-3 nerves converge to this nucleus
Why does referred pain occur with a HA?
if neuron receives afferent input from 2 different cervical receptive fields stimulation of one the receptive fields may produce pain in the other
EX: c1 or c2 can be so irritated it cause nausea
What are the three major categories of HA and which can PT treat?
- migraine
- tension
- cervicogenic
What are red flags associated with HA?
persistent unrelenting HA, associated trauma, supine position increases HA (ICP), visual changes, CNS sx, fever, weight loss, onset with exertion (ICP), temporal arteritis
What must be tested with every pt who presents with HA?
CN testing
What is the major cause of onset for migraines?
hormonal changes/stimulation (puberty, pregnancy)
lasting 4-72 hours
What is the frequency pattern of migraines?
cyclical
What are of the head is usually associated with migraines?
unilateral frontal lobe above eyes
What is the quality of pain associated with migraines?
mod-severe and pulsating which is different than most types of HA
What type of aggravating factors are associated with migraines?
movement- stress, strong sense like smell or loud music
What can usually help to relieve migraines?
neurotryptan with ibuprofen or indomethacin
How is family history and migraines related?
runs in families especially in females
What are common characteristics of tension HA?
insidious onset lasting 30 min to 7 days in a band like pattern around the head
usually mild to mod pain no debilitating caused by stress or tension
What can help with tension HA?
stress reduction, exercise, NSAIDS
What are characteristics of cervicogenic HA?
likely caused by micro or macro trauma to neck such as poor prolonged posture or WAD/concussions
can last a few hours or several days which starts as dull ache but then becomes throbbing
