Lecture 9: Osteopathic Approach to Head Pain Flashcards Preview

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Flashcards in Lecture 9: Osteopathic Approach to Head Pain Deck (32)
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1

What nerves should be considered for head pain of anterior 2/3 vs. posterior 1/3?

Anterior 2/3 --> Trigeminal n.

Posterior 1/3 --> Lesser Occipital (C1-3), Recurrent branches of IX and X

2

Relevant sympathetic spinal levels associated with head pain?

T1-T4

3

Mean age of onset for tension HA?

Peak prevalence?

- MAO = 25-30 yo

- Peak prevalence = 30-39 yo

4

Anxiety and depression often associated w/ what type of headache?

Chronic tension-type HA

5

Peripheral pain mechanisms are more likely important for what type of tension HA?

Episodic tension-type HA

6

Central pain mechanisms are more likely involved in what type of tension HA?

Chronic tension-type HA

7

What are the clinical features (signs/sx's) of Tension-type HA's?

Bilateral

- Mild to moderate intensity

- Pressure or tightening quality (nonpulsating)

- Absence of N/V

- Not aggravated by routine physical activity

8

How long can Episodic Tension HA's last?

30 minutes to 7 days

9

Chronic Tension HA's are defined as having episodes for how long (days/months)?

≥ 15 days/month on average for ≥ 3 months

10

What is the most common abnormal PE finding for Tension HA's?

Pericranial muscle tenderness - tends to be mostly scalp

11

How to treat the neurological component (5-models) of a tension-type HA?

- Analgesics and NSAIDs = 1st line

- Combination analgesics w/ caffeine = 2nd line

- Metaclopramide

12

3 focuses for the Metabolic component (5-models) in tx of Tension-HA?

- Sleep hygiene

- Hormonal influences - menstrual

- Hydration

13

Using the 5-models what component should be addressed first in the treatment of Migraine, Cervicogenic, and Tension HA's?

- Respiratory/circulatory

- Address lymphatics first to reduce irritants from inflammatory milieu

14

Using the 5-models approach what should be addressed via the neurological component for Migraine, Cervicogenic, and Tension HA's?

- Address counterstrain points anteriorly and posteriorly in the cervicals, upper thoracics, upper ribs, and UE's

- Use cranial to address other contributing SD's

15

Which treatment technique for SD's has been shown to be an effective method for treating tension HA?

MFR

16

How does a menstrual migraine differ than a normal one?

Typically w/o aura and more severe

17

Using the 5-models approach what should be addressed via the Biomechanical component for Tension HA's?

- Address myofascial SD's

- Address joint SD's w/ cranial, MET, Still's, HVLA, or FPR

18

What are 2 likely risk factors for Migraines?

1. Medication overuse

2. MS

19

What is the mnemonic used for Migraine Diagnosis?

POUND

Pulsating

- Duration 4-72 hOurs

Unilateral

Nausea or vomiting

Disabling

*4/5 criteria met has + likelihood ration 24 for definitive possible migraine

20

Differential Diagnoses for Migraines?

- Tension HA or Cluster HA

- Cervical spine dz --> greater occipital neuralgia

- Acute cervical strain --> Whiplash

- Intracranial mass or Meningitis or Subarachnoid hemorrhage or TIA

- Sinusitis

- Cavernous sinus thrombosis

- Optic neuritis or Acute Glaucoma

- SLE

- TMD

- Epilepsy

21

What is pathognomonic for migraine w/ aura?

Spreading oligemia (reduced blood volume) in brain

22

Migraine w/o aura seems to be associated with what messenger molecules?

- NO

- 5-HT

- CGRP

23

Using the 5-models how do you treat the Biomechanical components of Migraines?

Address joint SD with Cranial, MET, Still's, HVLA or FPR

24

Cervicogenic HA is caused by disorder of what?

Cervical spine and its component bony, joint, and/or soft tissue elements

*Usually NOT associated w/ neck pain

25

Involvement of which cervical facet is the most frequent source of Cervivogenic HA?

- C2-C3 = most frequent

- AA is probably 2nd

26

Facet pain from C5-C6 and C6-C7 may contribute to what type of relfex resulting in TrP pain referral to the head?

Somato-somatic reflex

27

For diagnosis of Cervicogenic HA, evidence of causation by at least two of the following 4 items must be met?

1. Developed in temporal relation to the onset of cervical disorder/lesion

2. Significantly improved or resolved w/ improvement in or resolution of cervical disorder/lesion

3. Cervical ROM is reduced AND HA is made significantly worse by provocative maneuvers

4. Abolished following diagnostic blockade of a cervical structure or its nerve supply

28

What are 5 differential diagnoses for Cervicogenic HA?

1. Migraine - POUND

2. Tension HA

3. C2 neuralgia

4. Neck-tongue syndrome

5. Occipital Neuralgia

29

If the pain associated with a HA is myofascial what category does it best fit under?

Tension HA

30

What are the common signs/sx's of C2 neuralgia?

- Paroxysmal sharp or shock-like pain centered in occipital region

Ipsilateral eye lacrimation and conjunctival injection are common