worst headache of life
SAH
new onset focal neurologic weakness
stroke
onset headaches at >50 yr old
temporal arthritis
neoplasm
associated systemic symptoms
meningitis
encephalitis
acute eye pain
acute angle glaucoma
high blood pressure
hypertensive urgency/emergency
preeclampsia
Tension Headache Pain Pattern
bilateral tight/achy pain
radiation from occipital/cervical region
tension headache etiology
cervicogenic C1-3
trigeminal cervical complex
tension head common causes
myofascial pain referral
cervical facet referral
TMJD
Myofascial pain referral
Tension headache
due to overuse or injury to muscles
generates a trigger point
trigger point
seen in myofascial pain in tension headaches
palpable knot in muscle
palpation creates a twitch response
reproduces pain pattern
Conservative tx for myofascial pain
manual manipulation - ischemia compression
PT
Spray and stretch
dry needling
Cervical Facet referral
tension headache
due to degeneration/arthritis, injury, overuse/poor posture
generated by the cervical facet joint capsule
cervical facet sxs
palpation of joint reproduces sxs
protective muscle spasms during movement
painful loss of range of motion
cervical facet tx
RICE
Conservative
Pharm
Injection
TMJD causes
tension headache
malocclusion
disc displacement/joint degeneration
myalgia
TMJD pain generators
intra-articular - joint
extra-articular - pterygoid m., temporalis m., masseter m.
TMJD associated sxs
decreased ROM of jaw
clicking of joint
pain with opening/closing/chewing
TMJD tx
bite splint, stretching conservative pjarm trigger point injection surgery contraindicated
Preventive Tension headhace
SSRI, tricyclics
smoking cessation
Migraine pain pattern
unilateral throbbing burning pain
may shift
multiple phases
migraine associated sxs
aura
NAUSEA
photophobia
phonophobia
Migraine phases
premonitory - fatigue, irritability, difficulty speaking/reading
aura
headache
postdrome - fatigue, inability to concentrate/comprehend
Migraine subtypes
migraine without aura migraine with aura hemiplegic migraine migraine and vertigo abdominal migraine retinal migraine
Migrane triggers
emtional stress hormones irregular sleep diet caffeine and alcohol weather dehydration smells meds
miagraine etiology
cortical spreading depression theory
depolarization of ion channels cuases spreading wave of neuro depression
inappropriate nociceptive sensitization of trigeminocervical pain
migraine tx
manipulation decreases number of migraine days
accupuncture - evidence of some prophylaxis
triptan, ergots
avoid triggers
Medication rebound define
chronic pain med use
>15day/month for 3 months
medication rebound pain generator
chemical dependence on med
medication rebound pain generator sxs
headache recurring around the same time every day
always relieved with taking the same meds
medication rebound tx
stop offending medication to break the cycle
Cluster headache pain pattern
trigeminal autonomic cephalgias
unilateral brief cycles
cluster headache sxs
autonomic sxs sweating swelling tearing stuffy/runny nose
cluster headache etiology
hypothalamic activation triggers trigeminal autonomic reflex
cluster headache tx
oxygen triptan ergos intranasal lidocaine prophylaxis - verapamil
