Primary Headache Flashcards by Zachary Harbin

What are the primary causes of headaches?

Tension type headache
Migraine
Medication overuse
Cluster headache/trigeminal cephalgias

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What are some secondary causes of headaches?

Worst headache of life –> subarachnoid hemorrhage
New onset focal neurologic weakness –> Stroke
Onset of headache at >50 years old –> temporal arteritis or neoplasm
Acute eye pain –> acute eye pain
High blood pressure –> hypertensive urgency or emergency or preeclampsia

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What is needed to be done in the PE during a neurologic exam?

Rule out emergent conditions
Alert and oriented
CN exam
Extremity neurologic exam
Cerebellar exam
Walking gait
Special tests

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What is the pain pattern of a tension type headache?

Bilateral tight/achy pain

- Band like

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Where does the pain radiate in tension type headaches?

Radiation from occipital/cervical region

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What are the different categories of tension type headaches?

Infrequent: <1 day per month
Frequent or episodic: 1-15 days/month
Chronic: 15 days/month

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What are some common causes of tension type headache?

Myofascial pain referral
Cervical facet referral
TMJ dysfunction

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How does myofascial pain referral cause tension type headaches?

Trigger point is the pain generator
Due to dysfunctional muscles
Discrete, focal, hyperirritable

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What is a trigger point?

Palpable nodule “knot” in muscle

- Palpation –> twitch response which is visible and reproduces pain pattern

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What is myofascial pain referral primarily due to?

Acute trauma
Chronic strain/overuse
Sedentary lifestyles

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What is the difference between trigger points and tender points?

Trigger point
1. Has characteristic pain pattern
2. Only in taut band of muscle tissue
3. Elicits pain pattern and twitch response when pressed
Tender point
1. No pain pattern
2. In muscles, tendons, ligaments, and fascia –> no taut band
3. No radiating pattern or twitch response when pressed

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What are some conservative therapies for myofascial pain referral?

Manual manipulation like ischemia compression
PT
Spray and stretch
Dry needling
Trigger point injections with lidocaine and steroids
Pharm: OTC analgesics, NSAIDS, antidepressants, muscle relaxants, BOTOX

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What are tension type headache caused by cervical facet referral primarily due to?

Degeneration/arthritis
Injury
Overuse/poor posture

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What is the pain generator in cervical facet referral?

Cervical facet joint capsule

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What are some associated symptoms with cervical facet referral?

Palpation of joint reproduces symptoms

- Protective muscle spasms during ROM with painful loss of ROM

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What is the treatment for cervical facet referral causing tension headaches?

RICE
Conservative –> manual medicine, PT
NSAIDs and steroids
Injection with lidocaine and steroids
Radiofrequency ablation

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How does TMJD cause tension headaches?

Internal: malocclusion, bruxism, excessive opening

- External: trauma and displacement to joint/disc

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What are the pain generators of TMJD?

Myofascial pain due to guarding/overuse
Joint capsule pain
Disc dislocation

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What are some associated symptoms with TMJD?

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Decreased ROM of jaw
Clicking, crepitus of joint (pop can be joint displacing)
Pain with opening/closing/chewing
Jaw deviation
Pain in the morning due to nocturnal bruxism

What are some treatment options for TMJD?

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TMJ specific –> bite splint, biofeedback, passive stretching
Conservative –> manual medicine, PT
Pharm –> NSAIDs or muscle relaxants
Joint or trigger point injection
Surgery generally contraindicated

What is done in the biomechanical treatment for tension headaches?

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Splint, stretching, spray and stretch, dry needling
OMT, PT
Injections/radiofrequency ablation

What are some metabolic treatments for tension headaches?

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Pharm –> NSAIDs and steroids

What are some neurologic treatments for tension headaches?

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Pharm –> muscle relaxers

- Preventative –> SSRIs or tricyclics

What are some behavioral treatments for tensions headaches?

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RICE
Prevent overuse
Biofeedback (CBT)
Smoking cessation (nicotine use correlates with headache)

What are some behavioral etiologies of tension headaches?

- Postural overuse --> anterior carry of neck or reverse lordosis of cervical spine due to long hours of studying - Arms raised overuse causing dysfunction between shoulder blades (hairdressers or factory workers)

Who are migraines most often seen in?

- Females more than males - Most common in 30-39 - Genetic basis

What are some clinical features of migraines?

- Recurrent attacks | - Multiple phases --> prodrome, aura, migraine headache, postdrome

What are some associated symptoms of migraines?

- Unilateral throbbing burning pain - Aura - Nausea - Photophobia - Phonophobia

What is seen in the prodrome phase of migraines?

- Fatigue - Irritability - Depression or euphoria - Food cravings - Constipation - Neck stiffness

When does the prodrome phase of migraines present?

- 24-48 hours prior to onset

What is the aura phase of migraines?

- <1 hour of focal neurologic symptoms - Visual, sensory, language, or motor disturbances - Numbness and tingling

What is seen in the postdrome of migraines?

- Fatigue - Inability to concentrate - Depressed mood

What are some common triggers of migraines?

- Emotional stress - Hormones - Irregular sleep - Diet - Caffeine and alcohol - Changes in weather - Dehydration - Smells - Medications

What are some biomechanical treatments for migraines?

- Manipulation to decrease number of migraine days | - Acupuncture

What are some respiratory/circulatory treatments for migraines?

- Stay hydrated

What are some metabolic treatments for migraines?

- Don't skip meals

What are some neurologic treatments for migraines?

- Abortive: triptans, ergots - Prophylaxis: propranolol, amitriptyline, topiramate, BOTOX - Anti-seizure meds

What are some behavioral treatments for migraines?

- Mindfulness/meditation - Yoga/Tai chi - Biofeedback - Avoid triggers

What is the pain generator in medication overuse/rebound?

- Chemical dependence on medication

What are the associated symptoms of medication overuse/rebound?

- Headache recurring around the same time every day | - Always relieved by taking medication

What treatment can help medication overuse/rebound headaches?

- Education is key | - Stop offending medication and can bridge cessation with other/different meds

What is the pain pattern of trigeminal cephalalgia/cluster headache?

- Unilateral severe, sharp, and stabbing pain around the eye | - Cycles during a cluster period

What are some associated symptoms of trigeminal cephalgia/cluster headaches?

- Autonomic symptoms

What are some treatment options for trigeminal cephalgias/cluster headaches?

- O2 - Triptans - Ergotamine - Intranasal lidocaine - Verapamil is used prophylactically

What is the respiratory/circulatory treatment for cluster headaches?

- O2 is aborative

Primary Headache Flashcards

(45 cards)