SBO6 week 1 head, face, neck pain and thoracic outlet Flashcards
what are the red flags to consider in headache presentations?
SNOOP: systemic symptoms or illness neurological signs onset older populations previous HA Hx
what are three primary headaches?
- TTH
- Migraine with or withour aura
- Cluster
other: exercise, sex, ice-cream induced headache
WHO AM I? i am diagnosed after 5 attacks if: -i last 4-72 hours 2 of the following: -unilateral -pulsating -moderate to severe -aggravated by PA 1 of: -nausea, vomiting, photo/phonophobia i may be accompanied by aura: -reversible, develop over 5 minutes, last 5-60 mins e.g. visual, sensory, speech *scintillating scotoma
Migraine
WHO AM I? i am diagnosed after 10 attacks if: 30 mins-7 days duration 2 of the following: -bilateral -pressing/tightening -mild-moderate -not aggravating by PA not accompanied by nausea or vomiting OR more than one of photo/phonophobia
Tension Type Heahache
WHO AM I? i am diagnosed after 5 attacks if: -unilateral -severe-very severe -orbital, supraorbital or temporal -15-180 minutes -every 2nd day to 8 times/day accompanied by at least one of: -lacrimation or rhinorrhea -eyelid, forehead or facial oedema -miosis or ptosis
Cluster Headache
WHO AM I?
-unilateral
-begin at occipital region, radiate to parietal, vertex, behind eye (occipital, frontal, tempral or orbital)
-moderate-severe
-hrs to days
non-throbbing unless accompanied with migraine
-accompanied with dysfunction of the upper cervical spinal segments: motion restriction and tenderness
mechanism: convergence of cervical and trigeminal sensory fibres in the trigeminocervical nucleus
associates SSX: nausea, vomiting, photophobia, phonophobia, dizziness
Cervicogenic headache
WHO AM I?
- thunderclap HA
- unilateral
- frontal, temporal, occipital, suboccipital region
- sudden onset
- unilateral head or facial pain
- constant and severe
- unlike anything ever experienced
- neuro SSX: UL, LL deficits, Horner’s syndrome (miosis, ptosis, anhidrosis), cranial nerve neuropathy, pulsating tinnitus
CAD
if you suspect a patient has a CAD in progress, what examinations are you going to perform?
BP
Cranial Nerve Examinations
Proprioception and coordination
which nervous sructures relate to head and facial pain?
CNV Trigeminal nerve;
V1-opthalmic
V2-Maxillary
Vs-Mandibular
trigeminalcervical nucleus/complex
auricular nerve C2, C3
lesser and greater Occipital nerves
define radicular pain
pain caused by inflammation and/or compression of a nerve root
rarely limited to one dermatome
the 2 most common causes of cervical radiculopathy are:
spondylosis (OA)
disc herniation
what features may cause you to suspect radiculopathy?
sensory or motor changes
radicular pain
deep tendon reflexes
if a patient presents with sensory changes in more than one dermatome, what might you suspect?
peripheral nerve entrapment, thoracic outlet syndrome, spondylosis
if a patient presents with sensory changes involving both upper and lower limb or the trunk, what structure might you suspect is dysfuntional?
spinal cord
what are common causes of cervical myelopathy?
buckling of ligamentum flavum
PLL ossification
central canal stenosis
