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PHTY3260 Cervical > Week 5 & 6 > Flashcards

Week 5 & 6 Flashcards

1
Q

Are females or males more likely to suffer from headaches?

A

females

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2
Q

How common is neck pain in migraine?

A

~75-80% of cases report neck pain accompanying migraine

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3
Q

What are the three types of headaches?

A

migraine, tension-type headache (TTH) and cervicogenic headache

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4
Q

Contrast primary vs secondary headaches.

A

primary (i.e. migraine or tension-type) may have no particular cause

secondary (i.e. cervicogenic) is secondary to musculoskeletal dysfunction

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5
Q

True or false, all headaches can be worsened with medication overuse.

A

True

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6
Q

What is the population incidence of cervicogenic headache?

A

0.8-2.2% (less common than migraine or TTH)

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7
Q

Where does TTH commonly present headache/pain?

A

forehead

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8
Q

Where does migraine commonly present headache/pain?

A

unilaterally (+/- neck)

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9
Q

Where does cervicogenic headache present headache/pain?

A

unilateral, back and top of the head (+ ipsilateral neck)

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10
Q

Can any of the three types of headache be diagnosed with imaging or bloods?

A

No- all are diagnosed using a criteria on clinical presentation

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11
Q

What is the diagnostic criteria for migraine?

A

+/- aura preceding ~5-60 minutes

headache lasting 4-72 hours

at least 2:
unilateral (but can change sides)
pulsating quality
moderate to severe intensity
aggravated by physical activity

at least 1:
vomiting or nausea
photophobia/phonophobia

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12
Q

What is the difference between episodic and chronic migraine?

A

episodic= <15 per month
chronic= >15 per month, 7 of which are ‘true’ migraine

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13
Q

What are the 5 stages of migraine?

A
  1. early warning symptoms (i.e. mood change)
  2. aura
  3. headache +/- nausea, vomiting, sensitivity to light, sound, smell
  4. resoluation
  5. recovery (feeling drained or energetic ~24 hours)
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14
Q

What is the hypothesised cause of migraines?

A

potentially certain parts of the brain being hypersensitive to particular stimuli i.e. emotion, sensory or sudden change in the internal or external environment

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15
Q

What are some common triggers for migraines?

A

dietary (i.e. missed or delayed meals, caffiene withdrawal, wine, bee, spirites, chocolate, citrus, aged cheese, MSG, dehydration)

environmental (i.e. blight/flickering lights, strong smells, travel, altitude, weather changes, loud sounds)

hormonal (i.e. menstruation, ovulation, oral contraceptives, pregnancy, hormone replacement therapy, menopause)

physical/emotional (i.e. sleep, viral infection/cold, back or neck pain, stress, arguments, relaxation after stress)

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16
Q

What is the diagnostic criteria for TTH?

A

headache lasting 30 minutes to 7 days

at least 2:
pressing/tightening/non-pulsating quality
bilateral, bandlike headache
mild to moderate intensity, not aggravated by physical activity

both:
no nausea or vomiting
no more than one photophobia or phonophobia

17
Q

What causes TTH?

A

not sure

some triggers include emotional tension, anxiety, tiredness or stress

genetics may have a role

18
Q

What is the diagnostic criteria for cervicogenic headache?

A

unilateral without side-shift
associated with ipsilateral neck pain
pain starts in the neck
no pulsating
aggravated by neck movement
restricted neck ROM
eliminated by cervical diagnostic block
possible nausea, phono/photophobia

19
Q

What 3 msk dysfunctions are commonly seen in cervicogenic headache?

A

reduced ROM (esp. cervical rotation and extension)

segmental joint dysfunction in upper 3 segments (i.e. pain, hypomobility, local muscle spasm)

altered muscle behaviour in the CCFT (increased superficial muscle activity)

20
Q

Name some red flags in headache patients.

A

severe & sudden onset

subacute headache progressively worsening

neurological signs or changes in consciousness

1st ever headache

recent trauma

general malaise

21
Q

Two main arteries that supply the brain.

A

vertebral arteries (supply 20%)

carotid arteries (supply 80%)

22
Q

What is cervical arterial dissection (CAD)?

A

dissection of a vertebral or carotid artery causing a change in blood flow and potential formation of a clot, leading to stroke

incidence 2.97 per 100,000

23
Q

CAD is an important cause of stroke in what population?

A

young people <45 years (~25%)

24
Q

Has CAD been linked with neck manipulation?

A

yes- whether causative or missed diagnosis though unsure

25
Q

How can we recognise CAD?

A

acute onset of new, unusual pain
moderate-severe pain
transient neurological features (i.e. balance/gait, speech, visual disturbance)
age <55 years
Horner’s syndrome
spontaneous nystagmus (particularly bi-directional)

26
Q

What is horner’s syndrome?

A

Horner’s syndrome:
ptosis (unilateral eyelid droop)
miosis (unequal pupils)
facial droop

27
Q

Why are neck afferents important for everyday function?

A

they provide information to the brainstem to integrate with other sensory information

allow us to know head position in relation to body

inform postural control

eye/trunk head coordination

sensory matching

28
Q

What sensorimotor dysfunction could we see with neck pain?

A

altered proprioception (joint position and movement sense)

altered eye movement control (smooth pursuit & gaze stability)

altered eye/head and trunk/head coordination

altered standing balance (static & dynamic)

29
Q

What causes abnormal afferent input in neck disorders?

A

direct damage from trauma

functional impairment in muscles

morphological changes in muscle

inflammation

altered muscle activity

pain

sympathetic nervous system i.e. stress

30
Q

Are sensorimotor control impairments more common in traumatic or idiopathic neck disorders?

A

traumatic- however could still be present with idiopathic as well

31
Q

Describe cervicogenic dizziness.

A

episodic, vague unsteadiness with a close temporal relationship with neck pain

32
Q

What is vertebrobasilar insufficiency (VBI)?

A

insufficient blood flow through the vertebral artery to the hindbrain

33
Q

Where are the potential sites of tension on the vertebral artery that may cause VBI?

A

1st part- muscle compression (anterior/medial scalenes)

2nd part- vertebral bodies (disc, z joints, canals, think degenerative conditions)

3rd part- C1/2 rotation causes kinking of the contralateral artery

34
Q

What are the causes of VBI?

A

atherosclerosis

head position

Bow-Hunters syndrome (rare)

post-traumatic headache/dizziness

35
Q

What are the common signs of VBI?

A

5 D’s (dizziness, diplopia, dysarthria/dysphasia, drop attacks, dysphagia)

3 N’s (nausea, nystagmus, numbness)

PHTY3260 Cervical (6 decks)

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