Week 5 & 6

Question 1

Are females or males more likely to suffer from headaches?

Answer 1

females

Question 2

How common is neck pain in migraine?

Answer 2

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

Question 3

What are the three types of headaches?

Answer 3

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

Question 4

Contrast primary vs secondary headaches.

Answer 4

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

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

Question 5

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

Answer 5

True

Question 6

What is the population incidence of cervicogenic headache?

Answer 6

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

Question 7

Where does TTH commonly present headache/pain?

Answer 7

forehead

Question 8

Where does migraine commonly present headache/pain?

Answer 8

unilaterally (+/- neck)

Question 9

Where does cervicogenic headache present headache/pain?

Answer 9

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

Question 10

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

Answer 10

No- all are diagnosed using a criteria on clinical presentation

Question 11

What is the diagnostic criteria for migraine?

Answer 11

+/- 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

Question 12

What is the difference between episodic and chronic migraine?

Answer 12

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

Question 13

What are the 5 stages of migraine?

Answer 13

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)

Question 14

What is the hypothesised cause of migraines?

Answer 14

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

Question 15

What are some common triggers for migraines?

Answer 15

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)

Question 16

What is the diagnostic criteria for TTH?

Answer 16

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

Question 17

What causes TTH?

Answer 17

not sure

some triggers include emotional tension, anxiety, tiredness or stress

genetics may have a role

Question 18

What is the diagnostic criteria for cervicogenic headache?

Answer 18

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

Question 19

What 3 msk dysfunctions are commonly seen in cervicogenic headache?

Answer 19

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)

Question 20

Name some red flags in headache patients.

Answer 20

severe & sudden onset

subacute headache progressively worsening

neurological signs or changes in consciousness

1st ever headache

recent trauma

general malaise

Question 21

Two main arteries that supply the brain.

Answer 21

vertebral arteries (supply 20%)

carotid arteries (supply 80%)

Question 22

What is cervical arterial dissection (CAD)?

Answer 22

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

Question 23

CAD is an important cause of stroke in what population?

Answer 23

young people <45 years (~25%)

Question 24

Has CAD been linked with neck manipulation?

Answer 24

yes- whether causative or missed diagnosis though unsure

Question 25

How can we recognise CAD?

Answer 25

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)

Question 26

What is horner's syndrome?

Answer 26

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

Question 27

Why are neck afferents important for everyday function?

Answer 27

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

Question 28

What sensorimotor dysfunction could we see with neck pain?

Answer 28

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)

Question 29

What causes abnormal afferent input in neck disorders?

Answer 29

direct damage from trauma functional impairment in muscles morphological changes in muscle inflammation altered muscle activity pain sympathetic nervous system i.e. stress

Question 30

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

Answer 30

traumatic- however could still be present with idiopathic as well

Question 31

Describe cervicogenic dizziness.

Answer 31

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

Question 32

What is vertebrobasilar insufficiency (VBI)?

Answer 32

insufficient blood flow through the vertebral artery to the hindbrain

Question 33

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

Answer 33

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

Question 34

What are the causes of VBI?

Answer 34

atherosclerosis head position Bow-Hunters syndrome (rare) post-traumatic headache/dizziness

Question 35

What are the common signs of VBI?

Answer 35

5 D's (dizziness, diplopia, dysarthria/dysphasia, drop attacks, dysphagia) 3 N's (nausea, nystagmus, numbness)