Review: OAT Head Pain Flashcards

1
Q

PE components in osteopathic approach to head pain

A

HEENT

Neuro (including muscle strength, CNs, DTRs)

OSE (flexion, extension, traction, and compression of cervical spine)

Psychological disposition

Special tests as indicated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Areas of possible TART or lymphatic findings in PE for head pain

A
Cranial
Cervical
Upper thoracic
Upper ribs
Upper extremities
Sacrum
Posture/leg length
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Osteopathic considerations in terms of location of head pain as well as possible sympathetic involvement

A

Anterior 2/3 = trigeminal n.

Posterior 1/3 = lesser occipital (C1-3), recurrent branches of IX and X

Sympathetics: T1-4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Epidemiology of tension headache

A

Mean age at onset 25-30

Peak prevalence at age 30-39

Female to male ratio 5:4

30-78% mean lifetime prevalence of tension type headache globally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Risk factors for tension headache and associated conditions

A

Likely: Stress, mental tension, emotional disturbance

Possible: poor self-rated health, inability to relax after work, sleeping few hours per night

Associated: anxiety, depression, migraine +/- aura, medication overuse headache

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Tension HA causes

A

Uncertain cause; susceptibility influenced by genetic factors in epidemiological and twin studies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Tension HA pathogenesis proposed

A

Active myofascial trigger points in head, neck, and shoulder

Episodic tension-type headache: peripheral pain mechanisms likely more important

Chronic tension type headache: central pain mechanisms more likely involved

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Clinical features of tension type HA

A

Bilateral, mild to moderate intensity, pressing or tightening quality (nonpulsating)

Not aggravated by routine physical activity

No N/V; may have photophobia or phonophobia but not both

May increase in frequency or duration over time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Difference between episodic tension HA and chronic tension HA

A

Episodic: HA can last 30 minutes to 7 days; infrequent with less than 10 episodes occurring on less than 1 day per month over the course of a year; or can be frequent with greater than 10 episodes on 1-14 days per month for greater than 3 months; often develops into chronic type

Chronic: episodes on more than 15 days per month on average for more than 3 months; may be continuous and unremitting, pts with chronic type more likely to seek care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Most common abnormal HEENT finding with tension headache

A

Pericranial muscle tenderness — tends to be mostly the scalp

Can also have dysfunction of frontal, temporal, masseter, pterygoid, SCM, splenius, and trapezius mm. (More likely with episodic than chronic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

General 5 models for tension HA tx

A

Behavioral: identify triggers, encourage following prescriptions, biofeedback, CBT and relaxation, counseling

Neurologic: analgesics and NSAIDs, caffiene, metaclopramide

Biomechanical: PT and acupuncture, OMT/manual therapy level 2, intra-oral appliance

Metabolic: sleep hygiene, hormonal influences, hydration

Respiratory-circulatory: hydration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

5 models OMT for tension headache

A

Biomechanical: address myofascial SDs, address joint SDs with cranial, MET, Still’s, HVLA, or FPR

Resp/circ: address lymphatics first to reduce irritants from inflammatory milieu

Neuro: address counterstrain points in cervicals, upper thoracics, upper ribs, and upper extremities; use cranial to address other SDs

Metabolic: improvement is d/t other approaches

Behavioral: exercise Rx to support tx of SDs contributing symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

One study showed that _______ (osteopathic technique) is more effective than control intervention for tension HA

A

MFR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Epidemiology of migraine

A

Currently about 15% of adults; 21% of US females and 10% of US males

Most common in american indian or alaska native > white > black or african american > hispanic or latino > native hawaiian or pacific islander > asian

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Risk factors for migraine

A

Analgesic overuse (defined as daily or almost daily for over 1 month)

MS

Possibly oral contraceptives

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Migraine associated conditions

A

Tension HA

Episodic syndromes: recurrent GI disturbance, vestibular migraine, benign paroxysmal torticollis

Migraine during pregnancy: preeclampsia, vascular dx (stroke, MI, PE, HTN, DM, smoking)

Endometriosis, obesity, depression, pain conditions, syncope, meniere’s disease

17
Q

POUND mnemonic for migraine dx

A

Pulsating

4-72 hOurs duration

Unilateral

Nausea or vomiting

Disabling

[4-5 criteria = likely a migraine]

18
Q

Precipitating factors for migraine

A

Menses, diet, fasting, stress, stress let-down, exertion, altered sleep, visual stimuli, odors, smoking, alcohol, caffeine withdrawal, oral contraceptives, vasodilators, change in weather

19
Q

Differential dx for migraine

A

Tension HA, cervical spine dz (greater occipital neuralgia), acute cervical strain, intracranial mass, meningitis, subarachnoid hemorrhage, TIA, cluster HA, cavernous sinus thrombosis, optic neuritis, acute glaucoma, pseudotumor cerebri, SLE, cervical a. dissection, TMD, epilepsy, sinusitis

20
Q

Migraine pathogenesis

A

With aura: spreading oligemia (reduced blood volume) in brain

Without aura is uncertain

No longer considered vascular based phenomena in terms of arterial constriction/dilation

Intracranial pain sensitive structures are meninges and intracranial blood vessels

May also be associated with spreading suppression of initial neuronal activation and increased occipital cortex oxygenation as well as dorsal pontine activation

21
Q

General 5 models for migraine tx

A

Behavioral: bed rest, identify triggers, encourage following prescription, biofeedback, CBT and relaxation, aerobic exercise and yoga, counseling

Neuro: analgesics and NSAIDs, triptans for moderate to severe, metaclopramide, prophylactic meds like TCAs

Biomechanical: PT and accupuncture, OMT manual therapy level 2

Metabolic: sleep hygiene, hormonal influences - menstrual, hydration

Resp/circ: prophylactic meds: beta blockers, hydration

22
Q

5 models OMT considerations for migraine

A

Resp/circ: address lymphatics first to reduce irritants from inflammatory milieu

Biomechanical: address joint SDs with cranial, MET, Still’s, HVLA, or FPR

Neuro: address counterstrain points in cervicals, upper thoracic, upper ribs, upper extremities

Metabolic: improvement d/t other approaches

Behavioral: exercise Rx to support tx of SDs contributing to sxs

23
Q

Type of headache caused by disorder of cervical spine and its component bone, joint, and/or soft tissue elements, usually but not invariable accompanied by neck pain

A

Cervicogenic HA

24
Q

IHS dx of cervicogenic HA

A

A. Any HA fulfilling criterion C

B. Clinical and/or imaging evidence of disorder or lesion within cervical spine or soft tissues of neck known to be able to cause HA

C. Evidence of causation demonstrated by 2 of the following: developed in temporal relation to onset of cervical disorder/lesion, significantly improved or resolved with improvement in cervical disorder/lesion, cervical range of motion is reduced AND HA is made significantly worse by provocative maneuvers, abolished following diagnostic blockade of cervical structure or its nerve supply

D. Not better accounted for by another ICHD-3 dx

25
Q

DDX for cervicogenic HA

A

Migraine

Tension HA

C2 neuralgia

Neck-tongue syndrome (rapid head turning causes subluxation of posterior AA and C2 spinal root compression —> neck pain, occipital pain, ipsilateral tongue sensory symptoms, onset is typically during childhood or adolescence

Occipital neuralgia

26
Q

General 5 models tx for cervicogenic HA

A

Behavioral: no data; exercise Rx to enhance OMT

Neuro: pregabalin, anesthetic blockade, radiofrequency block

Biomechanical: PT and accupuncture, OMT, surgery

Metabolic: glucocorticoid injection

Resp/circ: no data, hydration

27
Q

5 models OMT considerations for cervicogenic HA tx

A

Resp/circ: address lymphatics first to reduce irritants from inflammatory milieu

Biomechanical: address joint SDs with MET, Still’s, or FPR; HVLA may irritate facilitated segments

Neurologic: address anterior and posterior counterstrain points

Metabolic: improvement d/t other approaches

Behavioral: exercise Rx