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36 Cards in this Set
- Front
- Back
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Trigger points in muscles of the head and neck can radiate pain to various parts of the head
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"Travell Trigger Points
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a unilateral lower motor neuron facial paralysis resulting from dysfunction of the facial nerve (VII)
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Bell’s Palsy
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Etiology for Bells Palsy
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unclear; viral infection, exposure to cold air
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Which foramen for CN VII
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Stylomastoid Foramen
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The ___ foramen exits the skull near the sutural junction of the occiput and mastoid portion of the temporal bones
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stylomastoid
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What Cranial somatic dysfunction may be involved in Bell's Palsy
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internally rotated temporal bone
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Which side open in TMJ
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anterior and inferior rotation
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Which side closed in TMJ
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posterior and superior rotation
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___ attaches to disk and draws anteriorly with opening- when tight- prevents posterior motion
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Lateral pterygoid
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The TMJ is formed by the ___ fossa of the ___ bone as well as the fibrous capsule & ligaments
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head of the mandible & mandibular, temporal
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Oligemia
“Spreading depression” Trigeminal nucleus caudalis activation Sterile neurogenic inflammation |
Pathophysiology of Migraines
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Usually unilateral, can be bilateral
Triggers – bright lights, fatigue, insomnia, hypoglycemia, stress, ETOH, menstruation, wine, cheese, weather changes, caffeine, smoking, food additives (MSG) Temporal, behind eye Throbbing, pulsating Moderate-severe Lasts 4-72 hours |
Migraine Headaches
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Aggravated by exertion
Photo/phonophobia, nausea, vomiting With or without aura- typically lasts 15-30 minutes Anorexia, diarrhea, motion sickness, smell sensitivity, “ice cream HAs” May be thought to be a “sinus HA” Female> male +family history |
Migraine Headaches
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Osteopathic Approach to Treating of Migraine Headaches
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Cranial Dysfunctions (esp. Temporal bone motion & SB/Rot patterns)
Upper Thoracic Spine - Sympathetic innervation Cervical spine (C1-C3) Also strain patterns in sacrum and coccyx, lower extr., abdomen may contribute to increased tension higher Postural effects Effects on craniosacral Thoracic inlet & lymphatic drainage |
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Causes: stress, anxiety, depression, fatigue, emotional, bruxism
Bilateral (may be unilateral) Pressing, band-like, tightness Mild to moderate intensity No prodrome or aura Not aggravated by exertion No nausea or vomiting Either or neither photophobia or phonophobia Duration-30 min.-1 week. |
Tension-Type Headache
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Treatment of Tension Headaches
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Pharmacologic (NSAIDS, muscle relaxants, antidepressants, etc)
Sleep hygiene Exercise program/ physical therapy Psychological counseling Relaxation techniques – visual imagery |
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Osteopathic Approach to Treating Tension Headaches
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Affected muscles
Cervical spine, upper thoracic, head, Trapezius, Levator scapula OA AA C2 on C3 Poor posture, ergonomics can contribute Associated myofascial trigger points |
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Muscles in Vertex pain TG
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SCM
(sternal)clavicular Splenius capitus |
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Muscles in Occipital pain TGs
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SCM (both)
Semispinalis Multifidus Suboccipitals |
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Muscles in Temporal pain TGs
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Trapezius
SCM (sternal) Temporalis |
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Muscles in Frontal pain TG
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SCM (both)
Frontalis |
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Unilateral
Severe Orbital, supraorbital, and/or temporal Lasts 15-180 minutes Typically occur at night |
Cluster Headaches
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Associated Symptoms:
Ipsilateral autonomic Sx-lacrimation, rhinorrhea, nasal congestion, conjunctival injection, Horner’s syndrome (ptosis, miosis), forehead and facial sweating |
Cluster Headaches
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Male> female
1-8 episodes daily; “Clusters” for 1-6 months Patient may pace, head-bang; may be suicidal |
Cluster Headaches
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Extracerebral vasodilation likely
Neuronal dysfunction Trigeminovascular system involved Hypothalamus involved Parasympathetic and sympathetic dysfunction |
Theories on the Pathophysiology of Cluster Headaches
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Treatment of Cluster Headaches
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Oxygen therapy
Pharmacologics Abortive treatment Prophylaxis |
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Osteopathic Approach to Treating Cluster Headaches
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OMT: Same as for migraine
Cranial C1-C3 Upper thoracics 1st rib Thoracic inlet & lymphatic drainage Also, Sphenopalatine ganglion release |
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Unilateral facial nerve paralysis
Viral? Sensation intact Motor affected including forehead, upper lid. Treatment temporal |
Bell’s palsy
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Treatment of Bell’s Palsy
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Protect the eye
AAN Guidelines 2005-2006 Benefit not definitively established Steroids probably effective Acyclovir plus prednisone possibly effective Insufficient evidence for facial nerve decompression |
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Head of mandible & articular disc move anteriorly relative to the temporal bone
Head of the mandible rotates about a transverse axis on the inferior surface of the articular disc |
Motion of the TMJ: Opening Mouth
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Heads of mandible glide anteriorly & articular discs move posteriorly
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Motion of the TMJ:Protrusion
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Heads of mandible glide posteriorly & articular discs move anteriorly
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Motion of the TMJ: Retraction
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Head of mandible & articular disc move posteriorly relative to temporal bone
Head of the mandible rotates opposite direction on the transverse axis |
Motion of the TMJ: Closing Mouth
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If Left TMJ motion is restricted & pt opens mouth:
Right side of the mandible & right articular disc glide1.___ 2.__ side is restricted RESULT: 3.___ |
1. anteriorly
2. Left 3. Deviation of the chin to the left side |
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Treatment of TMJ Dysfunction
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Muscle relaxants, antidepressants
Lifestyle- reduce stress Nocturnal bite plate Jaw exercises Referral to dentist Local anesthetic corticosteroid joint injection Botulinum toxin injection into the masticatory muscles Dental surgery |
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OMT for TMJ Dysfunction
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Muscle energy techniques for the jaw/ muscles of mastication
Stretching the pterygoid muscle/ inhibition of tender points Cranial (temporal bone) OA, C2, and C3 may be involved |
