Opp2: Test 1: 12. Kribs: Upper Cervical Somatic Dysfunction And Headaches

Front 1

what is a major source of intracranial head pain?

Back 1

Dura Mater

Front 2

What nerve is a major source of extracranial pain?

Back 2

Greater Occipital n.

Front 3

this structure Connects the CNS and peripheral musculoskeletal system, causing the two structures to function as a membranous unit. It can be a source of tension headaches

Back 3

Myodural bridge

Front 4

Red flag questions when diagnosing cephalgia are: (3)

probably more just to read

Back 4

Pain Level?

Associated Symptoms?

Any recent changes in headache pattern?

Front 5

sudden severe headaches
neck stiffness and fever
injury
first or worst headache of ones life
visual changes

are all what?

Back 5

huge red flags for headache

Front 6

When do you order diagnostic tests for head pain?

Back 6

Focal or sudden onset of neurological symptoms or signs.

Progressive headaches

Symptoms of increasing intracranial pressure.

Front 7

an overweight fatty female presents to your office with headache nausea and vomiting. Upon fundoscopic exam you see papilledema and evidence for a suparachnoid hemmorhage with optic neurititis. What does the chunker have?

**

Back 7

Pseudotumor Cerebri

Front 8

A young man presents to your office saying that he thinks he has the flu. He has headache, vomiting, hoarseness, and difficulty swallowing. On exam, he is afebrile and his oropharyngeal exam is normal. Cranial nerve exam yields a decreased gag reflex. What does he likely have? What test would you order to confirm this?

**

Back 8

Arnold Chiari Malformation

MRI: it would show the cerebellum protruding into the spinal canal

Front 9

this headache is usually bilateral and feels like tightening or vice like gripping. The pain can radiate into the trapezius muscle and posterior neck. What type of headache is this? is it provoked by low level activity?

Back 9

Tension headache

NOT provoked by low level activity

Migraine symptoms usually absent

Front 10

3 top causes of tension headaches?

Back 10

Emotional
Stress, Anxiety, Depression, Anger

Postural
Occupational, postural imbalance, poor posture, abnormal spinal curvatures

Muscle hypertonicity/fatigue
Prolonged frowning, bruxism
fatigue such that head and neck cannot be supported

Front 11

nerves that provide sensory info to your head tend to leave out of upper cervical rami... thus you can have pain that originates from there causing your headaches

Back 11

Muscles in back of neck and suboccipital triangle
Innervated by suboccipital nerve (Dorsal rami of C1)
Greater occipital nerve originates from dorsal rami of C2.
Exits between C1-C2 and penetrates semispinalis, splenius, and trapezius.
Impingement from SD can cause pain in scalp

Front 12

Cervicogenic vs Tension Headache

Stress, jaw clenching TMJ syndrome

Back 12

Seen in tension headache

would have neck movement problems in cervicogenic over C1-3 facets

Front 13

Cervicogenic vs Tension Headache

character of pain?

Back 13

Cervicogenic: Moderate, not excruciating or throbbing

Tension: Bilateral, not throbbing, moderate, band-like head pressure

Front 14

inflammation of the greater occipital nerve =

Back 14

Greater Occipital Neuralgia

Directly related to unresolved cervical strain.

Front 15

pt comes in with a headache with numbness or tingling of the scalp on one side of their head. They say that the pain is brief and sharp only lasting for a few seconds. They say it even hurts to brush their hair. What do they have?

Back 15

Occipital Neuralgia Signs and Symptoms

Front 16

key places to tx for Occipitial neuralgia

Back 16

OA, AA, Suboccipital triangle

Front 17

what is the goal of tx for tension type headaches? thus what are some of your tx options?

Back 17

Normalization of muscle and fascial tone in the head and neck.

Key Articular regions include:
Occipital Atlantal joint
Atlantoaxial joint
C2 on C3

Front 18

pt presents with headache, nausea, vomiting, photophobia, phonophobia, and inability to perform usual tasks. They say the pain is episodic, about 1-2 times a month. What do they have?

**

Back 18

Migraine

*3/5 of these symptoms >90 % specific for migraines

Front 19

what is the pathogenesis of migranes?

Back 19

a trigger (physical, chem, psyc) leads to release of 5HT and NE.

causes vascular dilation

triggers trigeminal system

creating tightness and spasms of the muscles in the back of the head and neck.

Front 20

here are some of the OMT options for tx of migrane

Back 20

Upper thoracic somatic dysfunction will increase sympathetic tone to head
Upper cervicals: C1-3 nerve roots increase pain stimulus to spinal nucleus of TG nerve
Occipitomastoid s/d can decrease drainage through the jugular foramen
Gentle indirect to head, cervicals, thoracic and ribs.

Front 21

a pt is having an acute headache that is believed to be a migraine, what type of techniques should be avoided?

Back 21

Avoid direct during acute headache as it may increase blood flow to an inflamed vascular bed and worsen the headache.

Front 22

What can create an environment for development of migraines?

**

Back 22

CONNECTIVE TISSUE STRESS CAN CAUSE DRAG ON INTRACRAINIAL DURA

which then can create an environment for development of migraines

Front 23

at the OA (C0-C1) segment, what is the primary movement? When sidebending is introduced, what way will rotation occur?

Back 23

Primary motion is flexion and extension

When sidebending is introduced, rotation will occur in opposite direction (SLRR)

Front 24

for OA, if your diagnosis is

E SL Rr

what is your tx position?

What way does the pt sidebend?

Back 24

Tx position: F Sr Rl

Patient SB Left

Front 25

dx and tx for AA dysfunction?

Back 25

Flex neck to C1
Keep neck flexed, to isolate motion to AA
Rotate R and L and compare
For ME treatment
Rotate to direct barrier
Have patient push away from direct barrier

Front 26

Vertebral Artery Challenge Test
Cervical Compression Test
Beighton Hypermobility Screen
DTRs or UE strength testing not relevant to upper cervical neurologic testing

are all what?

Back 26

Screening Tests Prior to Treatment of Upper Cervical Somatic Dysfunction

Front 27

Rheumatoid arthritis is what for direct treatment of the upper cervical spine?

Back 27

CONTRAINDICATED (especially for HVLA)

Front 28

in a pt with headache, what should you treat with OMT first?

Back 28

Treat upper thoracics and ribs first

then Cervical muscle tension and dysfunction (what can patient tolerate)

finally (because now you are just makin things up) Cranial motion