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28 Cards in this Set

  • Front
  • Back
what is a major source of intracranial head pain?
Dura Mater
What nerve is a major source of extracranial pain?
Greater Occipital n.
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
Myodural bridge
Red flag questions when diagnosing cephalgia are: (3)

probably more just to read
Pain Level?

Associated Symptoms?

Any recent changes in headache pattern?
sudden severe headaches
neck stiffness and fever
first or worst headache of ones life
visual changes

are all what?
huge red flags for headache
When do you order diagnostic tests for head pain?
Focal or sudden onset of neurological symptoms or signs.

Progressive headaches

Symptoms of increasing intracranial pressure.
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?

Pseudotumor Cerebri
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?

Arnold Chiari Malformation

MRI: it would show the cerebellum protruding into the spinal canal
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?
Tension headache

NOT provoked by low level activity

Migraine symptoms usually absent
3 top causes of tension headaches?
Stress, Anxiety, Depression, Anger

Occupational, postural imbalance, poor posture, abnormal spinal curvatures

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

Stress, jaw clenching TMJ syndrome
Seen in tension headache

would have neck movement problems in cervicogenic over C1-3 facets
Cervicogenic vs Tension Headache

character of pain?
Cervicogenic: Moderate, not excruciating or throbbing

Tension: Bilateral, not throbbing, moderate, band-like head pressure
inflammation of the greater occipital nerve =
Greater Occipital Neuralgia

Directly related to unresolved cervical strain.
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?
Occipital Neuralgia Signs and Symptoms
key places to tx for Occipitial neuralgia
OA, AA, Suboccipital triangle
what is the goal of tx for tension type headaches? thus what are some of your tx options?
Normalization of muscle and fascial tone in the head and neck.

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


*3/5 of these symptoms >90 % specific for migraines
what is the pathogenesis of migranes?
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.
here are some of the OMT options for tx of migrane
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.
a pt is having an acute headache that is believed to be a migraine, what type of techniques should be avoided?
Avoid direct during acute headache as it may increase blood flow to an inflamed vascular bed and worsen the headache.
What can create an environment for development of migraines?


which then can create an environment for development of migraines
at the OA (C0-C1) segment, what is the primary movement? When sidebending is introduced, what way will rotation occur?
Primary motion is flexion and extension

When sidebending is introduced, rotation will occur in opposite direction (SLRR)
for OA, if your diagnosis is


what is your tx position?

What way does the pt sidebend?
Tx position: F Sr Rl

Patient SB Left
dx and tx for AA dysfunction?
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
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?
Screening Tests Prior to Treatment of Upper Cervical Somatic Dysfunction
Rheumatoid arthritis is what for direct treatment of the upper cervical spine?
in a pt with headache, what should you treat with OMT first?
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