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28 Cards in this Set
- Front
- Back
what is a major source of intracranial head pain?
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Dura Mater
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What nerve is a major source of extracranial pain?
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Greater Occipital n.
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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
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Myodural bridge
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Red flag questions when diagnosing cephalgia are: (3)
probably more just to read |
Pain Level?
Associated Symptoms? Any recent changes in headache pattern? |
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sudden severe headaches
neck stiffness and fever injury first or worst headache of ones life visual changes are all what? |
huge red flags for headache
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When do you order diagnostic tests for head pain?
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Focal or sudden onset of neurological symptoms or signs.
Progressive headaches Symptoms of increasing intracranial pressure. |
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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?
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Pseudotumor Cerebri
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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?
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Arnold Chiari Malformation
MRI: it would show the cerebellum protruding into the spinal canal |
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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?
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Tension headache
NOT provoked by low level activity Migraine symptoms usually absent |
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3 top causes of tension headaches?
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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 |
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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
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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 |
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Cervicogenic vs Tension Headache
Stress, jaw clenching TMJ syndrome |
Seen in tension headache
would have neck movement problems in cervicogenic over C1-3 facets |
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Cervicogenic vs Tension Headache
character of pain? |
Cervicogenic: Moderate, not excruciating or throbbing
Tension: Bilateral, not throbbing, moderate, band-like head pressure |
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inflammation of the greater occipital nerve =
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Greater Occipital Neuralgia
Directly related to unresolved cervical strain. |
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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?
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Occipital Neuralgia Signs and Symptoms
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key places to tx for Occipitial neuralgia
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OA, AA, Suboccipital triangle
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what is the goal of tx for tension type headaches? thus what are some of your tx options?
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Normalization of muscle and fascial tone in the head and neck.
Key Articular regions include: Occipital Atlantal joint Atlantoaxial joint C2 on C3 |
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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?
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Migraine
*3/5 of these symptoms >90 % specific for migraines |
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what is the pathogenesis of migranes?
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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. |
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here are some of the OMT options for tx of migrane
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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. |
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a pt is having an acute headache that is believed to be a migraine, what type of techniques should be avoided?
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Avoid direct during acute headache as it may increase blood flow to an inflamed vascular bed and worsen the headache.
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What can create an environment for development of migraines?
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CONNECTIVE TISSUE STRESS CAN CAUSE DRAG ON INTRACRAINIAL DURA
which then can create an environment for development of migraines |
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at the OA (C0-C1) segment, what is the primary movement? When sidebending is introduced, what way will rotation occur?
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Primary motion is flexion and extension
When sidebending is introduced, rotation will occur in opposite direction (SLRR) |
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for OA, if your diagnosis is
E SL Rr what is your tx position? What way does the pt sidebend? |
Tx position: F Sr Rl
Patient SB Left |
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dx and tx for AA dysfunction?
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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 |
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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
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Rheumatoid arthritis is what for direct treatment of the upper cervical spine?
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CONTRAINDICATED (especially for HVLA)
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in a pt with headache, what should you treat with OMT first?
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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 |