Intracranial sources: dural sinuses, dural veins, arterial structures, dura mater (only at the base of the skull rest is insensitive), periosteum

Extracranial sources: skin, fascia (skin and muslce), mucosa, arteries, veins (less sensitive than the arteries)

Cranial nerves: trigeminal (CN V), Facial(CN VII), Glossopharyngeal (CN IX), Vagus ( CN X)

Cervical Nerves: Dorsal Rami of C2 and C3 become greater and lesser occipital nerves. These are superficial and easily palpated when inflamed (Between mastoid and external occipital protuberance)

Bone

Diploic and emissary veins (run through skull into the sinuses)

Neural tissue of brain

Pia mater and arachnoid membranes

ependymal lining of ventricles (secrete CSF)

dura mater except at base of skull (only place that it is sensitive)

Vascular: broadest classification scheme (8% of the population that seeks treatment for headahce, however 50% of pt population who seek intervention at HA and and pain clinics)

Muscle Contraction headache: Tension headache, most common cause of head ache (60-70% of head aches)

traction or inflammatory headache's

Cranial neuralgia and other cuases (catch all)

Migrinae HA

Cluster HA

Toxic vascular headache

Hypertensive vascular HA

M/F have a greater prevelence? of vascular head aches?

What can this be realted to ?

WHat age do these typically on set?

F

menstal cycle

First ccurrence of vascular HA between 5-40 yoa, typically at puberty

Great prevelence for 35-40 yoa

Vascular HA; Migraines

if boths parents are effected there will be a 70% chance of having migraines

Freq varies from several times/week to several times/year

typically the more frq the more sever

can last for 4-24 hrs

Which HA may be preceded by an aura

What antamical issue is this associated with?

some forms of migraines

associated with constriction of arterial blood flow

Scintillating scotama

Teichopsia

Unilateral facial weakness and/or hemiparesis

Hallucinations: can be visual, olfactory, and/or auditory

What are the characteristics of Scintillating Scotama?

What is this?

An aura precending a migrane.

Scintillating Scotama: Flashing lights moving across visual field

What is a Teichopsia?

What are the characteristics of this?

Teichopsia: Flittering scotoma, kuminous appearance before the eyes

An aura preceding migraine

A history of at least 5 HA including:

HA lasting 4-72 hours

HA with at least 2 of the following characteristics:

Unilateral

Pulsating (typical of vascular headaches)

Intensity moderate to sever

Aggravated by normal activity

During the headache, at least 1 of the following: Nausa/vomiting, photophobia r phonophobia

No other conditions explains these sx

What are the characteristics of a classical migraine?

What is a classical migranie called?

Magraine with Aura: classical or typical migraine

HA has characteristic of migrane without aura

Hx of at least 2 headaches including at least 3 of the following characteristics:

1 or more reversible aura sym (might disappera befor headache begins)

Aura develops gradually in 5+ minutes

No aura symptoms lasts >60 minutes

HA follows aura within 60 min

Type of migraine with aura

same characteristics as mig. w/o aura

transient motor weakness

sensory or speech disturbance

?TIA

at least on family member has same symptoms

Uncommon

Can be associated with whiplash

Little evidence that basilar artery actualy involved

Has aura

Constrictio of basialr artery

HA with bilateral neruolgocial Sx: vertigo, dysarthria, ataxia, syncope, blurred vision, bilateral paresthesia(sensory loss).

No motor weakness

Uncommon

HA associated with visual disturbances

Associated with CN III(occulomotor)

Can last day to weeks

Looks like Horners syndrome (droppy eye lid, ptosis, constriced pupil )

Stress or stress release

Fatigue

Hypoglycemia

Hormonal Fluctuations

Bright sunligh or flash

Dietary : MSG, caffeine, chocolate, nitrates (preservd meats red wine)

prodrome or aura diappears

Unilateral HA

Throbbing or pulsating pain

Facial pallor (paleness) (during pre-period have headache)

Cold hands and feet (bc blood is shunted to the head)

Tendernes over superficial blood vessels of head (vasodilation of Cranial blood vessels)

hyperesthesia of scalp

Anorexia (loss of appetiate)

nausa/vomiting

fluid retention

anti-inflammatory meds

Analgesics

anti-migraine medications: ergotamine, Imitrex (vasoconstrictors decreasing the blood flow to the head)

OCP

PT for associated muscle spasm

Vascular cluster headaches occur in what gender and age more often?

what is the occurance of cluster headaches/day

duration?

M, 20-30 yoa

1-3/day recurring daily for wks or months

duration: each HA is short duration (15 min- 3 hrs)

There may be long intervals between clusters

No prodrome (aura)

Often triggered by alcohol

Awaken with headache

pain most intense within minutes of onset

Unilateral pain usually: w/in cluster, may occur on either side in subsequent clusters

Pain is around or behind eye (ptosis may be present)

Nasal congestion on same side

Restlessness, agitation (typically up pacing around)

Occur with various diseases (most commonly with fever--> secondary to vasodilation that accompanies fever)

hangover: dehydration and vascodilation

Cause by increased intracranial pressure: diastolic BP of >110 mmHg

Contributing factors: essential hypertensions (HTN w/O know cause)

Triggered by: excessive exercise, anger, toemia of pregnancy

HA is worst on awakening and better with gentle exercise

Episodic tension headache

Chronic tension headache

Cervical headache

Caused by sustained muscle contraction (tension)

head and neck muculature

non-vascular and non-inflammatory (no pulsating characteristic)

Non-specific ache:

poorly locatized, worse in the scalp, temples or back of the neck

dull pressure like

bilateral

tight band or vise like

usually occurs as an isolated incident (may occur constantly or daily though)

Worsened or triggered by stress, fatigue, noise, glare

episodie tension headaches

associated with stress or fatigue

Occipital release (especially when tell you starts in the back and goes to the front)

cervical mobilization

Modalities

Massage

Stretching

Relaxation

Classificationof chronic tension HA?

S/S?

mild to moderate HA that occus >=15 days/mnth

bilatearal, tightening, pressing, squeezing, non-pulsating

Canlast hours or be continusous

trigger points in neck and upper bakc

does not response to simple anlgesics

Cervical headaches:

Caused by what?

managed how?

caused by cervical dysfunction: facet dysfunction, whiplash, cervical spondylosis

treat cause (examination very important)

Mobilization

Occipital release

massage

modalities

 relaxation

Traction and inflammatory headaches:

caused by?

Caused by irratation of pain sensitvie structures within head: by traction, pressure, inflammation

Causes: brain tumor (initially the head ache is less severe than migraine, dull steady aching in quality, relieved by simple analgesics in early stages, bcomes progressively worse

HematomaL epidural or subdural, headcahe may be very severe

Lumbar puncture: spinal tap HA, spinal HA

Occurs in 20-25% of pt undergoing a spinal tap

Loss of CSF from puncture site, less CSF in CNS and the brain drops against foramen magnum which places structures that are pain sensitive aggraved, also creates traction in pain sensitve structures within the crainium

managed with an epidural blood patch component

Lumbar puncture: loss of CSF

Abscess, meningitis, aneurysm