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Headaches
Quiz 1 Headaches
124
Anatomy
Professional
10/24/2012

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Cards

Term
What are 5 primary headaches
Definition
tension
cervicogenic
classic migraine
common migrane
cluster
Term
What is the second most common complaint in the primary care setting ?
Definition
headaches
Term
Less than ___ of headaches are due to serious underlying intracranial pathology
Definition
1%
Term
What is the subject of discomfort in the region of the head or the face?
Definition
headache
Term
What are the red flags of headaches
Definition
Systemic, weight loss
Neurological symptoms or signs
Onset or sudden
Onset late in life
Pattern change
Term
Sudden onset of headache is a sign of a ____
Definition
subarachnoid hemorrhage
Term
Onset of headache later in life is a sign of ___
Definition
brain tumor
Term
Pattern changes of the headache is indicative of ___
Definition
brain tumor
Term
Tight, band-like, bitemporal non-throbbing pain
Definition
Tension type headache
Term
Occipital headaches worse with neck movement
Definition
cervicogenic headache
Term
Aura followed by unilateral throbbing headache
Definition
classic migrane
Term
Unilateral throbbing headache without an aura
Definition
common migrane
Term
Unilateral throbbing headache, red teary eye and nose
Definition
cluster headache
Term
Tender swollen superficial temporal artery
Definition
temporal artery
Term
Blood pressure greater than 200/120
Definition
hypertension
Term
Tenderness over sinus; worse with bending forward
Definition
sinusitis
Term
Headache worse in the morning, positive Dejerine’s triad
Definition
brain tumor
Term
Trigger points with specific referred pain pattern
Definition
myofacial pain
Term
Scalp tenderness followed by a vesicular rash
Definition
herpes zoster
Term
Sudden onset of severe headache with neck stiffness
Definition
subarachnoid hemorrhage
Term
Pain and clicking on movement of the jaw
Definition
TMJ dysfunction
Term
Severe cutting pain in the distribution of CN V
Definition
Trigeminal neuralgia
Term
Neck stiffness, fever and/or convulsions
Definition
Meningitis
Term
To diganose a migrane a patient will describe ___ headaches with or without aura lasting ____
Definition
unilateral; 1-3 days
Term
What is the predisposition for migrane headaches
Definition
genetics
caffeine, alcohol, chocolate, cheese
Term
Migrane with aura is defined as a
Definition
classic migraine
Term
What is the minimum attack to diganose a classic migrane
Definition
2 attacks minimum
Term
What are the 3 other factors necessary to identify a classic migraine
Definition
reversible aura
aura develops gradually over 4+ min
Aura does not last more than 1 hr
Unilateral headache follows Aura
Term
If a classic migraine is diagnosed what 1 factor may also must be present
Definition
Nausea or vomiting
phonophobia or photophobia
aura shows blind spot
surrounded by flashing lights
may have old time move appearance
Term
An aura showing a blind spot is also called
Definition
scotoma
Term
An aura surrounded by flashing lights is called
Definition
scintillation
Term
Migraine without an aura is known as
Definition
common migraine
Term
Common migraine needs a minimum of ___ attacks
Definition
5
Term
What other 2 factors are necessary to diagnose a common migraine
Definition
unilateral location
pulsatile quality
worse on climbing stairs
Term
What factors do you need at least 1 of to diagnose a common migraine
Definition
nausea or vomiting
photophobia
phonophobia
Term
What 2 factors will classify a migraine as complicated
Definition
ataxia and vertigo
Term
If a migraine is complicated what may be implicated
Definition
brain stem ischemia
Term
Can you adjust a patient with a classic or common migraine
Definition
yes with nutrition advice
Term
What is a chronic recurrent headache that is common in men
Definition
tension type headache
Term
Tension type headaches may be related to
Definition
muscle tension and stress
Term
To diagnose a tension type headache how many headaches does the patient need to have and for how long
Definition
10 episodes lasting for 30 min to 7 days
Term
What 2 additional criteria do you need to have to diagnose a tension type headache
Definition
bilateral location
pressing or tightening or squeezing in character
mild or moderate intensity
not aggravated by activity
Term
what should not be present in a tension type headache
Definition
nausea
photophobia
phonophobia
Term
What time is tension type headaches usually the worst
Definition
afternoon, early evening
Term
Can you adjust a tension type headache
Definition
yes with stress reduction, exercise

* refer if chiropractic is unsuccessful or headache worsens**
Term
Discomfort or pain in the head originating from the cervical spine
Definition
cervicogenic headache
Term
Cervicogenic headaches may be related to neck movement with possible aberrant firing of cervical mechanoreceptors with interneuronal connections with the ___ nucleus
Definition
spinal trigeminal nucleus(sensory to eye)
Term
Spinal trigeminal nucleus extends into the cervical region of the spinal cord to __
Definition
C5 level
Term
What dermatomes do cervicogenic headaches refer pain to
Definition
C2-3
Term
What 3 areas do cervicogenic headaches radiate to
Definition
forehead
orbital
temporal
Term
Cervicogenic headaches radiate and needs one of what other criteria
Definition
abnormal tenderness of neck muslces
limitation of passive neck movements
changes in tone or texture of neck muscles in response to active and passive stretching with or without vertigo
Term
What orthoneuro tests are positive for cervicogenic headaches
Definition
neck movements aggrivate pain
Term
What does xray show in cervicogenic headaches
Definition
abnormal movement in flexion/extension or abnormal posture
Term
Can you adjust a cervicogenic patient
Definition
yes, with muscle therapy
Term
Syndrome with recurrent paroxysmal episodes of sudden, severe, unilateral headaches
Definition
cluster headache
Term
cluster headaches last for ___
Definition
4-8 weeks
Term
what is the etiology of cluster headaches
Definition
alcohol
smoking
barometric pressure changes
napping in the afternoon
Term
cluster headaches are more common in
Definition
males
Term
cluster headache are due to activation of
Definition
parasympathetics
Term
cluster headaches are due to impairment of
Definition
sympathetic
Term
What is the minimum attacks of cluster headaches
Definition
5 in a predictable mannor (time everyday) with severe unilateral periorbital pain peaking in 10-15 min lasting up to 3 hrs
Term
What are other symptoms do you need at least one of in cluster headaches
Definition
ptosis, red eye, constricted pupil, tearing, nasal congestion and a runny nose.
Term
cluster headaches can occur ___ for ___ weeks
Definition
several times per day, for one to several weeks
Term
What investigations are needed for cluster headache
Definition
none, but you may do CBC/ESR to rule out underlying pathology
Term
How do you manage a cluster headache
Definition
refer to the hospital
give advice on avoiding alcohol, afternoon naps
suicide (advice that they decrease with age)
Term
headache with Part of a giant cell arteritis condition
Definition
temporal arteritis
Term
what is the eitology of temporal arteritis
Definition
autoimmune disease affecting the tunica media of the medium sized vessels
Term
Temporal arteritis is more common in
Definition
females age >60
Term
What headache is associated with polymyalgia rheumatica
Definition
temporal arteritis
Term
polymyalgia rheumatica is
Definition
joint muscle aches/fatigue
(fibromyalgia w/out trigger points)
Term
Temporal arteritis is a temporal headache with
Definition
scalp tenderness and jaw claudication
Term
The temporal artery in temporal arteritis may be
Definition
nodular, enlarged, tender
Term
With temporal artertitis there may be a sudden onset of
Definition
blindness
Term
what percentage of pain in temporal arteritis is in the temples
Definition
50%
Term
What percentage of pain in temporal arteritis has scalp tenderness
Definition
50-70%
Term
What percentage of temporal artertitis patients have polymyalgia rhuematica
Definition
40%
Term
An elderly women with headache and opthalamologic symptoms has
Definition
temporal arteritis until proven otherwise
Term
What investigations would be preformed with temporal artertitis patients
Definition
ESR (>50mm/hr)-rate that RBC fall
Biopsy of temporal artery
MRI confirms diagnossis
Term
ESR is the rate at which ___ fall
Definition
RBC
Term
If the ESR is high it will show
Definition
inflamed arteries
Term
What is the management for temporal arteritis?
Definition
Refer to the hospital as fast as you can for treatment of corticosteroids
Term
Infection of the air sinuses in the skull; may be acute or chronic
Definition
sinusitis
Term
What are 3 eitologies of sinusitis
Definition
Bacterial infections due to obstruction of the sinus
Strep pneumonia
Haemophilus Influenza
Term
What is the clinical picture of sinusitis
Definition
Fever, headache, facial pain, or pain between the eyes made worse with bending forwards
Term
In Sinusitis There may be ___ of the inflammed sinus along with a ___
Definition
tenderness upon percussion; purulent nasal discharge
Term
Tranillumination of the affected sinus in sinusitis will be
Definition
decreased
Term
What may complicate a sinusitis headache
Definition
brain abcess may be present with headache, fever, or convulsions
Term
What will xray show in a sinusitis headache
Definition
mucosal thickening, air fluid levels, loss of air space or opacification of one or more sinuses [60% sensitivity]
Term
What is the gold standard of diagnosing a sinusitis headache
Definition
CT Scan [95-98%]
Term
What is the management of a sinusitis headache
Definition
otorhinolaryngologist
adjustments and heat
Term
Elevated blood pressure >140/90 on at least 3 consecutive occasions will have a
Definition
hypertensive headache
Term
What is the etilogy of a hypertensive headache
Definition
unknown (95%)
Term
what are contributing factors of a hypertensive headache
Definition
diet
lack of exercise
obesity
alcohol
smoking
Term
What are the known causes of a hypertensive headache
Definition
Renal
Endocrine (hyperthyroidism, Cushings, hyperaldosterone, pheochromocytoma)
Cardiovascular (coarctation of the aorta)
Pregnancy
NSAIDS
Term
Hypertensive headaches are more common in
Definition
increases of age
African Americans
Term
Most hypertensive patients are ___
Definition
asymptomatic
Term
What do you need to beware of with hypertensive headaches
Definition
ausculatory gap in which the systolic pressure is underestimated
Term
When will hypertensive headaches present
Definition
walking in the morning
(BP is higher around 9 AM)
Term
In hypertensive headaches there may be evidence of
Definition
end organ damage
Term
End organ damage will show
Definition
cardiomegaly with a displaced apex beat
Silver wiring of vessels on funoscopy
Term
What are some addtional findings found with hypertensive headaches patients
Definition
purple striae & buffalo hump (Cushings)
goiter and bulging eyes (hyperthyroidism)
pain on the vertex of the head or back of the head
Term
In hypertensive patients xrays will show
Definition
cardiomegaly (increased cardiothroacic ratio)
Term
What will blood work evaluate in hypertensive headache
Definition
BUN and Creatinine to evaluate renal function
TFT (hyperthyroidism)
Serum electrolytes (Conns disease)
VMA (pheochromocytoma)
Term
What is the management of a hypertensive headache
Definition
comanage with a primary care physician
upper cervical adjustment
weight loss, diet, smoking cessation
Term
Headache caused by bleeding into the subarachnoid space
Definition
subarachnoid hemorrhage
Term
What is the etiology of a subarachnoid hemorrhage
Definition
rupture of an aneurysm or arteriovenous malformation in the brain
Term
Sudden onset of “the worst headache ever” with neck stiffness, nausea and vomiting; there may be loss of consciousness, no fever is the clinical picture of a
Definition
subarachnoid hemorrhage
Term
What ortho tests are positive with a subarachnoid hemorrhage?
Definition
Kernigs
Brudzinski
Term
What will confirm subarachnoid hemorrhage
Definition
CT scan
Term
What is the management with subarachnoid hemorrhage
Definition
refer to hospital
Term
A group of disorders affecting the TMJ
Definition
TMJ joint dysfunction
Term
What is the etiology of TMJ dysfunction
Definition
multifactoral including DJD, trauma, stress
Term
What are 3 symptoms that show the clinical picture of TMJ disfunction
Definition
Pain in the ear or temporal region
clicking or popping sounds on opening of the jaw
tenderness on palpation and limiting opening (unable to put 2 knuckles between teeth)
Term
What would an xray show in TMJ dysfunction
Definition
Degenerative changes
Term
What would a CT scan diagnose for TMJ dysfunction
Definition
disc, or osseous derangements
Term
What is the management for TMJ dysfunction?
Definition
Manipulation
Trigger point therapy in muscles of mastication
Term
Disorder of the trigeminal nerve producing excruciating pain in the face
Definition
Trigeminal Neuralgia
Term
What is the etiology of trigeminal neuralgia
Definition
unknown
(may be related to aberrent blood vessel in close relation to the trigeminal nerve or to one of its branches)
Term
Trigeminal neuralgia is more common in
Definition
middle aged or older females
Term
What is trigeminal neuralgia triggered by
Definition
cold, touch, wind, or chewing
Term
What is the clinical picture often seen with trigeminal neuralgia
Definition
sudden onset of severe excruciating, lancinating pain
Term
Trigeminal neuralgia will last
Definition
a few seconds to 2 minutes along the trigeminal nerve distribution.
Term
What other investigations may be seen with trigeminal neuralgia
Definition
vascular studies may be seen with aberrant vessels
Term
What is the management of trigeminal neuralgia
Definition
co manage with a neurologist

Adjustments of the cervicals may be helpful for the trigeminal nucleus
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