HA develops within minutes (thunderclap headache),
inability to move a limb or abnormalities on neurological examination, mental confusion, being woken by HA,
HA that worsens with changing posture.
HA worsened by exertion /Valsalva manoeuvre visual loss or visual abnormalities, jaw claudication, neck stiffness, fever, and HA in people with HIV, cancer or risk factors for thrombosis.
What are primary and secondary HA and what causes them?
Primary HA are not caused by other disease. Examples are migraine and tension type). Secondary HA caused by some other underlying condition.
AKA: occipital neuralgia.
Causes: can be caused by compression (causing irritation or injury) of the greater occipital nerve by over-tight neck mms, osteophytic growth as the nerve leaves the spine, trauma or tumour. Also diabetes, blood vessel inflammation (vasculitis), and prolonged neck flexion.
Symptoms: gradual onset of post head, above eye, temporal pain. Usually unilat.
Who? 20-60 yrs.
Osteopathy? Some evidence osteopathic ttt such as HVT, ST and MET is effective.
Examinations-MT: observe for altered neck posture, decreased ROM in Csp, trigger points in s.occipitals, neck and shoulder mms. Nerve blocks can confirm diagnosis but MRI shows nothing.
Migraine: cause, symptoms, most likely people to be effected?
Causes: Vascular origin, facilitated segment in the brain stem. Trigeminal nerve involved.
Symptoms: prodrome up to 2 days before, aura (visual, sensory, physical) just before. One sided, throbbing
Can become less sever but more frequent with age.
Who? male: female 1:3. 12% population.
Osteopathy? Some small studies suggest manipulation can decrease pain intensity and frequency of migraine.
Tension type HA.
Primary HA, most common HA.
Causes: associated with stress, mms contraction.
Symptoms: pain on both sides of the head, forehead, temples or the back on head and/or neck.
Who? 40% population. More common in females. 30-39 age group most affected.
Osteopathy? Systematic review showed manipulation to be affective.
Osteopathy? If we can reduce BP through relaxation advise, reducing stress, lifestyle advise.
Causes: Symptoms: progressively worse over time worse am, pain may wake you up. Accompanied by nausea and vomiting. Headache pain that is relieved by vomiting is a typical symptom of brain tumour. Straining/ Leaning forward agg. pain. Not relieved by painkillers.
Who? 2 peaks incidence; childhood, then larger peak in 70.
Bleeds cause HA?
The headache attributed to Sub-arachnoidHaemorrhage - often unilateral, accompanied by nausea, vomiting, disorders of consciousness and nuchal rigidity ((neck stiffness), and less frequently by fever and cardiac dysrythmia
Headache attributed to intracerebral haemorrhage Headache is more frequent and more severe in haemorrhagic than in ischaemic stroke. It is usually overshadowed by focal deficits or coma, but it can be the prominent early feature of cerebellar haemorrhage which may require emergency surgical decompression.
Causes: C3 facet and its nerve most vulnerable to whiplash injury.
Symptoms: Pain from the C2–3 facet is referred to the occipital region but is also referred to the frontotemporal and periorbital regions.
Osteopathy? The majority of cervicogenic headaches occurring after whiplash resolve 1 yr. treat as cervicogenic HA, evidence for myofascial release etc
Causes: Inflammation of meninges caused by infection with viruses, bacteria, or other microorganisms.
Symptoms: severe headache and neck stiffness, pain on passive neck flexion. Fever, photophobia and altered mental status.
Who? Babies, uni students and adults 55+.
Osteopathy? Obviously not.
Examinations- Koernig sign (below pic) and Brudinski’s (Flexing the patient’s neck causes flexion of the patient’s hips and knees.)
Hormonal changes, Fatigue, Clenching and grinding, Poor posture.
Symptoms: ‘vice-like grip’. achy, throbbing headache HA in temples, back of the head/ shoulders. Clenching and grinding of the teeth, both of which may be TMJ symptoms, produce mms pain which can cause HA. Displaced disc in the TMJ may cause pain in the joint referred into the temples, forehead or neck. Worse am or pm depending on when teeth grinding occurs.
Osteopathy? Seems to be treated will good results-SF masseter, Temporalis, gapping TMJ joint.
Questions: Do you hear popping, clicking or cracking sounds when you chew? Do you hear a grating sound (like crumpling of newspaper) when you chew?
Briefly list other HA and how to recognise them.
Thunderclap HA-Severe and sudden-onset. It is defined as a severe headache that takes seconds to minutes to reach maximum intensity. It can be indicative of a number of medical most importantly subarachnoid hemorrhage problems