Headache

Overview

Authors
Affiliations

Nate Yomogida, B.S., SPT

Doctor of Physical Therapy

B.S. in Kinesiology

Chloë Kerstein, B.S., SPT

Doctor of Physical Therapy

B.A. in Neuroscience

Reading list
  • Ch37 Headache1
  • Sleep
    • Ch107 Sleep and headache2

Headache is one of the most common neurologic symptoms

Risk Factors

  • Gender: Women 3:1
  • Occupation: White collar workers > Blue collar workers

Pathophysiology

The brain parenchyma lacks nociceptors, thus the headache must be referred from other sources3. Headache symptoms are caused by mechanical traction, inflammation, and/or irritation of innervated structures in the head3. These structures include:

  • Blood vessels3
  • Meninges3
  • Scalp3
  • Skull3

The supratentorial dura (most of the intracranial cavity) is innervated by the trigeminal nerve (CN V), while the dura of the posterior fossa is innervated mainly by CN X, but also by CN IX and the first three cervical nerves. The close anatomical relation between pain systems in the spinal trigeminal nucleus and the dorsal horn of the first few cervical nerve roots (see Figure 14.5C,D) may explain the common co-occurrence of headache and neck pain.

Classification

Primary headache

  • Migraine
  • Cluster headache
  • Cervicogenic Headache (Trigeminal autonomic cephalgias)
  • Tension-type headache

Secondary headache

  • Head trauma3
  • Intracranial hemorrhage3
  • Cerebral infarct3
  • Carotid or vertebral artery dissection3
  • Venous sinus thrombosis3
  • Reversible cerebral vasoconstriction syndrome3
  • Post-ictal headache3
  • Hydrocephalus3
  • Idiopathic intracranial hypertension (pseudotumor cerebri)3
  • Low CSF pressure Toxic or metabolic derangements3
  • Meningitis3
  • Epidural abscess3
  • Vasculitis3
  • Neoplasm3
  • Trigeminal and other cranial neuralgias3
  • Disorders of the eyes, ears, sinuses, teeth, joints, or scalp3
  • Psychiatric disorders3

Primary Headaches

Cervicogenic

  • Unilateral
  • Ramhorn pain pattern w neck ext
  • Non throbbing
  • Moderate non excruciating pain

Migraine

  • Drop in serotonin levels causing trigeminal n to release substances (neuropeptides) which travel to the brain’s meninges. Cause BV’s to become dilated and inflamed resulting in a HA.
  • 4-72 hours, generally less than 24 hours
  • Unilateral usually, but can be bilateral
  • Read more

Tension Type Headache

  • Bilateral
  • Periorbital, temporal , occipital
  • Dull ache, heavy weight, mod to severe
  • Can to trigger point release= typically stress and tension precipitating factors
  • Do not wake up with this, as day moves on it builds (usually d/t muscle tension)
  • Read more

Cluster

  • Cluster headache
  • Unilateral
  • Temporal, frontal , retrooribtal, occipital
  • Unknown cause
  • Diagnosis: Need at least 5 attacks unilaterally, lasting 15 min to 3 hours
  • Read more

Examination

  • Neurodynamic testing
  • Spurling’s Test
  • Distraction test
  • Valsalva test

Treatment

Reading list
  • Treatment of Headache, Neck Pain, and TMJ Dysfunction with Counterstrain:4

References

1.
Goodman C, Fuller K. Goodman and Fuller’s Pathology. 5th ed. Elsevier, Inc; 2020.
2.
Kryger MH, Roth T, Goldstein CA. Kryger’s Principles and Practice of Sleep Medicine - E-book. Elsevier Health Sciences; 2021. https://books.google.com/books?id=yDVVEAAAQBAJ
3.
Blumenfeld H. Neuroanatomy Through Clinical Cases. 3rd ed. Oxford university press; 2022.
4.
Myers HL, Devine WH, Fossum C, et al. Compendium Edition: Clinical Application of Counterstrain. Compendium ed. Osteopathic Press; 2012.

Citation

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