cervical spine (vascular pathologies, neck pain w mobility deficit, neck pain w radiating pain, neck pain w headaches (migraine, tension, cluster, cervicogenic))

vascular pathologies

• may present as _____ pain and/or _____, although ____, need to screen

neck, headache

vascular pathologes - used to identity ____ to tx, existence of serious _____, presence of _____

contraindications, pathology, risk factors

vascular pathology signs

• _____ disturbances

• ____ signs

• _____ dysfunctio

• behavior of ____ instability (anxiety, supporting ____/____)

gait, UMN, CN, upper cervical

risk factors for vascular pathology

• recent ____

• ____ abnormality

• Hx _____

• ____

• high _____

• ______

trauma, vascular, smoking, migraine, cholestrol, HTN

if Hx indicated vascular pathology = immediate _____

ER 

if risk factors for vascular pathology present but no precautions or contraindications

• monitor _____

• _____ artery auscultation and ____

• neuro exam (____, _____, gait, ____)

BP, carotid, palpation, CN, UMN, coordination

neck pain w mobility deficits: d/t ____/_____ pattern, other ____ restrictions

opening, closing, rom

clinical presentation neck pain w mobility deficits

• ____/____ neck pain

• limited ____

  • reproduce symptoms with ____/_____

  • ______

• pain related to _____/_____

• ____/____ deficits if subacute/chronic

central, unilateral, ROM, AROM, PROM, hypomobile, shoulder girdle, UE, strength, MC

Tx neck pain w mobility deficits

• manual: ____/____

• therex: rom, _____, isometrics, ____

• pt edu: ____ lifestyle 

• modalities 

mob, manip, stretching, posture, active 

neck pain w radiating pain: cervical ____

radiculopathy

clinical presentation neck pain w radiating pain

• UE ____/____ deficits

• ____reflexive

• (+) ____ cluster = (_____, _____, ____, ____)

dermatomal, myotomal, hypo, wainners, spurlings, distraction, ULTT, cervical rot<60 deg

Tx neck pain w radiating pain

• therex: _____, strengthening, _____

• manual: ____/____

• manual or mechanical _____

stabilization, stretching, mob, manip, traction

primary headaches: headache is ____ condition without other ___ cause 

primary, underlying 

types of primary headaches

migranes, tension, cluster

migraines: _____ and ____ mechanisms

• _____ event and associated _____ of the vessels in the ____ matter

• _____ of pain pathways

central, peripheral, vasodilatory, inflammation, dura, sensitization

migraines

• ____ predisposition

• ____% w aura, ___% w/o aura

genetic, 25, 75

3rd highest cause of disability world wide 

migraines 

migraine triggers:

• _____

• anxiety

• foods (____, ____)

• alcohol/_____

• menstruation

• _____

• altered ____ pattern

• missed ____

• changes in ____

• ____ trauma

• strong ____/____

stress, chocolate, cheese, coffee, fatigue, sleeping, meals, weather, head, lights, smells

migraine risk factors

• _____-____yo

• ____>____ (3:1)

20, 40, females, males

clinical presentation of migraines

• pain is _____ and may _____ between episodes

• ____ pain

• ____-____ intensity

• ____-____ hr

• photophonia, _____, _____, nausea, vomiting

• worse with _____

unilateral, switch sides, throbbing, mod, severe, 4, 72, phonophobia, activity

prodromal/preictal means _____

before migraine 

psotdromal/postictal means _____

after migraine

Tx migraine

• manual: mob/manip, _____

• therex: ____ lifestyle

• neuro reed

• pain ____ edu

STM, active, neuroscience

tension headache: peripheral _____ pain factors with central _____

myofascial, sensitization

risk factos for tension headache 

• ____-____yo

20, 40

clinical presentation of tension headache

• TTP ____ mm

• decreased ____ threshold of ____, ____ and ____ mm

• ____ pain in ____ region/____-like around head

• ____/____ (non pulsating)

• ____-___ intensity

• not aggravated by _____

• ____ min - ____ days

• _____, phonophobia

• no ____ or ____

pericranial, pain pressure, upper trap, SCM, splenus, bilateral, frontotemporal, band, mild, mod, exercise, 30, 7, photophobia, nausea, vomitting

Tx tension headache

• soft tissue to treat secondary _____ s/s

• no significant benefits from ____, ____ or ____ correction

myofascial, manip, strengthening, postural

cluster headache: ____ pain, PT _____

intollerable, not effective

risk factors for cluster headache 

• ____

• ____-____yo 

male, 20, 40 

clinical presentation cluster headache

• pain in ____, ____ and/or ___ region

• ____ pain

• boring, ____, ____, throbbing

• ____, ptosis, eye ____ or _____, eyelid ____, ____/____ sweating, nasal ____, sense of ____/agitation

orbital, supraorbital, temporal, several, sharp, stabbing, miosis, watering, bloodshot, forehead, fascial, conjestion, restlessness

cluster headache occur in series lasting ___-___

• symptom duration = ____-____

• once every other day up to ____ days

• remission period of ___-___

weeks, months, 15min, 3hr, 8, months, years

Tx tension headache

• no strong evidence of effective _____

• ____ out

PT intervention, refer

secondary headaches: symptom of another ____

primary medical condition 

cervicogenic headaches: HA referred from ____ structures (____-____)

upper c-spine, C1, C3

cervicogenic headaches most commonly referred from ____-____

• ____, facets, ____, discogenic/____

C2, C3, myofascial, ligaments, radicular

clinical presentaion cervicogenic headaches

• ____ headache that does not _____

• s/s last ___-___

• ____ to ____ pain

• non___, non ____

• usually begins in ____ and radiates to ____

• ____, episodic

• pain associated with ____/____ movement

unilateral, switch sides, 1hr, weeks, moderate, severe, throbbing, lancinating, neck, head, chronic, head, neck

risk factors for cervicogenic headaches

• _____

• age ____-____

men, 30, 44

ICDH Dx criteria (at least ____)

• HA begins with onset of other _____

• HA improves with tx of ____

• ____ cervical ROM and HA worse with _____ provocative assessments

• HA abolished with _____ blockade of ____ segment

2, cervical disorder, cervical disorder, decreased, c-spine, anesthestic, affected

exam for cervicogenic headaches

• (+) ____ test

• palpation of affected structures _____

• ____ c-spine

flexion rotation, reproduces, HA, hypomobile

special tests for cervicogenic headache

• cervical ____ test

• ____, ____, ____ joint mobility assessment

flexion rotation, C0-1, C1-2, C2-3

Tx cervicogenic headache 

• manual: ____, mob/manip, ____

• therex: ____ and ____ for deep neck flexors, ____ and ____ strengthening 

SNAG, STM, strength, endurance, cervical scapulothoracic