Differentiating Headaches: Clinical Sports Medicine and Physiotherapy

Differentiating between vascular, cervical, and other headache. How to appropriately screen for intracranial signs in acute headache presentations, and treat when muscles or joints are the culprit

Which four headache types should spring to mind first when you think of headaches (4 most common)?

1. Headache associated with viral illness,

2. Vascular headache (migraine, cluster headache)

3. Cervical headache (referred from muscles, joints, and fascia of the cervical region)

4. Tension headache or muscular contraction headache

____---___________ headache and ___-______________ headache are of particular concern in sportspeople.

• Exercise-induced

• Post-traumatic

T/F: The majority of headaches require medical assessment

F: Though, certain symptoms may indicate the presence of more serious abnormalities and require medical assessment.

Which symptoms of headache may indicate the presence of more serious abnormalities and require medical assessment?

• Thinking haemorrhage or tumours

• Systemic symptoms (weight loss recently, malaise, fever)

• Sudden, severe onset

• New or unaccustomed headache

• Neurological symptoms (drowsiness, weakness, or numbness in limbs)

• Local extra-cranial symptoms (ears, sinuses, teeth)

• Increasing headache over a few days

• Headaches that wake pt up in the middle of the night

• Chronic headache with localised pain**

Select the clinical feature applicable to a vascular headache

Throbbing pain

List the following for a cervical headache:

• Age of onset

• Location / site

• Side

• Type of pain

• Constancy

• Time course

• Neurological symptoms?

• Hx of trauma

• Triggers

• Treatment

• 20-60 years of age

• Occipital, retro-orbital (behind the eyes), temporal

• Unilateral

• Dull ache

• Constant

• Days

• Occasionally (i.e. parasthesia)

• Trauma common (whiplash)

Brief episodes of headache after exercise is a cause for concern; t/f?

f. Benign.. and exercise usually aggravates headaches of all types

Why is a past history of head trauma important even if its relatively minor?

Could indicate subdural hematoma

Why is stress an important part of history taking

Because personal relationships, work pressures, and problems related to an athletes; sporting activity can aggravate headache.