Corbin Notes 1/22/12 Head and Facial The goal of the week is to be able to catergerize a headache.

What all does the head do? Try to find out where the headaches are starting and terminating 1. Find out the location 2. Frequency/timing 3. Type of pain( are they telling us they have an icepick going through there eye or is it dull to sharp. What are they telling you about the type of pain) Sinnus Innervention *Opthalmic and maxillary branches of 5th cranial nerve *Greater superfic Frontal Sinus *Opthalmic branch of the 5th cranial nerve *Pain reffered to the forehead and anterior cranial fossa Anterior Ethmoid *Opthalmic division *Anterior ethmoid nerve off nasociliary *Anterior septum, turbinates, ostiomeatal complex Posterior Ethmoid and Sphenoid *maxillary division *posterior ethmoid nerve *posterior septum parts of superior and middle turbinates

Opthalmic division Greater superficial petrosal nerve

Maxillary Sinus*5th cranial nerve Referred otalgia *Oral cavity(mandibular division of the 5th cranial nerve) *pharynx * hypopharynx * supraglottic larynx(Arnold branch of 10th cranial nerve) History First occurrence, timing, quality, treatments. associated symptoms, precipitationg factors (make sure that you know what they are taking and doing that is prescribed and not prescribed)

Physical Examination *Complete head and neck exam *cranial nerves *TMJ & Muscles of mastication *Scalp vessels *Trigger points *Neurologiacal Examination (If a patient has a tumor they most likely will have cogitative changes Ie things like vision, you will also see a slight change in the patients personality. )

Diagnostic Test- EEG, CT and/or MRI, EMG, TMJ radiography, Cervical spine films, Labs, Psychometric testing Headache Continuum-Cervical(C) vascular (V) and Pain intervention (PI) There is not a fine line between a tension headache and a Migraine. The continuum is what you are looking at where at different given points there is a continuum?????

Headache this year is considered as the 3rd top reason that patients come to see up in our offices. (there are not too many case studies on the topic of headaches and treatments) Objective vs Subjectice findings Subjective: The headache is dull, pressure like, generalized, worse in the scalp, temples. Or back of the neck, not one sided, feels like a tight band or vise on the head, occurs as an isolated incident(or occurs constantalyl or daily), difficulity sleeping Objectice: nausea vomiting ect

Affecting your life Impact this has had on their well being Restricted neck movements, change in the neck motion, contour, texture, tone, or response to active or passive stretching or contraction Abnormal tenderness of neck mm

Trauma headache there is no reason not to do a complete neurological exam. It is one of the most important things that you need to do.

Time to Refer Out Indications for neuroimaging patients with headache symptoms(Reason fot further investigation) Focal neurological findings on physical examination, headache starting after exertion of valsalvias maneuver, acute onset headache, headache awakens patient at night , change in well established headache pattern, new onsetheadache in patient less than 35, new onset headache in patient who has HIV infection or previously diagnosed with cancer. Hematology: Blood work is usually not needed One of the main things that you need to note is what is making this headache different from the others TTH-Characteristics 30min to 7days,pressing or tightening, mild to moderate pain, variable location, often bilateral, nausea and vomiting are rare.

TTH-Treatment Stress management-biofeedback, stress reduction, posture correction, Medication rarely needed in ETTH-benzodiazepines,amitriptyline CTTH-Abortive,NSAIDS,ASA-Caffeine butalbital, phenacetin

OTHER The literature to date suggest that several musculoskeletal abnormalities are more prevelany in primary headache suffers including the following. Research Headaches and spinal manipulation therapy after 6 weeks showed better results Nerve Split Top 5 for emergency room: Chronic headache, lowback pain, broken bones/torn ligaments, anxiety/depression,arthritis Fundamental distinction: Primary/benign vs. Headache of organic disease. Small percent catastrophic, Fears, anxiety Fundamental distinction: primary/benign vs headache of organic disease,small percent catastrophic,fears anxiety Hx: Clinical variables dispel uncertainty: 1. 2. 3. 4. Chronicity 6months Clinical characteristics (frequency,severity,location and associated symptoms) Cognitive changes

Organic causes

Migranes is about 3-1 female to male as far as headaches