SPIN: Specifity rules IN- no false positives

SNOUT: Sensitivity rules OUT- no false negs

Poss Test Qs:
**MYODURAL BRIDGE ASSESSMENT 5 Models:
(1) Structural
-occipital nerve impingement
-Left sided TMJ SD
-Cranial SD (due to poor CRI amplitude & Left Lateral Strain pattern)
-OA/AA SD
(2) Neurologic
-Tension Headache
-medication overuse headache
-herniated cervical disc
-cervical radiculopathy
-epidural hematoma
-SAH
-subdural hematoma
(3) Cardiopulmonary
-temporal arteritis
-pseudotumor cerebri
-vasculitis
-vertebral artery dissection
(4) Metabolic
-Pituitary apoplexy
-meningitis
-posterior fossa tumor
(5) Biopsychosocial
-stress
-anxiety
-coffee/water consumption
PLAN:
OMT: CV4, Frontal Lift, SBS Decompression, Cervical soft tissue, Thoracic soft t
issue/myofascial release. Counterstrain to Left AC1 and LC1.
Question #1: When should CT & MRI be used as a diagnostic tool for the complaint
of "headache"? Should either one be included in your current treatment plan for
this patient?
After a careful history and physicial, any suspicious findings such as cervical
radiculopathy (positive Spurling's) or diminished sensory or reflexes or papille
dema should warrant getting an MRI or CT.
Per the Algorithm:
History reveals ACUTE sx (high fever, Neuro deficits, Trauma)?
Must then R/O meningitis, SAH, brain pathology or other red flags (via CT, MRI a
nd LP)
MRI and CT should be used to rule out any of the RED FLAGS of headaches, such as
:

-arteriovenous malformations
-meningitis
-subdural hemorrhage
-temporal arteritis
-cervical artery dissection
-subarachnoid hemorrhage (thunderclap headache)
-vertebral dissection
-pseudomotor cerebri (idiopathic intracranial HTN)
-cervical spondylosis
-chiari malformation
-syringomyelia
-herniated cervical disc
Question #8: Explain how the greater and lesser occipital nerves play a role in
the pain distribution of a cervogenic headache.
Greater and Lesser occipital nerves come off of the dorsal rami of C1 to C3 and
innervate the posterior scalp. On palpation, the occipital region of the symptom
atic side of the neck/head will elicit pain.
In this type of cervogenic headache, pain localized to occipital region may proj
ect to forehead, orbit, temples, vertex or ears & can be aggrevated by neck move
ment or sustained neck postures.
Occipital Neuralgia arises from entrapment or trauma of these nerves.