Nishigami et al. (2018) developed a short form of the central sensitization inventory for use with patients with musculoskeletal pain. Statistical analysis was used to shorten the inventory to nine questions while maintaining the integrity and purpose of the test. The items remaining are as follows: 1. I feel unrefreshed when I wake up in the morning.
less legs syndrome, chronic fatigue syndrome, fibromyalgia, and migraine or tension headaches. This tool has been shown to help identify patients whose presenting medical issues may be comor- bid with symptoms of central sensitization (Mayer et al., 2012). It can be a useful tool for physical therapists treating headache patients, as central sensitization can be a significant contributor to chronic headaches. In particular, it can help measure psychosocial factors related to central sensitization and headache symptoms (Nishigami et al., 2018). Healthcare consideration: When assessing for central sensiti- zation, it is important to avoid thinking that the patient’s pain “is all in their head.” Neurologically, maladaptive coping strategies can influence the central nervous system, in essence “priming” the pump to create neurological hypersensitivity. The conse- quence of this neurological activity is to create symptoms such as increased response to sensory inputs. Clinicians should un - derstand that maladaptive cognitive coping strategies actually influence and change the nervous system. Differentiating common headache types Once medical history, clinical presentation, pain pattern, and psy- chosocial factors have been thoroughly reviewed and addressed, the next step in differential diagnosis is determining what type of headache is present. The International Classification of Headache Disorders (ICHD-III) presents headache diagnoses in a hierarchi- cal fashion, with migraine as the first consideration, tension-type headaches as the second, and cervicogenic headaches as the third (Fernandiz-de-las-Penas et al., 2020). These three types of headaches are commonly treated with nonpharmacological inter- ventions, with manual therapy being the most common nonmedi- cal treatment requested by patients (Fenandiz-de-las-Penas et al., 2020). Consequently, physical therapists often evaluate and treat these types of patients. There is significant overlap in symptomatology and clinical pre- sentation between these headache types, which makes accurate diagnosis difficult. In addition, according to Dale et al. (2020), headaches of different etiology have been shown to exhibit cen- tral sensitization, where the stimulus needed to generate a head- ache decreases over time, while the amplitude of the response to having a headache increases (Filatova et al., 2008). This results in tenderness to palpation, lowered pain thresholds, mechanical allodynia, and hyperalgesia. Thus, a finding such as tenderness in the upper cervical spine may contribute little to accurate diagno- sis (Dale et al., 2020). Healthcare consideration: Differential diagnosis of headache type is critical. It helps you understand the client’s clinical pic- ture, and it dictates treatment approach. One thing that makes differential diagnosis difficult is the fact that there is significant overlap in symptoms between different headache types. It is important for clinicians to know the International Classification of Headache Disorder criteria for each type of headache. In ad - dition, it is important to be familiar with headache red flags. This will help the clinician arrive at the most accurate headache diagnosis. A study by Dale et al. (2020) investigated the decision-making processes of physical therapists relating to evaluation and cat- egorization of patients with headaches. The study used an on- line survey with three hypothetical patients with headache case vignettes. The goal was to see how accurately the therapists could classify headache types according to the International Headache Society categories. The tension-type headache case was classi- fied correctly by 32.3% of the therapists, the migraine was clas- sified correctly by 41.7% of the therapists, and the cervicogenic headache case was classified correctly by 54.8% of the therapists. Years of clinical experience and formal manual therapy training were associated with improved consistency. Since effective edu -
2. My muscles feel stiff and achy. 3. I feel pain all over my body. 4. I have headaches. 5. I do not sleep well. 6. I have difficulty concentrating.
7. Stress makes my physical symptoms get worse. 8. I have muscle tension in my neck and shoulders. 9. I have difficulty remembering things.
Even without using a specific central sensitization inventory, cli- nicians who are aware of the above list of central sensitization symptoms can ask about and/or listen for this information as a means of informally assessing the presence of central sensitiza- tion. This provide a deeper understanding of the patient and their symptoms and help the clinician develop a more effective treat - ment plan. cation and treatment are based on an accurate diagnosis, differ- ential diagnosis of these headache types is important. Migraine headaches Migraine headaches are considered the second leading cause of disability worldwide (de Almeida Tolentino et al., 2021). This type of headache generally begins in childhood to early adulthood, although they can first occur in someone beyond 50 years of age, most commonly in perimenopausal and menopausal women (Cavallaro Goodman et al., 2018). Currently, medications have the highest level of evidence for effectively managing migraine headaches (de Almeida Tolentino et al., 2021). However, physical therapy can be used in conjunction with pharmacological inter- ventions. Specifically, evidence shows therapy can be used to ad- dress musculoskeletal and/or vestibular symptoms accompanying migraine (Carvahlo et al., 2020). Migraine manifests itself as recurrent attacks of headache with a range of accompanying symptoms. In approximately one- third of patients with migraines, headache is sometimes or always pre- ceded or accompanied by transient neurological phenomena, referred to as migraine aura (Eigenbrodt et al., 2021). The patho- genesis of migraine is attributed to involvement of the peripheral and central activation of the trigeminovascular system (Eigen- brodt et al., 2021). The third edition of the International Classification of Headache Disorders classifies three main types of migraine: migraine with- out aura, migraine with aura, and chronic migraine: ● Migraine without aura. Migraine without aura is character- ized by headaches that recur and last 4 to 72 hours (Eigen- brodt et al., 2021). Typical features of this headache type in- clude unilateral location (although bilateral pain is reported by 40% of individuals), pulsating quality, moderate or severe pain intensity, and aggravation by routine physical activity. Associ- ated symptoms include photophobia, phonophobia, nausea, and vomiting. Prodromal symptoms include depressed mood, yawning, fatigue, and craving for certain foods (Eigenbrodt et al., 2021). ● Migraine with aura . Approximately one-thirds of individuals with migraine experience an aura (Eigenbrodt et al., 2021). Aura is defined as transient focal neurological symptoms that precede or accompany migraine headaches (Eigenbrodt et al., 2021). The majority of migraine patients have visual au- ras. About one-third of patients with migraines have sensory symptoms involving pins and needles and/or numbness that spreads gradually in the face or arm (Eigenbrodt et al., 2021). Less common aura symptoms include speech disturbance, motor weakness, and retinal disturbances such as repeated monocular visual disturbances (Eigenbrodt et al., 2021).
EliteLearning.com/ Physical-Therapy
Book Code: PTCA2624
Page 105
Powered by FlippingBook