New York Physical Therapy Ebook Continuing Education

the more likely the patient has the condition. For example, if a positive test result has a likelihood ratio of 9.3, this means this result is 9.3 times more likely to happen in a patient with the condition than it would be in a patient without the condition.

Self-Assessment Quiz Question #5 If 100 patients known to have a disease were tested and 43 were positive, then the test has a 43%____________. On the other hand, if 100 people with no disease are tested and 96 return a completely negative result, then the test has a 96% ______________. a. Positive likelihood ratio; negative likelihood ratio. b. Negative likelihood ration; positive likelihood ratio.

c. Specificity; sensitivity. d. Sensitivity; specificity. HEADACHE DIFFERENTIAL DIAGNOSIS

Introduction Headaches are one of the most common health conditions. About 60 million Americans experience at least one severe headache each year. It is estimated that between 1.7% and 4% of the world’s population experiences recurrent headaches, making this the third leading cause of disability among the world’s adult population (Dale et al., 2020). About 10% of patients suffering from headaches are diagnosed with chronic daily headaches (Mohammandi et al., 2021). Chronic daily headaches are defined as those that occur 15 days a month or more for a period of three months. They are associated with a poor life quality (Mohammadi et al., 2021). The conversion from primary headaches to chronic daily headaches has been associated with overuse of analgesics (pain medications), hypertension, allergies, diabetes, obesity, and hypothyroidism (Mohammadi et al., 2021). Self-Assessment Quiz Question #6 Headaches are considered chronic if they occur ___ days a month or more over a period of ___months.

diagnosis of headaches for physical therapists involves determining the type of headache or source of the headache symptoms. Physical therapists are not able to successfully treat all types of headaches. For example, migraine headaches are often addressed via medication, and the role of the physical therapist in their management is less defined (Carvalho et al., 2020). By contrast, cervicogenic headaches, which originate from dysfunction in the upper cervical spine, are often effectively treated by physical therapists. A systematic review by Racicki et al. (2013) found that physical therapy interventions, especially cervical manipulation and mobilization combined with cervicoscapular strengthening, are effective interventions for decreasing cervicogenic headache intensity and frequency. Differential diagnosis of headaches begins with understanding the types of headaches. Self-Assessment Quiz Question #7 Evidence shows that physical therapists are not able to effectively treat all types of headaches. The type of headaches that physical therapists are considered quite effective in treating is: a. Migraine with aura. b. Migraine without aura. c. Cervicogenic. d. Cluster. ● Disorder of the cranium, neck, eyes, ears, nose, sinuses, teeth, mouth, or other facial or cervical structure. ● Psychiatric disorder. Understanding whether a headache is primary or secondary helps the therapist determine the origin of the patient’s symptoms, whether a medical referral might be helpful, and whether physical therapy treatment might be helpful. Healthcare consideration: Knowing the differences between a primary and secondary headache is necessary for determining the source of your client’s head pain. A primary headache is caused by dysfunction in the pain-sensitive structures within the cranium or upper cervical spine. Secondary headaches are caused by an underlying or known disease or condition that affects the nervous system, such as an infection or head/neck trauma. Self-Assessment Quiz Question #8 Which of the following is considered a secondary headache? a. Brain abscess. b. Migraine.

a. 15; 3. b. 10; 2. c. 15; 6. d. 10; 6.

The brain itself does not feel pain because it has no pain receptors (Carvallaro Goodman et al., 2018). Differential Types of headaches The International Headache Society (HIS) developed a classification system to help clinicians in the diagnosis and management of headaches (Dale et al., 2020). Per the HIS, headaches are classified as primary or secondary based on the patient’s clinical presentation and associated symptoms. Primary headaches Primary headaches are caused by over activity of or problems with the pain-sensitive structures within the cranium or upper cervical spine. They are not caused by underlying disease or structural problems (Anarte et al., 2019). According to the HIS, primary headaches include: ● Migraine headaches.

● Tension-type headaches. ● Cervicogenic headaches. ● Other primary headache disorders. Secondary headaches

Secondary headaches are considered symptoms of an underlying or known disease (Anarte et al., 2019) or conditions that affect the nervous system (Dale et al., 2020). These headaches may be attributed to:

● Trauma or injury to the head and/or neck. ● Cranial and/or cervical vascular disorder. ● Nonvascular intracranial disorder. ● Substance use or its withdrawal. ● Infection. ● Disorder of homeostasis.

c. Tension-type. d. Cervicogenic.

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