DIFFERENTIAL DIAGNOSIS FOR HEADACHES AND CERVICAL SPINE PAIN Self-Assessment Answers and Rationales
10. The correct answer is B. Rationale: Headaches related to COVID-19 have been descried as moderate to severe, bilateral, with a pressing or pulsating quality. 11. The correct answer is D. Rationale: Rapid onset of severe headache is always cause for concern. According to the Ottawa Subarachnoid Hemorrhage Rule, headache related to subarachnoid hemorrhage should be suspected with age 40 years or older, neck pain or stiffness, witnessed loss of consciousness, onset during exertion, sudden onset of severe headache, and limited neck flexion on examination. This rule recommends further investigation if one or more of these conditions are present. High blood pressure is not included in the Ottawa Subarachnoid Hemorrhage Rule. 12. The correct answer is B. Rationale: The new onset of tension-type headaches is most common in the 20s and is rare after age 50. Infection, medication overuse, and head and neck trauma have all been identified as frequent causes of headache in persons 50 years and older. 13. The correct answer is A. Rationale: Although it is not unusual to see a slight increase in heart rate, respiration, or body temperature during pregnancy, especially in the third trimester, an increase in blood pressure is a cause for concern and might be an indication of several serious conditions, including cortical vein/cranial sinus thrombosis, carotid artery dissection, or pituitary apoplexy. 14. The correct answer is C. Rationale: Medications that can increase the possibility of intracranial bleed as a source of headache include NSAIDs, anticoagulants, and glucosteroids. 15. The correct answer is A. Rationale: Both polymyalgia rheumatica and temporal arteritis are potential sources of headache and are characterized by tenderness over the temporal artery. 16. The correct answer is A. Rationale: Nausea and vomiting, photophobia, and phonophobia are all common symptoms associated with migraine headaches. By contrast, muscle tenderness in the upper cervical spine is more commonly associated with tension-
1. The correct answer is A. Rationale: Only 1% of physical therapy cases are estimated to present as musculoskeletal injuries even though they originate from systemic or viscerogenic issues. Although this is a small percentage, differential diagnosis to identify viscerogenic and systemic issues is critical to effectively evaluating physical therapy clients. 2. The correct answer is D. Rationale: Many patients with musculoskeletal injuries present with maladaptive pain coping strategies. It is not uncommon for clients to believe that their pain is a direct consequence of proportional tissue damage and to not understand the influence of maladaptive strategies such as catastrophizing. It is within the realm of physical therapy practice to recognize these maladaptive strategies and to provide pain neuroscience education to help the client understan d how these strategies are contributing to their pain experience. 3. The correct answer is B. Rationale: Conditions related to musculoskeletal dysfunction are almost always indicated by a change in activity or a change in position. In addition, night pain is always considered a red flag, as typically rest relieves musculoskeletal pain. Finally, sharp, knifelike pain is not often associated with musculoskeletal conditions. 4. The correct answer is A. Rationale: Night pain is considered a red flag for the possibility of both tumor and infection. As such, when night pain is present, further medical investigation and possible referral to a physician are indicated. 5. The correct answer is D. Rationale: Sensitivity is the ability of a test to correctly identify patients who have a disease or a condition. In this case, 43 of the 100 patients who actually had the disease tested positive, so the test has a sensitivity of 43%. By contrast, the second test was able to correctly identify 96% of those who did not have a disease, so the specificity of that test is 96%. 6. The correct answer is A. Rationale: Headaches that occur 15 or more times per month over a period of three months are considered chronic. 7. The correct answer is C. Rationale: Cervicogenic headaches originate from dysfunction in the upper cervical spine, including impaired muscle function and joint motion issues. These are problems that physical therapists can address and, as such, physical therapists are often effective in treating cervicogenic headaches. 8. The correct answer is A. Rationale: Primary headaches arise from overactivity or problems with pain structures within the cranium or upper cervical spine. Primary headaches include migraine, tension-type, and cervicogenic. Secondary headaches are considered symptoms of an underlying disorder. Headaches that arise from a brain abscess are considered secondary headaches. 9. The correct answer is C. Rationale: Metastases to the brain are highest with lung cancer, breast cancer, and malignant melanoma. Although metastases to the brain are rare—less than 0.1%—when the patient’s history includes one of these types of cancer, the physical therapist should consider whether the source of the headache pain might be cancer metastases.
type cervicogenic headaches. 17. The correct answer is A.
Rationale: Although the onset of migraines is often associated with peri- or postmenopause, the most common age for onset of
this type of headache is puberty. 18. The correct answer is C.
Rationale: Although nausea and vomiting are associated with migraine headaches, the International Classification of Headache Disorders specifically eliminates nausea and vomiting as a symptom of tension-type headaches. 19. The correct answer is B. Rationale: Cervical range of motion limitations can contribute to cervicogenic headache. C1–C2 is responsible for 33% for cervical flexion–extension, while C2–C3 is responsible for 60% of cervical rotation.
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Book Code: PTNY1024
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