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-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. 20. The correct answer is C. Rationale: About half of cervical rotation comes from the C1/C2 level, and the flexion–rotation test is used to isolate this level and assess rotation motion. A positive test is present when there is a range of motion restriction with firm resistance or a 10-degree difference in motion between the painful and nonpainful sides. Dysfunction in the upper cervical spine is associated with cervicogenic headaches. 21. The correct answer is C. Rationale: The deep cervical flexor muscles, longus colli and capitis, provide cervical segmental support and stability. The craniocervical flexion test is used to test for dysfunction in these muscles. 22. The correct answer is C. Rationale: According to the International Classification of Headache Disorders, one of the diagnostic criteria for cluster headaches is a sense of agitation or restlessness. Patients with cluster headaches have a difficult time lying down and characteristically pace the floor.
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. 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.
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