b'CODING Update ComplianceLEGAL NUTRITIONUpdateANJC NewsANJC Leadership ANJC News! NUTRITION LEGAL EASEREHAB UpdateHeadache Assessment andANJC Scholarships Treatment: Should they StayBy Dr. Donald C. DeFabio or Should they Go?CHIRO AssistHeadache is a leading cause of disability worldwide and the ninth most common reason for a visit to the doctor in the US. LEGAL Q&A However, headache (HA) is a symptom, and before we can discuss treatment, we need to review the diagnosis of HA Executive Directors Update and then decide the appropriate treatment.2020 ANJC AWARDSThere are over 200 HA disorder classifications that are divided into three categories: primary, secondary, and cranial and facial neuropathies. Primary HA is the second cause of disability worldwide and is often treated by PCPs as opposed to specialists. Primary HA includes:Legislative UpdateMigraine with and without auraINSURANCE Update INSURANCE UpdateTension type ClusterTECHNIQUE Update CLUSTERMedication overuse headache (MOH)MIGRAINE TENSION TYPE It is important to remember that a patient may have more Recurrent attacksRecurrent attacksFrequent (severalthan one HA disorder both in their history or at the time of Temporal lasting a fewlasting a fewa day) short at- evaluation. For example, Tom Smith has a history of cluster Pattern hours to days hours to days tacks (15 min to 3 hours) HA and today he presented with a tight band around the Generalized, head (possible tension type). Be sure to evaluate for both MedicareQ&AMedicare Update Typical Often unilateralmay be unilateralStrictly local attension type and cluster HA to be accurate in your diagnosis. OUR HEALTH or radiate to theeye or temporal Trigeminal neuralgia is a common cause of facial pain. It Characteristics & pulsatingneckIntensityModerate toMild to Extremelypresents as short (up to 2 minutes) excruciating bouts of severe moderate severe stabbing/electric shock-like pain in the trigeminal nerve None typically;Strictly ipsilat- distribution, mostly in the second and third branches. ItNausea and/ may have milderal autonomicoften has a sudden onset and will be triggered by sensory Associatedor vomiting,nausea features: Red Symptoms photo- and/or(not vomiting),and/or wateringstimuli such as touching, washing, applying make-up, orphono- and/orphoto and/oreye, running oreven talking, eating, chewing, drinking or smoking.osmophobia phonophobia blocked nostril, ptosis Trigeminal neuralgia is twice as prevalent in women and Avoidsis uncommon in children.Reactive physical activity,Marked agitation: Behavior preference forNone cannot lie stillIf you are the first provider to be seen for an apparent dark and quietduring attacks trigeminal neuralgia or cluster HA, immediate referral is Table 1 required.Table 1 outlines the characteristics of primary HA for reviewSecondary HA is related to an underlying pathology with the exception of MOH, which will present as an exacer- and often falls into the Yellow and Red flag category for bation of the patients current HA disorder with an increasetreatment. They present with various additional symptoms in symptoms and perhaps withdrawal symptoms. It is best toincluding neurological deficits, cognitive, gait and constitu-co-manage MOH with their medical specialist.tional findings such as fever, weight loss or stiff neck. Any Migraine with aura only affects 1/3 of migraineurs and evenrecurring HA with strenuous activity needs concern as does less experience aura symptoms with every HA attack. Thea new or recent onset HA, especially if it is of a different aura generally precedes the HA (but may also accompany)character than previously experienced. Table 2 highlights and involves visual symptoms over 90% of the time andreasons for referral.are usually is slowly-enlarging scintillating scotoma (ifCervicogenic HA is a secondary HA that is worsened by asked, patients may draw a jagged crescent to representneck movement, sustained awkward head position or the flickering). Also common is unilateral paraesthesiaexternal pressure over the cervical or occipital regions. The and/or numbness of hand, arm and/or face. An aura thatCervical Flexion Rotation Test is 100% sensitive 94% specific presents with vertigo, tinnitus, diplopia, ataxia, speech and/ to differentially diagnose cervicogenic HA from migraine, or language disturbances or motor disturbances needs ahowever, it only assesses motion at C1-2. This secondary HA specialist referral. we do treat and does not generally require referral.14 I Spring 2021 www.anjc.info'