Dr. Alex Jimenez, El Paso's Chiropractor
I hope you have enjoyed our blog posts on various health, nutritional and injury related topics. Please don't hesitate in calling us or myself if you have questions when the need to seek care arises. Call the office or myself. Office 915-850-0900 - Cell 915-540-8444 Great Regards. Dr. J

Origin Of Head Pain | El Paso, TX.

Origin: The most common cause of migraines/headaches can relate to neck complications. From spending excessive time looking down at a laptop, desktop, iPad, and even from constant texting, an incorrect posture for extended periods of time can begin to place pressure on the neck and upper back leading to problems that can cause headaches. The majority of these type of headaches occurs as a result of tightness between the shoulder blades, which in turn causes the muscles on the top of the shoulders to also tighten and radiate pain into the head.

Origin Of Head Pain

  • Arises from pain sensitive structures in the head
  • Small diameter fibers (pain/temp) innervate
  • Meninges
  • Blood vessels
  • Extracranial structures
  • TMJ
  • Eyes
  • Sinuses
  • Neck muscles and ligaments
  • Dental structures
  • The brain has no pain receptors

Spinal Trigeminal Nucleus

  • Trigeminal nerve
  • Facial nerve
  • Glossopharyngeal nerve
  • Vagus nerve
  • C2 nerve (Greater occipital nerve)

Occipital Nerves

origin headache el paso tx.http://dailymedfact.com/neck-anatomy-the-suboccipital-triangle/

Sensitization Of Nociceptors

  • Results in allodynia and hyperalgesia

origin headache el paso tx.http://slideplayer.com/9003592/27/images/4/Mechanisms+associated+with+peripheral+sensitization+ to+pain.jpg

Headache Types

Sinister:
  • Meningeal irritation
  • Intracranial mass lesions
  • Vascular headaches
  • Cervical fracture or malformation
  • Metabolic
  • Glaucoma
Benign:
  • Migraine
  • Cluster headaches
  • Neuralgias
  • Tension headache
  • Secondary headaches
  • Post-traumatic/post-concussion
  • “Analgesic rebound” headache 
  • Psychiatric

HA Due To Extracranial Lesions

  • Sinuses (infection, tumor)
  • Cervical spine disease
  • Dental problems
  • Temporomandibular joint
  • Ear infections, etc.
  • Eye (glaucoma, uveitis)
  • Extracranial arteries
  • Nerve lesions

HA Red Flags

Screen for red flags and consider dangerous HA types if present

Systemic symptoms:
  • Weight loss
  • Pain wakes them from sleep
  • Fever
Neurologic symptoms or abnormal signs:
  • Sudden or explosive onset
  • New or Worsening HA type especially in older patients
  • HA pain that is always in the same location
Previous headache history
  • Is this the first HA you’ve ever had?
    Is this the worst HA you’ve ever had?
Secondary risk factors:
  • History of cancer, immunocompromised, etc.

Dangerous/Sinister Headaches

Meningeal irritation
  • Subarachnoid hemorrhage
  • Meningitis and meningoencephalitis
Intracranial mass lesions
  • Neoplasms
  • Intracerebral hemorrhage
  • Subdural or epidural hemorrhage
  • Abscess
  • Acute hydrocephalus
Vascular headaches
  • Temporal arteritis
  • Hypertensive encephalopathy (e.g., malignant hypertension, pheochromocytoma)
  • Arteriovenous malformations and expanding aneurysms
  • Lupus cerebritis
  • Venous sinus thrombosis
Cervical fracture or malformation
  • Fracture or dislocation
  • Occipital neuralgia
  • Vertebral artery dissection
  • Chiari malformation
Metabolic
  • Hypoglycemia
  • Hypercapnea
  • Carbon monoxide
  • Anoxia
  • Anemia
  • Vitamin A toxicity
Glaucoma

Subarachnoid Hemorrhage

  • Usually due to ruptured aneurysm
  • Sudden onset of severe pain
  • Often vomiting
  • Patient appears ill
  • Often nuchal rigidity
  • Refer for CT and possibly lumbar puncture

Meningitis

  • Patient appears ill
  • Fever
  • Nuchal rigidity (except in elderly and young children)
  • Refer for lumbar puncture – diagnostic

Neoplasms

  • Unlikely cause of HA in average patient population
  • Mild and nonspecific head pain
  • Worse in the morning
  • May be elicited by vigorous head shaking
  • If focal symptoms, seizures, focal neurologic signs, or evidence of increased intracranial pressure are present rule our neoplasm

Subdural Or Epidural Hemorrhage

  • Due to hypertension, trauma or defects in coagulation
  • Most often occurs in the context of acute head trauma
  • Onset of symptoms may be weeks or months after an injury
  • Differentiate from the common post-concussion headache
  • Post-Concussive HA may persist for weeks or months after an injury and be accompanied by dizziness or vertigo and mild mental changes, which will all subside

Increase Intracranial Pressure

  • Papilledema
  • May cause visual changes

origin headache el paso tx.

https://openi.nlm.nih.gov/detailedresult.php?img=2859586_AIAN-13-37- g001&query=papilledema&it=xg&req=4&npos=2

origin headache el paso tx.

Temporal (Giant-Cell) Arteritis

  • >50 years old
  • Polymyalgia rheumatic
  • Malaise
  • Proximal joint pains
  • Myalgia
  • Nonspecific headaches
  • Exquisite tenderness and/or swelling over the temporal or occipital arteries
  • Evidence of arterial insufficiency in the distribution of branches of the cranial vessels
  • High ESR

Cervical Region HA

  • Neck trauma or with symptoms or signs of cervical root or cord compression
  • Order MR or CT cord compression due to fracture or dislocation
  • Cervical instability
  • Order cervical spine x-rays lateral flexion and extension views

Ruling Out Dangerous HA

  • Rule our history of serious head or neck injury, seizures or focal neurologic symptoms, and infections that may predispose to meningitis or brain abscess
  • Check for fever
  • Measure blood pressure (concern if diastolic >120)
  • Ophthalmoscopic exam
  • Check neck for rigidity
  • Auscultate for cranial bruits.
  • Complete neurologic examination
  • If needed order complete blood cell count, ESR, cranial or cervical imaging

Episodic Or Chronic?

<15 days per month = Episodic

>15 days per month = Chronic

Migraine HA

Generally due to dilation or distension of cerebral vasculature

Serotonin In Migraine

  • AKA 5-hydroxytryptamine (5-HT)
  • Serotonin becomes depleted in migraine episodes
  • IV 5-HT can stop or reduce severity

Migraine With Aura

History of at least 2 attacks fulfilling the following criteria

One of the following fully reversible aura symptoms:
  • Visual
  • Somatic sensory
  • Speech or language difficulty
  • Motor
  • Brain stem
2 of the following 4 characteristics:
  • 1 aura symptom spreads gradually over ≥5 min, and/or 2 symptoms occur in succession
  • Each individual aura symptom lasts 5-60 min
  • 1 aura symptom is unilateral
  • Aura accompanied or followed in <60 min by headache
  • Not better accounted for by another ICHD-3 diagnosis, and TIA excluded

Migraine Without Aura

History of at least 5 attacks fulfilling the following criteria:
  • Headache attacks lasting 4-72 h (untreated or unsuccessfully treated)
  • Unilateral pain
  • Pulsing/pounding quality
  • Moderate to severe pain intensity
  • Aggravation by or causing avoidance of routine physical activity
  • During headache nausea and/or sensitivity to light and sound
  • Not better accounted for by another ICHD-3 diagnosis

Cluster Headache

  • Severe unilateral orbital, supraorbital and/or temporal pain
  • “Like an ice pick stabbing me the eye”
  • Pain lasts 15-180 minutes
At least one of the following on the side of headache:
  • Conjunctival injection
  • Facial sweating
  • Lacrimation
  • Miosis
  • Nasal congestion
  • Ptosis
  • Rhinorrhea
  • Eyelid edema
  • History of similar headaches in the past

Tension Headache

Headache pain accompanied by two of the following:
  • Pressing/tightening (non-pulsing) quality
  • “Feels like a band around my head”
  • Bilateral location
  • Not aggravated by routine physical activity
Headache should be lacking:
  • Nausea or vomiting
  • Photophobia and phonophobia (one or the other may be present)
  • History of similar headaches in the past

Rebound Headache

  • Headache occurring on ≥15 days a month in a patient with a pre-existing headache disorder
  • Regular overuse for >3 months of one or more drugs that can be taken for acute and/or symptomatic treatment of headache
  • Due to medication overuse/withdrawal
  • Not better accounted for by another ICHD-3 diagnosis

Sources

Alexander G. Reeves, A. & Swenson, R. Disorders of the Nervous System. Dartmouth, 2004.

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Dr. Alexander Jimenez ♛
Advanced Chiropractic & Wellness Authority ⚕ Healthcare Educator • Injury, Sciatica Specialist • 915-850-0900 📞
We Welcome You 👊🏻.
Purpose & Passions: I am a Doctor of Chiropractic specializing in progressive cutting-edge therapies and functional rehabilitation procedures focused on clinical physiology, total health, functional strength training and complete conditioning. We focus on restoring normal body functions after neck, back, spinal and soft tissue injuries.

We use Specialized Chiropractic Protocols, Wellness Programs, Functional & Integrative Nutrition, Agility & Mobility Fitness Training and Cross-Fit Rehabilitation Systems for all ages.

As an extension to dynamic rehabilitation, we too offer our patients, disabled veterans, athletes, young and elder a diverse portfolio of strength equipment, high performance exercises and advanced agility treatment options. We have teamed up with the cities premier doctors, therapist and trainers in order to provide high level competitive athletes the options to push themselves to their highest abilities within our facilities.

We’ve been blessed to use our methods with thousand of El Pasoans over the last 3 decades allowing us to restore our patients health and fitness while implementing researched non-surgical methods and functional wellness programs.

Our programs are natural and use the body’s ability to achieve specific measured goals, rather than introducing harmful chemicals, controversial hormone replacement, un-wanted surgeries, or addictive drugs. We want you to live a functional life that is fulfilled with more energy, positive attitude, better sleep, and less pain. Our goal is to ultimately empower our patients to maintain the healthiest way of living.

With a bit of work, we can achieve optimal health together, no matter the age or disability.

Join us in improving your health for you and your family.

Its all about: LIVING, LOVING & MATTERING! 🍎

Welcome & God Bless

EL PASO LOCATIONS

CENTRAL:
6440 Gateway East, Ste B

EAST SIDE:
11860 Vista Del Sol, Ste 128

PHONE: 915-850-0900 ✔️