6. Orofacial Pain Flashcards
1
Q
Headaches of vascular origin could be caused by what
A
cerebral aneurysm
2
Q
What is an important question to ask patients if you are suspicious of a Vacular and non-vascular intracranial pain disorder
A
is this the worst headache of your life?
3
Q
Signs and symptoms of a vascular or non-vascular intracrainal pain disorder
A
- Systemic symptom (i.e fever)
- Neurologic signs and symptoms
- Onset is sudden
- Onset after age of 40
- Pattern change
4
Q
What are the three groups of primary headaches
A
- Migraine headache
- Tension-like headache
- Trigeminal autonomic cephalgia
5
Q
Patients with migraines have increased risks of developing what other health abnormalities
A
- Psychiatric issues
- Sleeping disorders
- Epilepsy
- Stroke
- *Reason is side effects of meds are bad**
6
Q
What is the most accepted theory that explains the etiology of migraines (causes migraine symptoms)
A
Cortical spreading depression/ neurotransmitters and modulators release
7
Q
Describe cortical spreading depression
A
-Wave of electrophysiological hyperactivity followed by a wave of inhibition
8
Q
What can induce cortical spreading depression
A
hypoxic conditions (facilitates neuronal death in energy compromised tissue)
9
Q
What is responsible for the aura of a migraine
A
cortical spreading depression
10
Q
Diagnostic criteria for migraines without aura
A
5 or more attacks fulfilling this criteria…
- Headache has 2 more more characteristics
- Unilateral location
- Pulsating quality
- Moderate to severe pain intensity
- Aggrevated by routine physical activity
- During the headache one or more of these things happens
- Phonophobia and photophobia
- Nausea and vommiting
11
Q
Diagnostic criteria for migraine with aura
A
At least 2 attacks with the criteria below
- 1 or more aura symptoms
- Visual
- Sensory
- Speech/language
- Motor
- Brainstem (olfactory for example)
- Retinal (loss of vision in one eye)
- 2 or more of the characteristics
- 1 or more aura symptom over 5 mins or more and/or 2 or more aura symptoms in succession
- Each aura lasts 5-60 mins
- One or more aura symptom is unilateral
- Aura accompanied or followed by headache in less than 60 mins
12
Q
Factors that influence the onset of migraines are
A
- Familial history
- Triggered by foods or environmental agents
- Stress (common denominator in all headaches)
- Females
- Serotonin
13
Q
Management of migraines
A
- Triptans
- Ergots
- Beta blockers
- Ca channel blockers
- Antidepressants
- Anticonvulsants (carbamazepine – tegratol)
14
Q
Treatment for migraines is (abortive/preventative)
A
preventative
15
Q
How does the NTI Tension Suppression System work for reducing migraines
A
- Reduces muscle activity of those innervated by CN V
- Prevents bruxism and TMJ syndrome
16
Q
Downsides of the NTI Tension Supression system
A
- Results in malocclusion after just 6 months 9anterior open bites and intrusion of the incisors)
- Doesn’t treat the underlying cause of migraines (cortical spread depression)
17
Q
What is the most common headache
A
tension type headache (TTH)
18
Q
Pain experienced during a tension type headache is described how
A
pressing, tightness around the forehead or band-like
19
Q
Differences and similarities between tension-type headaches and migraines are
A
Differences
- TTH not aggrevated by routine exercise
- No nausea or vomiting
Similar
-Both may have phonophobia and photophobia
20
Q
What are the different subtypes of trigeminal autonomic cephalgia
A
- Cluster headache
- Paroxysmal
- Hemicrania Continua
- SUNCT
21
Q
Describe the autonomic signs seen in trigeminal autonomic cephalgia
A
- Lacrimation/ conjunctival injection
- Nasal congestion/ Rhinorrhea
- Eyelid edema
- Forehead/facial sweating
- Forehead/Facial flushing
- Miosis/Ptosis
22
Q
Describe the demographics of the population most commonly affected by cluster headaches
A
- Type A personality
- Males> Females
- Middle aged
- Without history of headaches or family history of migraines (may be genetic cause)
- Prior head trauma
23
Q
Describe the onset of cluster headache
A
- Occur in clusters
- Usually at the same time
- Most commonly occur at night 2-3 hours after falling asleep or REM
24
Q
Diagnostic criteria for cluster headaches
A
At least 5 attacks fulfilling this criteria
- Severe unilateral orbital, supraorbital and/or temporal pain lasting 15-180 mins (untreated)
- Either or both….
- 1 or more autonomic signs
- Sense of restlessness or agitation
- Frequency from 1/2d to 8/d
25
Horner syndrome is associated with what headache and what is it
- Cluster headaches
| - unilateral eyelid drooping or a small pupil
26
What can provoke cluster headache attacks
- alcohol and smoking
| - Sleeping (onset is influenced by circadian rhythms)
27
Management of cluster headaches
- Oxygen (7L/min for 15 mins)
| - Ergotamines or Sumatriptan
28
Dx criteria for paroxysmal hemicrania headaches
At least 20 attacks fulfilling criteria
- Severe unilateral orbital, supraorbital, and/or temporal pain lasting 2-30 min
- 1 or more autonomic ipsilateral symptoms
- Frequency >5/day for > half the time
- Prevented with therapeutic doses of indometacin
29
What is the most severe type of primary headache
cluster headache
30
Dx criteria for hemicrania continua
* *This is a continuous chronic headache**
- Unilateral
- Present >3 months
- Either or both
- 1 or more autonomic signs
- Restlessness or agitation
- Responds to therapeutic doses of indometacin
31
What are the names of the two headaches that respond to indometacin
paroxysmal and hemicrania continua
32
SUNCT is similar pain to
trigeminal neuralgia (TN) -- very sharp and stabbing pain
33
SUNCT is associated with what autonomic sign
conjunctival injection and tearing
34
What is used to manage SUNCT
anticonvulsant (i.e carbamazepine) or gabapentin
35
Is indomethacin effective for SUNCT
no
36
SUNCT pain may radiate where
jaws and neck
37
List the 4 different neuropathic pain disorders and the most frequently diagnosed neuralgia
- Classic TN **Most frequently diagnosed**
- Glossopharyngeal neuralgia
- Atypical odontalgia
- Burning mouth syndrome
38
Common symptom of trigeminal neuralgia is
reporting pain that jumps from tooth to tooth
39
TN most typically affects what orofacial region
- Maxillary and mandibular branches of CNV
| - Unilateral (mostly right side)
40
CN exam on individual with TN will be (normal/abnormal)
normal
41
What pateints are more prone to TN
- MS patients
| - People with familial occurance
42
Why does MS increase the risk of TN
demylination lesions of the trigeminal root entry zone
43
Pathogenesis of TN
- Unsure
| - May be due to nerve compression or vascular anomalies and demylinating conditions
44
Most common treatment for TN is
anticonvulsants (carbamazepine or tregatol)
45
People with TN are at risk for what other health issues
Aplastic anemia, bone marrow suppression
46
Patients with glossopharyngeal neuralgia have difficulty doing
swallowing
47
Pain in glossopharyngeal neuralgia is located where
- Unilateral
- Pharyngeal
- Auricular
48
Quality of pain for glossopharyngeal neuralgia is
sharp, electric and peircing
49
Pathophysiology of GN
Similar to TN (unknown but may be due to nerve compression)
50
What can often simulate myofascial pain
pulpitis
51
Describe atypical odontalgia
Chronic pain in a tooth or a site where teeth have been extracted without an identifiable cause
52
Other names for atypical odontalgia are
- Atypical facial pain
| - Phantom tooth pain
53
Quality of pain for atypical odontalgia is
dull, throbbing, burning
54
Associated features of phantom tooth pain are
dysaesthesia and paresthesia
55
T/F Patients with atypical odontalgia will not respond to local anesthetic
f
56
Eagles syndrome is what type of pain disorder
cervical pain disorder
57
Symptoms of eagles syndrome are
- Dysphagia
- Sensation of foreign body in throat
- Constant dull ache in throat
- Pain in tilting head told affected side
Secondary complaints:
- Otalgia
- Headache
- Pain distributed in carotid artery
- TMJ
- Generalized facial pain
58
Eagles syndrome is the result of calcification of
Stylohyoid ligament
59
Surgical option for eagle syndrome includes
shortening of the styloid process
60
What are the different extra-cranial causes of orofacial pain
- Giant cell arteritis
- Ear infection
- Sinus infection
- Lyme disease
- Herpes zoster
61
Giant cell arteritis that can cause orofacial pain commonly exists in what arteries
temporal
62
Temporal a. are a branch off what main a.
carotid
63
Cause of giant cell arteritis is
autoimmune (they think)
64
Ususal age onset for giant cell arteritis is
50
65
Major complication of giant cell arteritis is _ and caused by...
irreversible blindness (vision will become blurry and will be permenantly lost if not treated) ... caused by acute ischemic opic neuropathy
66
Vision will worsen with giant cell arteritis if you do what
palpate the temporal artery (will be tender to palpation)
67
Dx of giant cell arteritis is confirmed how
biopsy
68
Other symptoms of temporal arteritis are
- Masticatory muscle pain and fatigue brought on by chewing
- Headaches
- Scalp tenderness
- Fatigue, fever, malaise, weight loss, night sweats
- Elevated erythrocyte sedimentation rate >50 mL/hr
- Absence of lymphadenopathy
69
Management of temporal arteritis
- Refer to rheumatologist and opthamologist
| - High dose corticosteroids (prednisone)
70
Dx of temporal arteritis is confirmed with
biopsy of artery
71
Otitis media is often a complication preceding what
viral upper respiratory tract infection
72
Otitis media is caused by (viral/bacterial) infection
could be either
73
Compare the child and adult eustachian tube
child is shorter and straighter (more prone to obstruction)
74
Symptoms of Otitis media are
- Ear "plugging"
- Fever
- Drainage
- Difficulty sleeping
- Pulling at one/both ears
- Loss of balance
- Decreased hearing
75
What are the main bacteria responsible for inflammation of the sinuses in sinusitis
- Strep pneumoniae
- Hemophilus pneumoniae
- Moraxella catarrhalis
76
Symptoms of sinusitis are
- Nasal stuffiness
- Sinus fullness
- Post nasal drip
- Tenderness over sinuses
- Aching of maxillary teeth
77
Lyme disease is tick borne (viral/bacterial) infection
bacterial (borrelia burgdoferi)
78
Key characteristic of lyme disease is
bull's eye rash
79
Symptoms of lyme disease
- Flu like
- Joint pain
- Neurologic problems
80
Majory of herpes zoster is involved where
80% in V1
81
Describe the quality of pain of herpes zoster virus (shingles)
burning, sharp
82
Associated features of shingles include
- Herpetic maculopapular rash
- Itching
- Fever
83
Describe postherpetic neuralgia
- Complication of shingles
| - Pain that persists more than 3 months after healing of shingles rash
84
Cause of postherpetic neuralgia is
damage to the nervous system
85
T/F Acyclovir can reduce the incidence of postherpetic neuralgia
f
86
Dx criteria of orgasmic headache
At least 2 episodes of pain in head/neck with this criteria
- Brought on by and occuring only during sex
- Either or both
- Increasing in intensity with increasing sexual excitement
- Abrupt explosive intensity just before or with orgasm
- Lasting from 1 min to 24 hr with severe intensity or up to 72 hrs with mild intensity
87
Signs to seek medical help with a headache are
-Very severe
-Accompanied with stiff neck (meningitis)
-Sudden onset without previous hx
-When different from previous headaches
-Last more than a day
Slurred speech, blurred vision, numbness, memory loss, trouble walking
-Waken patient in sleep
-After trauma (concussion)
-Convulsions or loss of conciousness
88
Review cases
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