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TMD > 6. Orofacial Pain > Flashcards

6. Orofacial Pain Flashcards

1
Q

Headaches of vascular origin could be caused by what

A

cerebral aneurysm

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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?

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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
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4
Q

What are the three groups of primary headaches

A
  • Migraine headache
  • Tension-like headache
  • Trigeminal autonomic cephalgia
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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**
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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

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7
Q

Describe cortical spreading depression

A

-Wave of electrophysiological hyperactivity followed by a wave of inhibition

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8
Q

What can induce cortical spreading depression

A

hypoxic conditions (facilitates neuronal death in energy compromised tissue)

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9
Q

What is responsible for the aura of a migraine

A

cortical spreading depression

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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
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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
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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
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13
Q

Management of migraines

A
  • Triptans
  • Ergots
  • Beta blockers
  • Ca channel blockers
  • Antidepressants
  • Anticonvulsants (carbamazepine – tegratol)
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14
Q

Treatment for migraines is (abortive/preventative)

A

preventative

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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

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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)
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17
Q

What is the most common headache

A

tension type headache (TTH)

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18
Q

Pain experienced during a tension type headache is described how

A

pressing, tightness around the forehead or band-like

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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

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20
Q

What are the different subtypes of trigeminal autonomic cephalgia

A
  • Cluster headache
  • Paroxysmal
  • Hemicrania Continua
  • SUNCT
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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
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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
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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
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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
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25
Q

Horner syndrome is associated with what headache and what is it

A
  • Cluster headaches

- unilateral eyelid drooping or a small pupil

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26
Q

What can provoke cluster headache attacks

A
  • alcohol and smoking

- Sleeping (onset is influenced by circadian rhythms)

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27
Q

Management of cluster headaches

A
  • Oxygen (7L/min for 15 mins)

- Ergotamines or Sumatriptan

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28
Q

Dx criteria for paroxysmal hemicrania headaches

A

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
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29
Q

What is the most severe type of primary headache

A

cluster headache

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30
Q

Dx criteria for hemicrania continua

A
  • *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
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31
Q

What are the names of the two headaches that respond to indometacin

A

paroxysmal and hemicrania continua

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32
Q

SUNCT is similar pain to

A

trigeminal neuralgia (TN) – very sharp and stabbing pain

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33
Q

SUNCT is associated with what autonomic sign

A

conjunctival injection and tearing

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34
Q

What is used to manage SUNCT

A

anticonvulsant (i.e carbamazepine) or gabapentin

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35
Q

Is indomethacin effective for SUNCT

A

no

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36
Q

SUNCT pain may radiate where

A

jaws and neck

37
Q

List the 4 different neuropathic pain disorders and the most frequently diagnosed neuralgia

A
  • Classic TN Most frequently diagnosed
  • Glossopharyngeal neuralgia
  • Atypical odontalgia
  • Burning mouth syndrome
38
Q

Common symptom of trigeminal neuralgia is

A

reporting pain that jumps from tooth to tooth

39
Q

TN most typically affects what orofacial region

A
  • Maxillary and mandibular branches of CNV

- Unilateral (mostly right side)

40
Q

CN exam on individual with TN will be (normal/abnormal)

A

normal

41
Q

What pateints are more prone to TN

A
  • MS patients

- People with familial occurance

42
Q

Why does MS increase the risk of TN

A

demylination lesions of the trigeminal root entry zone

43
Q

Pathogenesis of TN

A
  • Unsure

- May be due to nerve compression or vascular anomalies and demylinating conditions

44
Q

Most common treatment for TN is

A

anticonvulsants (carbamazepine or tregatol)

45
Q

People with TN are at risk for what other health issues

A

Aplastic anemia, bone marrow suppression

46
Q

Patients with glossopharyngeal neuralgia have difficulty doing

A

swallowing

47
Q

Pain in glossopharyngeal neuralgia is located where

A
  • Unilateral
  • Pharyngeal
  • Auricular
48
Q

Quality of pain for glossopharyngeal neuralgia is

A

sharp, electric and peircing

49
Q

Pathophysiology of GN

A

Similar to TN (unknown but may be due to nerve compression)

50
Q

What can often simulate myofascial pain

A

pulpitis

51
Q

Describe atypical odontalgia

A

Chronic pain in a tooth or a site where teeth have been extracted without an identifiable cause

52
Q

Other names for atypical odontalgia are

A
  • Atypical facial pain

- Phantom tooth pain

53
Q

Quality of pain for atypical odontalgia is

A

dull, throbbing, burning

54
Q

Associated features of phantom tooth pain are

A

dysaesthesia and paresthesia

55
Q

T/F Patients with atypical odontalgia will not respond to local anesthetic

A

f

56
Q

Eagles syndrome is what type of pain disorder

A

cervical pain disorder

57
Q

Symptoms of eagles syndrome are

A
  • 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
Q

Eagles syndrome is the result of calcification of

A

Stylohyoid ligament

59
Q

Surgical option for eagle syndrome includes

A

shortening of the styloid process

60
Q

What are the different extra-cranial causes of orofacial pain

A
  • Giant cell arteritis
  • Ear infection
  • Sinus infection
  • Lyme disease
  • Herpes zoster
61
Q

Giant cell arteritis that can cause orofacial pain commonly exists in what arteries

A

temporal

62
Q

Temporal a. are a branch off what main a.

A

carotid

63
Q

Cause of giant cell arteritis is

A

autoimmune (they think)

64
Q

Ususal age onset for giant cell arteritis is

A

50

65
Q

Major complication of giant cell arteritis is _ and caused by…

A

irreversible blindness (vision will become blurry and will be permenantly lost if not treated) … caused by acute ischemic opic neuropathy

66
Q

Vision will worsen with giant cell arteritis if you do what

A

palpate the temporal artery (will be tender to palpation)

67
Q

Dx of giant cell arteritis is confirmed how

A

biopsy

68
Q

Other symptoms of temporal arteritis are

A
  • 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
Q

Management of temporal arteritis

A
  • Refer to rheumatologist and opthamologist

- High dose corticosteroids (prednisone)

70
Q

Dx of temporal arteritis is confirmed with

A

biopsy of artery

71
Q

Otitis media is often a complication preceding what

A

viral upper respiratory tract infection

72
Q

Otitis media is caused by (viral/bacterial) infection

A

could be either

73
Q

Compare the child and adult eustachian tube

A

child is shorter and straighter (more prone to obstruction)

74
Q

Symptoms of Otitis media are

A
  • Ear “plugging”
  • Fever
  • Drainage
    • Difficulty sleeping
    • Pulling at one/both ears
    • Loss of balance
    • Decreased hearing
75
Q

What are the main bacteria responsible for inflammation of the sinuses in sinusitis

A
  • Strep pneumoniae
  • Hemophilus pneumoniae
  • Moraxella catarrhalis
76
Q

Symptoms of sinusitis are

A
  • Nasal stuffiness
  • Sinus fullness
  • Post nasal drip
  • Tenderness over sinuses
  • Aching of maxillary teeth
77
Q

Lyme disease is tick borne (viral/bacterial) infection

A

bacterial (borrelia burgdoferi)

78
Q

Key characteristic of lyme disease is

A

bull’s eye rash

79
Q

Symptoms of lyme disease

A
  • Flu like
  • Joint pain
  • Neurologic problems
80
Q

Majory of herpes zoster is involved where

A

80% in V1

81
Q

Describe the quality of pain of herpes zoster virus (shingles)

A

burning, sharp

82
Q

Associated features of shingles include

A
  • Herpetic maculopapular rash
  • Itching
  • Fever
83
Q

Describe postherpetic neuralgia

A
  • Complication of shingles

- Pain that persists more than 3 months after healing of shingles rash

84
Q

Cause of postherpetic neuralgia is

A

damage to the nervous system

85
Q

T/F Acyclovir can reduce the incidence of postherpetic neuralgia

A

f

86
Q

Dx criteria of orgasmic headache

A

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
Q

Signs to seek medical help with a headache are

A

-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
Q

Review cases

A

ok

TMD (13 decks)

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