Chapter 7 - Facial Pain/HA Flashcards
How migraines occur
Excite, then Slow depolarization
Suppression brain activity
Release substance P, cGRP, neurokinin A (proinflammatory)
Activate nociceptors, central tgmnlvascular neurons
Called cortical spreading depression
How often shingles patients get Post-hermetic neuralgia
25%
DDx Secondary HA
Trigeminal neuralgia Persist Idio facial pain TMJ Rhinosinusitis Trauma Vascular Neoplasm Substance Infxn Somatization/Psych
Eye disorders causing HA
Acute glaucoma, refractive error, heterophoria/tropia
HA prevalence
46% in general
42% TTH
11% migraine
Tension HA- Sx, Tx
Min-days, b/l, pressing, episodic, not worse with normal physical activity, no nausea
May have photo/phonophobia
OTC
Prevent with amitriptylene
Migraine Dx
At least 5
4-72 hr
2 of: u/l, pulse, mod/severe, aggravate by phys activity
Either N/V or photo/phonophobia
Triptan MOA
Activate 5-HT1B, 1D
Constrict vessels, decrease neuropeptide release
When to Dx someone with sinus HA
Most (88%) actually meet criteria for migraine
Evidence of current or past infection/inflammation
2 of: temporal relation, HA correlates with sinus sx, HA worse with pressure over sinuses, same side as sinusitis
Five characteristics of trigeminal neuralgia
Paroxysmal, provoked by light touch, confines to TGMNL area, unilateral, normal sensory exam
Post-herpetic trigeminal neuropathy
Usually V1 Unilateral head/face pain 3 mo Burning, Pruritic May have allodynia, sensory changes Pale/light purple scars Occurs in 10% zoster opthalmicus TCA, gabapentin, pregabalin, opioid, lidocaine Psych
Persistent Idiopathic Facial Pain
No neurological or dental cause
Daily, > 2 hr, >3 mo
TCA, gabapentin
Surgery for contact HA
Most people with contact points don’t have HA
Trial of topical anesthesia to contact point prior to surgery
Prevalence of TMD groups
1 (Myofascial) 45%
2 (Disc displacement) 41%
3 (arthritis/osis/algia) 30%
Group 1 and 2 have 10% prevalence each in Gen pop
Criteria for TMJ Pain
Pain relates to jaw movement and mastication
TTP mm mastication or over joint
Relief with anesthetic block
