Chapter 9: Facial Pain, Headache and Otalgia

Question 1

Vascular headaches of the migraine type

Answer 1

1. Classic migraine
2. Common migraine
3. Cluster headache
4. Hemiplegic migraine and Ophthalmoplegic migraine
5. Lowe-half headache

Question 2

1. Recurrent attacks of headache
2. Unilateral
3. Associated with anorexia, sometimes with nausea and vomiting
4. Preceded by, or associated with, conspicuous sensory, motor and mood disturbances
5. Often familial
6. Pain phase: cranial arterial distention and dilatation, no permanent changes in the involved vessel

Answer 2

Vascular headaches of the migraine type

Question 3

Sharply defined, transient visual and other sensory or motor prodromes or both

Answer 3

Classic headache

Question 4

Without striking prodromes
Unilateral
Atypical or sick headache
Summer, Monday, week-end, relaxation, premenstrual and menstrual headache

Answer 4

Common migraine

Question 5

Unilateral on the same side
Associated with flushing, sweating, rhinorrhea and increased lacrimation
Brief in duration
Occurring in closely packed groups separated by long remissions
Erythroprosopalgia, ciliary or migrainous neuralgia, erythromelalgia of the head or histamine cephalalgia, petrosal neuralgia

Answer 5

Cluster headache

Question 6

Sensory and motor phenomena persist during and after the headache

Answer 6

Hemiplegic migraine and Ophthalmoplegic migraine

Question 7

Centered primarily in the lower face

Atypical facial neuralgia, sphenopalatine ganglion neuralgia, vidian neuralgia

Answer 7

Lower half headache

Question 8

Ache or sensation of tightness, pressure or constriction, widely varied in intensity, frequency and duration, sometimes long-lasting and commonly suboccipital
Associated with sustained contraction of skeletal muscles in the absence of permanent structural change, usually as part of the individual’s reaction during life stress
Tension, psychogenic and nervous headache

Answer 8

Muscle-contraction headache

Question 9

Headaches and nasal discomfort, recurrent and resulting from congestion and edema of nasal and paranasal mucous membranes

Answer 9

Headache of nasal vasomotor reaction

Question 10

Associated with generally nonrecurrent dilatation of cranial arteries

Answer 10

Nonmigrainous vascular headache

Question 11

Headache resulting from traction on intracranial structures, mainly vascular, by masses

Answer 11

Traction headache

Question 12

Traction headache

Answer 12

1. Primary or metastatic tumors of meninges, vessels or brain
2. Hematomas
3. Abscess
4. Postlumbar puncture headache
5. Pseudotumor cerebri

Question 13

Due to readily recognized inflammation of cranial structures

Answer 13

Headache due to overt cranial inflammation

Question 14

Behind or above one eye with extension to temple or maxilla

Nasal congestion, lacrimation, conjunctival injection; may occur at night

Answer 14

Cluster headache

Question 15

Hatband, bitemporal, occipital, suboccipital

Chronic anxiety; in some cases may be related to occupational muscle fatigue

Answer 15

Muscle-contraction headache

Question 16

In and around nose, ethmoid and maxillary areas; may radiate into frontal area
Nasal obstruction and rhinorrhea often occur

Answer 16

Nasal vasomotor reaction

Question 17

In area of temporal (often bilateral) or other involved branches of extracranial arteries
Ischemic optic neuritis

Answer 17

Temporal arteritis

Question 18

Pain in area of involved sinus; sphenoid sinusitis may cause retro-orbital, occipital or vertex pain
Fever, malaise, tenderness over involved sinus, nasal discharge and congestion, associated URTI

Answer 18

Acute sinusitis

Question 19

Infrequently causes chronic head pain; may be confused with vasomotor reaction
Nasal polyposis, chronic suppurative nasal discharge

Answer 19

Chronic sinusitis

Question 20

In and around ear with radiation into neck and temporal area

Aural fullness; clicking in joint

Answer 20

TMJ dysfunction

Question 21

Face; any of 3 divisions of the trigeminal nerve

Associated with trigger zones that respond to light contact

Answer 21

Trigeminal neuralgia

Question 22

Pharynx with radiation into ear

Salivation; trigger zones in tonsillar region

Answer 22

Glossopharyngeal neuralgia

Question 23

Most excruciating of the vascular headaches

Answer 23

Cluster headache

Question 24

Unilateral facial and head pain occurs primarily in men
With sudden onset and abrupt cessation
No prodrome
1 to 3 attacks per day of short duration, typically 45 minutes to 1 hour
Periods of remission may last from months to even years, averaging 2 years

Answer 24

Cluster headache

Question 25

Focus of pain is usually centered behind one eye, with radiation to involve the entire side of the face and neck Pain is often associated with flushing, sweating, increased lacrimation and rhinorrhea on the involved side Precipitated by alcohol, histamine and other vasodilators

Answer 25

Cluster headache

Question 26

Modes of treatment (cluster headache)

Answer 26

1. Inhalation of 100% oxygen 2. Ergotamine 3. Local application of anesthetic nose drops 4. Methylsergide 5. Psychotherapy

Question 27

Pain is often a chronic nature and is located in the frontal, temporal, occipital and suboccipital regions Tension is a common cause

Answer 27

Muscle-contraction headache

Question 28

Patient complains of the sensation of a tight band (hat band) around the head, but it is not severe enough to be painful Sensation is produced by a mild, involuntary increase in temporal muscle tension

Answer 28

Muscle-contraction headache

Question 29

Treatment consist of sympathetic listening (heat and massage)

Answer 29

Muscle-contraction headache

Question 30

Secondary to structural abnormalities in the neck

Answer 30

Muscle-contraction headache

Question 31

Headache pain tends to be dull and is moderately by massage and/or heat Other therapies: NSAID's, PT, anti-depressants, muscle relaxants

Answer 31

Cervical spondylosis

Question 32

Irritation of one or more of the cervical roots may lead to headaches, often present upon waking

Answer 32

Cervical radiculopathy

Question 33

Simple muscle pain that has been linked with physical allergy and autonomic instability

Answer 33

Myalgia

Question 34

Localized inflammatory condition involving muscle and overlying and adjacent fasciae with resultant fibrosis

Answer 34

Myofascitis

Question 35

Acute frontal headaches that wad frequently present upon arising Tenderness in the area of the floor of the frontal sinus on the involved side

Answer 35

"Vacuum" type pain

Question 36

Causes constant, moderately severe head pain that tends to be bilateral Associated with tenderness in the area of the involved arteries May mimic migraine, muscle-contraction, or cluster headache Not influenced by cough or head movements

Answer 36

Temporal arteritis

Question 37

Occurs in older individuals Accompanied by generalized weakness and anemia ESR is often markedly increased Treatment: high-dose, prolonged prednisone

Answer 37

Temporal arteritis

Question 38

Diagnosis of temporal arteritis

Answer 38

Biopsy

Question 39

Sinusitis (pain locations)

Answer 39

1. Maxillary: anterior facial (cheek) with radiation into teeth, orbital and malar regions 2. Ethmoids: interocular with spread into frontal location 3. Frontal: forehead, interocular and temporal areas 4. Sphenoid: retro-orbital, radiation toward vertex and occasionally the mastoid areas

Question 40

Is a common cause of secondary otalgia Frequently complaining of ear infection Deep, boring pain in the ear mimicking acute otitis media Accompanied by muscle spasm

Answer 40

TMJ dysfunction

Question 41

Involved muscle in TMJ dysfunction

Answer 41

1. Temporalis 2. Masseter 3. Medial and lateral pterygoid muscles Trapezius Suboccipital Frontal Occipital

Question 42

Patient exhibits malocclusion and, on occasion, malposition of the maxilla and/or mandible

Answer 42

TMJ dysfunction

Question 43

May cause joint dysfunction or muscle spasm | Manifested as morning headache and unconscious stress-induced daytime grinding producing evening headache

Answer 43

Bruxism (grinding of the teeth)

Question 44

Translation

Answer 44

Evidence of opening or closing click, crepitus or restricted anterior motion on opening

Question 45

Complete otolaryngologic exam (TMJ dysfunction)

Answer 45

Dentition | Function of masticatory muscles

Question 46

Maximal mouth opening (between the edges of the upper and lower incisors)

Answer 46

Average adult: 40 mm

Question 47

Indicate decrease in joint function and translation

Answer 47

Measurement of less than 40 mm

Question 48

Initial symptomatic treatment (TMJ dysfunction)

Answer 48

1. Soft to liquid diet 2. Heat applied over the affected muscles 3. Anti-inflammatory drugs

Question 49

Disocclude the teeth and allow the mandible to assume the normal position--> allowing the muscles of mastication to relax and assume a more normal function

Answer 49

Oral splints

Question 50

Pain is of sudden onset, sharp and lancinating and initiated at trigger zones about the face which react to physical contact or drafts of air

Answer 50

Trigeminal neuralgia

Question 51

Least affected in trigeminal neuralgia

Answer 51

Ophthalmic division

Question 52

The pain as a rule is of a chronic nature, with longer episodes and less severe attacks Trigger zones are uncommon

Answer 52

Secondary type of trigeminal neuralgia

Question 53

Drug treatment (trigeminal neuralgia)

Answer 53

1. Phenytoin 2. Baclofen 3. Clonazepam 4. Valproic acid 5. Carbamazepine

Question 54

Unresponsive to the medical treatment (trigeminal neuralgia)

Answer 54

1. Alcohol injection 2. Rhizotomy (percutaneous radiofrequency rhizotomy) Other: surgical ablation of the gasserian ganglion or nerve decompression

Question 55

A tic douloureaux of this nerve is relatively rare | Paroxysms of stabbing pain in the ear, with trigger zones in the tonsillar area, accompanied by salivation

Answer 55

Glossopharyngeal neuralgia

Question 56

A secondary form of glossopharyngeal neuralgia

Answer 56

Seen briefly after tonsillectomy

Question 57

Unresponsive to drug therapy (glossopharyngeal neuralgia)

Answer 57

1. Suboccipital craniectomy | 2. Rhizotomy

Question 58

Pain upon palpation of the common carotid arteries Acute: lasting 1 to 2 weeks, with no recurrence Chronic: possibly related to migraines Treatment: corticosteroid

Answer 58

Carotidynia