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Boies > Chapter 9: Facial Pain, Headache and Otalgia > Flashcards

Chapter 9: Facial Pain, Headache and Otalgia Flashcards

1
Q

Vascular headaches of the migraine type

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

Vascular headaches of the migraine type

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3
Q

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

A

Classic headache

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4
Q

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

A

Common migraine

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5
Q

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

A

Cluster headache

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6
Q

Sensory and motor phenomena persist during and after the headache

A

Hemiplegic migraine and Ophthalmoplegic migraine

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7
Q

Centered primarily in the lower face

Atypical facial neuralgia, sphenopalatine ganglion neuralgia, vidian neuralgia

A

Lower half headache

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8
Q

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

A

Muscle-contraction headache

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9
Q

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

A

Headache of nasal vasomotor reaction

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10
Q

Associated with generally nonrecurrent dilatation of cranial arteries

A

Nonmigrainous vascular headache

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11
Q

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

A

Traction headache

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12
Q

Traction headache

A
  1. Primary or metastatic tumors of meninges, vessels or brain
  2. Hematomas
  3. Abscess
  4. Postlumbar puncture headache
  5. Pseudotumor cerebri
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13
Q

Due to readily recognized inflammation of cranial structures

A

Headache due to overt cranial inflammation

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14
Q

Behind or above one eye with extension to temple or maxilla

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

A

Cluster headache

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15
Q

Hatband, bitemporal, occipital, suboccipital

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

A

Muscle-contraction headache

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16
Q

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

A

Nasal vasomotor reaction

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17
Q

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

A

Temporal arteritis

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18
Q

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

A

Acute sinusitis

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19
Q

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

A

Chronic sinusitis

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20
Q

In and around ear with radiation into neck and temporal area

Aural fullness; clicking in joint

A

TMJ dysfunction

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21
Q

Face; any of 3 divisions of the trigeminal nerve

Associated with trigger zones that respond to light contact

A

Trigeminal neuralgia

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22
Q

Pharynx with radiation into ear

Salivation; trigger zones in tonsillar region

A

Glossopharyngeal neuralgia

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23
Q

Most excruciating of the vascular headaches

A

Cluster headache

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24
Q

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

A

Cluster headache

25
Q

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

A

Cluster headache

26
Q

Modes of treatment (cluster headache)

A
  1. Inhalation of 100% oxygen
  2. Ergotamine
  3. Local application of anesthetic nose drops
  4. Methylsergide
  5. Psychotherapy
27
Q

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

A

Muscle-contraction headache

28
Q

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

A

Muscle-contraction headache

29
Q

Treatment consist of sympathetic listening (heat and massage)

A

Muscle-contraction headache

30
Q

Secondary to structural abnormalities in the neck

A

Muscle-contraction headache

31
Q

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

A

Cervical spondylosis

32
Q

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

A

Cervical radiculopathy

33
Q

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

A

Myalgia

34
Q

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

A

Myofascitis

35
Q

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

A

“Vacuum” type pain

36
Q

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

A

Temporal arteritis

37
Q

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

A

Temporal arteritis

38
Q

Diagnosis of temporal arteritis

A

Biopsy

39
Q

Sinusitis (pain locations)

A
  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
40
Q

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

A

TMJ dysfunction

41
Q

Involved muscle in TMJ dysfunction

A
  1. Temporalis
  2. Masseter
  3. Medial and lateral pterygoid muscles
    Trapezius
    Suboccipital
    Frontal
    Occipital
42
Q

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

A

TMJ dysfunction

43
Q

May cause joint dysfunction or muscle spasm

Manifested as morning headache and unconscious stress-induced daytime grinding producing evening headache

A

Bruxism (grinding of the teeth)

44
Q

Translation

A

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

45
Q

Complete otolaryngologic exam (TMJ dysfunction)

A

Dentition

Function of masticatory muscles

46
Q

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

A

Average adult: 40 mm

47
Q

Indicate decrease in joint function and translation

A

Measurement of less than 40 mm

48
Q

Initial symptomatic treatment (TMJ dysfunction)

A
  1. Soft to liquid diet
  2. Heat applied over the affected muscles
  3. Anti-inflammatory drugs
49
Q

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

A

Oral splints

50
Q

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

A

Trigeminal neuralgia

51
Q

Least affected in trigeminal neuralgia

A

Ophthalmic division

52
Q

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

A

Secondary type of trigeminal neuralgia

53
Q

Drug treatment (trigeminal neuralgia)

A
  1. Phenytoin
  2. Baclofen
  3. Clonazepam
  4. Valproic acid
  5. Carbamazepine
54
Q

Unresponsive to the medical treatment (trigeminal neuralgia)

A
  1. Alcohol injection
  2. Rhizotomy (percutaneous radiofrequency rhizotomy)

Other: surgical ablation of the gasserian ganglion or nerve decompression

55
Q

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

A

Glossopharyngeal neuralgia

56
Q

A secondary form of glossopharyngeal neuralgia

A

Seen briefly after tonsillectomy

57
Q

Unresponsive to drug therapy (glossopharyngeal neuralgia)

A
  1. Suboccipital craniectomy

2. Rhizotomy

58
Q

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

A

Carotidynia

Boies (27 decks)

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