Exam 4 - HA, Trigeminal Neurologia, Bells Palsy Flashcards
how many nerve pathways are in the face
3
2 in cheek; 1 in forehead
trigeminal neuralgia usually affects the nerves located where
the cheek
maxillary, mandibular branches
sudden, severe, unilateral pain along the trigeminal nerve
brief, stabbing, reoccuring
trigeminal neuralgia
trigeminal neuralgia etiology
compression of the nerve as it exists the brainstem
how is trigeminal neuralgia Dx
H&P
medications for trigeminal neuralgia
antiseizure (Gabapentin) tricyclic antidepressants (Lyrica)
what to assess for trigeminal neuralgia pts
dental care
*may not brush their teeth on the affected side
Bells Palsy is acute ___ ___
facial paralysis
cranial nerve affected by Bells Palsy
CN VII - Facial
how long does it take to recover from Bells Palsy
3-9 months
may have residual tearing, facial weakness
etiology of bells palsy
unknown
could be r/t acute demyelination (like Guillian Barre), reactivation of HSV or HSZ, viral infection (Eptein-Barr, CMV, etc)
s/sx of Bell’s Palsy
sudden unilateral facial paralysis pain around ear hearing deficit tearing or dry eye weak muscles - poor chewing unilateral loss of taste Bell's Phenomenon
Bell’s Phenomenon
cannot close eyelid
upward movement of eye when attempted
Bell’s Palsy treatment
most heat gentle massage electrical stimulation Rx exercises corticosteroids **taper off, do not stop abruptly; take with food, water to prevent stomach irritation
ways to protect the face with Bell’s Palsy
drafts, cold chew on unaffected side nutrition oral hygiene dark glasses artificial tears, ointments, patches tape lids shut facial sling coping measures r/t body image
most common pain symptom
HA
primary HA types
migraine
tension
cluster
examples of secondary HA
sinus
alcohol/hangover
fever
tumor
most painful HA
cluster
pain is often around eyes and is woken in the middle of the night
cluster
severe intense throbbing pain with pulsating character mostly localized on one side
migraine
may occur one or a few times a week or continuous for several days
lasts 30 minutes to 7 days
tension
tension HA pain location
bilateral band like pressure at the base of skull
how to Dx tension HA
H&P
preventative tension HA treatment
tricyclic antidepressants
SSRIs
biofeedback
stress reducation
abortive treatment tension HA
NSAIDS Tylenol ASA Muscle relaxants Combo meds: Excedrin, Goodies Powder
associated s/sx of migraines
irritability
sweating
N/V
photophobia/phonophobia
premonitory (aura) symptoms with migraines
scotomas (dark spots in vision)
smells
cause of migraines
idiopathic
series of neurovasuclar events
neural hyperexcitability
genetics
how to Dx migraines
H&P
abortive treatment: migraines
ASA NSAIDS Combo drugs serotonin receptor agonists corticosteroids
preventative treatment: migraines
beta blockers antidepressants antiseizure botox biofeedback -cognitive behavior therapy, relaxation therapy
how long can cluster HA last
minutes to hours
s/sx of cluster HA
eye edema tearing facial flushing nasal congestion pupil constriction aura
cause of cluster HA
idiopathic
hypothalamus
-irregular melatonin, cortisol
-circadian rhythm
cluster HA triggers
smells weather changes napping alcohol drafts/cool breeze, wind
Dx cluster HA
H&P
abortive treatment: cluster HA
100% O2 via face mask
alpha blockers
serotonin receptor agonist
preventative treatment: cluster HA
alpha blockers
corticosteroids
CCB
biofeedback
what can cause a rebound HA
overuse of pain meds
