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5th Oral Disease - Facial Pain > Facial Pain - Headaches > Flashcards

Facial Pain - Headaches Flashcards

1
Q

What to use for pain hx?

A

SOCRATES

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2
Q

What is temporal arteritis?

A

Unilateral/bilateral headache - continuous and throbbing w/ temporal artery signs

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3
Q

What causes temporal arteritis?

A

Intense inflammatory response around arterial internal elastic lamina
Intense inflammatory exudate thickens the wall so lumen becomes reduced = reduce ed blood supply to end organ

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4
Q

What can reduced blood supply to end organ cause?

A

Ischaemia and claudication

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5
Q

What can temporal arteritis be associated with?

A

Polymyalgia rheumatica - autoimmune condition

Disorder of proximal muscle of limb girdle

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6
Q

Who does temporal arteritis affect?

A

Often elderly

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7
Q

Characteristics of temporal arteritis?

A

New persistent headache

One of the following
Swollen tender scalp artery w/ elevated ESR/ CRP (inflam markers in blood)
Temporary artery biopsy demonstrating arteritis

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8
Q

What can give improvements in 3 days w/ temporal arteritis?

A

Steroid therapy

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9
Q

How does temporal arteritis present?

A

New onset headache
Pain on mastication (40% case) - due claudication
Scalp tenderness
Generally unwell

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10
Q

How to diagnose temporal arteritis?

A

Tenderness or decreased pulsation of temporal vessel
Elevated ESR (>50mm/h)
Biopsy - gold standard
Doppler scanning

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11
Q

Why can doppler scanning be useful?

A

Look for thickening of the walls

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12
Q

Why do you need adequate length during biopsy?

A

Inflammation can be patchy = skip lesions

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13
Q

What other condition can be associated with temporal arteritis?

A

50% involvement ophthalmic artery = blindness

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14
Q

How to manage temporal arteritis and what doses give?

A

Steroids - prednisolone

Visual symptoms - 80mg day
No visual symptoms - 60mg day

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15
Q

What does TAC stand for?

A

Trigeminal autonomic cephalagias

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16
Q

What is TAC?

A

Trigeminal pain w/ autonomic features

17
Q

What can TAC include?

A

Cluster headache
Paroxysmal hemicrania
SUNCT (indistinguishable from trigeminal neuralgia)

18
Q

What is the definition of a cluster headache?

A

Unilateral pain. principally in the ocular, frontal and temporal areas recurring in severe bouts w/ daily attacks for several months
Usually w/ rhinorrhoea and lacrimation

19
Q

What is prevalence of cluster headaches?

A

1%
Males 5:1
Age 18-40

20
Q

What is presentation of cluster headaches?

A

Unilateral - can switch sides
Throbbing, burning, severe pain
Wake pt from sleep

21
Q

How long do cluster headaches last?

A

20-40 minutes

22
Q

What are associated features/ factors of cluster headaches?

A

Lacrimation
Rhinorrhoea
Conjunctival injection
Horner’s syndrome

23
Q

How to manage acute attack of cluster headache?

A

Oxygen 100% 10-12L/min

Sumatriptan (5HT1 agonist)

24
Q

How to prevent cluster headache?

A

Avoid alcohol/ caffeine

Medication: verapamil, lithium, prednisolone, methylsergide, gabapentin, GON

25
Q

What is a migraine?

A

Episodic headache

Accompanied by nausea, photophobia and photophobia

26
Q

What is aura?

A

15% pt get this before headahce/ facial pain

Loss of feeling or visual changes

27
Q

How long can migraine last?

A

4-72 hours

28
Q

What can trigger migraines?

A 
Hormones
Relxation
Perfume
Stress
Oestrogen
29
Q

Why can migraine be felt as facial pain?

A

Trigeminal nerve innervated structures of face and some of dura of the brain

30
Q

Tx of migraine?

A

Simple analgesics
5HT1 agonist - ‘triptan’
Antiemetic

31
Q

Prevention of migraines?

A

If >2 a week and interfere w/ daily function

Medication (don’t control pain) - amitriptyline, B blockers
Pt education - trigger
Psychological
Intraoral splints

5th Oral Disease - Facial Pain (4 decks)

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