Facial Pain - Headaches Flashcards
What to use for pain hx?
SOCRATES
What is temporal arteritis?
Unilateral/bilateral headache - continuous and throbbing w/ temporal artery signs
What causes temporal arteritis?
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
What can reduced blood supply to end organ cause?
Ischaemia and claudication
What can temporal arteritis be associated with?
Polymyalgia rheumatica - autoimmune condition
Disorder of proximal muscle of limb girdle
Who does temporal arteritis affect?
Often elderly
Characteristics of temporal arteritis?
New persistent headache
One of the following
Swollen tender scalp artery w/ elevated ESR/ CRP (inflam markers in blood)
Temporary artery biopsy demonstrating arteritis
What can give improvements in 3 days w/ temporal arteritis?
Steroid therapy
How does temporal arteritis present?
New onset headache
Pain on mastication (40% case) - due claudication
Scalp tenderness
Generally unwell
How to diagnose temporal arteritis?
Tenderness or decreased pulsation of temporal vessel
Elevated ESR (>50mm/h)
Biopsy - gold standard
Doppler scanning
Why can doppler scanning be useful?
Look for thickening of the walls
Why do you need adequate length during biopsy?
Inflammation can be patchy = skip lesions
What other condition can be associated with temporal arteritis?
50% involvement ophthalmic artery = blindness
How to manage temporal arteritis and what doses give?
Steroids - prednisolone
Visual symptoms - 80mg day
No visual symptoms - 60mg day
What does TAC stand for?
Trigeminal autonomic cephalagias
What is TAC?
Trigeminal pain w/ autonomic features
What can TAC include?
Cluster headache
Paroxysmal hemicrania
SUNCT (indistinguishable from trigeminal neuralgia)
What is the definition of a cluster headache?
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
What is prevalence of cluster headaches?
1%
Males 5:1
Age 18-40
What is presentation of cluster headaches?
Unilateral - can switch sides
Throbbing, burning, severe pain
Wake pt from sleep
How long do cluster headaches last?
20-40 minutes
What are associated features/ factors of cluster headaches?
Lacrimation
Rhinorrhoea
Conjunctival injection
Horner’s syndrome
How to manage acute attack of cluster headache?
Oxygen 100% 10-12L/min
Sumatriptan (5HT1 agonist)
How to prevent cluster headache?
Avoid alcohol/ caffeine
Medication: verapamil, lithium, prednisolone, methylsergide, gabapentin, GON
