Head Ache And Facial Pain Flashcards
Causes of facial pain?
Trigeminal neuralgia
Post herpatic neuralgia
Dental pain
Sinusitis
Temporo mandibular joint dysfunction
Cause of trigerminal neuralgia?
Compression by an abberant loop of A or V (superior cerebellar A mainly)
Clinical features of trigeminal neuralgia?
After 50 yrs
F > M
Sudden ,UL ,severe
Usually V2 or V3
May be repetitive
Trigger zones and trigger factors
Typically doesn’t disturb the sleep
No clinical evidence of neurological defecit
With time cycles come closer and pain ^.this results in an expression less mask like face
Ix or trigeminal neuralgia?
MRI only if atypical features are present
Indicated if,
-sensory loss
-<40 yrs
-BL
-poor response to conservative Mx
Mx of trigeminal neuralgia?
Medical-
Carbamezapine or other anti epileptic drugs (if not responding its not TN)
Surgical-
Micro vascular decompression
Ablative procedures of trigeminal nerve
Injection of alcohol around the ganglion -temporal
Classification of headaches?
Classification of headache?
Primary
-tension headache
-cluster headache
-migraine
Secondary
-underlying illness
Tension type headache main features and Mx?
Clinical features of tension type headache-
-Duration 30 min-7days
-no NV, photo or phonophobia
02 of the below are positive
-dull/pressure/head fullness like a tight band,non throbbing
-bl
-intensity mild to mod
-no aggression by normal physical activities but heavy ones could
Mx
-reassurance
-tricyclic anti depressants-low dose amitriptyline
-stress mx
-regular aerobic exercise
Cluster headache features and Mx?
9
Occurs in clusters daily for 1-2 months at a time
Alarm clock headache (usually at night)
M>F
Age 20s or 30s
UL
Usually begins around the eye
Excruciating pain,maximal within minutes
30min-3 hours (usually 45-60 mins)
Autonomic features-
-Lacrimation and redness in the ipsilateral eye
-nasal congestion on same side
-horners xd
Mx-
1.abortive therapy ( when attack)
-100% O2
-sumatriptan (subcut or IM)
-short course of steroids
2.preventive treatment
-verapamil (ccb)
-Li
-AED- topiramate,valproate
Pathophysiology of migraine?
Osmosis
3
Clinical features are migraine?
12
F>M 3:1
Onset- adolescence to early adult life
FHx is common (about 70%)
Typically episodic
Each episode lasts for hours-3 days
UL in most
Typically fronto-temporal
Moderate to severe intensity pain
Pulsating or throbbing
Associated with N V photo and phono phobia
Made worse by simple physical activity
After migraine will have sore at site and generally fatigue
Features of aura in migraine?
5
Has in 20% migraines (classical)
Duration approx 20 min
Followed by migration headache in <60 mins
Commonest aura is visual and contains
-photopsia (colored /flickering dots)
-fortifications spectra (zig-zag lines)
-scotoma (visualfield defecits)
Mx of migraine?
1.abortive therapy 2
-simple analgesics with antiemetic (NSAIDS + prokinetic (domperidone)
-triptans (5HT 1B/1D agonists) sumatriptan,rizatriptan,naratriptan
Works best when taken before full blown
Contraindicated in CAD,CVD and uncontrolled HTN
Very expensive
Sometimes use with caffeine to be more effective
2.migraine prophylaxis
If 2 or more/ month Or substantially interfearing with daily routine
After 6-12 months of effective prophylaxis gradual withdrawal should be considered
-BB (propanalol)
-TCAD (amitryptyline)
-CCB (flunarazine)
-5HT2antagonist (pizotifen)
-AED (topiramate,valporate)
-ARB (candesarton)
Indications for imaging in primary headache?
6
Medically sinister headaches?
Neurological -
^ ICP (SOL,BIH)
intracranial infection
SAH
Cervicogenic headaches
Non neurological-
Giant cell arteritis
Glaucoma
Acute HTN
Sinusitis
Refractory errors
Systemic disorders-
Drugs-Nitrates
