Head and face pain Flashcards
What nerves give sensory supply to the face?
What is SNOOP?
S= systemic symptoms: Fever, stiff neck, photophobia, vomiting
N= neuro Signs: Altered conscious state, focal neuro deficit, change in memory/ behaviour
O= onset: sudden or abrupt
O = old: +50
P = past HA history: change in pattern, frequency
What is the difference between a primary and secondary headache?
Primary headache: the headache cause is known
Secondary headache: Due to a unkwon cause: a headache atributed to other malignancy or illness
What are the primary headaches?
- cluster
- tension
- migraine
what are the more likely acute headaches?
upper respiratory tract infection
sinusitis: asthma/ allergic / infection
what are the most common chronic headaches?
- tension
- migraine
- cervicogenic
- combination headache: tension/ depression. cervical dysfunction, drugs
what are the serious cardiovascular disorders related to HA?
- CAD
- intracranial haemorrhage
- myocardial ischaemia
- hypertensive crisis
Other conditions related to HA?
- neoplasia (brain tumour)
- Severe infection (meningitis): rash, Cx stiffness, photophobia,
- TMJ dysfunction: sore jaw, grinding, clicking, bruxism, tenderness
- dental disorder: caries, gingivitis, bath breath, infection, under/over bite
- Eye disorder: refractive error, glaucoma
- trigeminal neuralgia: pain with temperature, icescream
- depression:
- anemia: pallor, fatigue
- metabolic disorder (thyroid)
- Drugs: meds, alcohol, caffeine
- exertional: sex, excercise
what drugs cause headaches?
alcohol
nicotine
caffeine
analgesic
antibiotics
vasodilators
What are the features of tension headache ?
Diagnosed after 10 episodes
Lasts from 30min to 7 days
band pattern
Must have two
Bilateral location
- Pressing or tightening quality (non-pulsatile)
- Mild to moderate intensity
- No aggravation with routine physical activity
NOT
nausea
vomiting
more than one sensory deficit (photo / phonophobia)
What are the features of cervicogenic HA
- unilateral
- occipital region
- dysfunction of Cx
- Arise from a convergence of trigeminal sensory fibres
What are the features of migraine
- diagnosed after 5 attacks
- last 4 – 72 hours
two of the following characteristics:
- •Unilateral location
- •Pulsating quality
- •Moderate or severe intensity
- •Aggravation by routine physical activity
•AND if I’m associated with at least one of nausea, vomiting, photophobia and phobia
What causes migraines and auras?
- Vascular desregulation
- spreding cortical depression: self propagating wave causes depolarization
-
neural sensitisation:
- increased nociceptive actiovation
- reduced supraspinal modulaiton
What are the features of cluster HA
- I can be diagnosed after 5 attacks if I fulfil the following criteria:
- I am unilateral in nature and cause severe to very severe pain in the orbital, supraorbital or temporal region
- If am accompanied by at least oneof the following:
- Lacrimation or rhinorrhea
- Eyelid, forehead or facial oedema
- Miosis &/or ptosis
- Restlessness or agitation
- I can last for 15 – 180 minutes
- My frequency can vary from once every second day to 8 times per day
What are the features of CAD
- I usually present with at least two of the following features:
- Sudden onset or “thunderclap” headache
- Unilateralpain: frontal, temporal, occipital or supraorbital region
- Unilateral neck or facial pain
- Constant and severe pain (ache/throbbing/sharp) – unlike anything ever experienced
- Neurological symptoms such as:
- Upper or lower limb deficits
- Horner’s syndrome
- Cranial nerve neuropathy
- Pulsating tinnitus
What is the acronym VINDICATE for Neck?
- Vascular/ visceral: ischaemia
- Infection / inflammation: sprain/ strain / meningitis
- Neoplasia: tumour
- Degenerative: spondilosis
- Idiopathic / iathrogenic: surgery/
- Congenital: born different
- Autoimune: MS/ RA
- Trauma: fracture/ whiplash
- Endocrine: fibromyalgia
What are the red flags fro acute neck pain?
Infection
fracture
tumour
neurological
vascular
What are the most common cause of Cx pain?
Vertebral joint dysfunction
musculoligamentous strains and sprains
cervical spondylosis
what are the serious neck dysorders
cardiovascular
- CAD
- Myocardial ischaemia
- haemorrhage
Neoplasia
- primary
- metastasis
Infection
- osteomyelitis
- meningitis
vertebral fracture
What are other neck disorders often missed?
Radiculopathy: Nerve root damage
Myelopathy: cervical Spinal cord damage
Thoracic Outlet Syndrome: compresion of brachial nerve
Cervical lymphadenitis: hotchkins lymphoma/ glandular fever
Psychogenic: stress/ depresion/ anxiety
Rheumatology
What is somatic pain ?
Pain due to damage on the in musculoskeletal structures
What are causes of cervical somatic pain
Discogenic
spondylosis
facet joint pain
myofascial pain
somatic refered pain
what aspect of the disc is innervated by nociceptor?
