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Head and Face Pain > Head and Face Pain Other Headaches > Flashcards

Head and Face Pain Other Headaches Flashcards

1
Q

What is Neuropathic Orofacial Pain?

A

Pain initiated or caused by a primary lesion or dysfunction in the nervous system.

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2
Q

Which conditions are associated with Neuropathic Orofacial Pain?

A
  1. Trigeminal Neuralgia (TN)
  2. Injury Induced
  3. Surgery Induced
  4. Postherpetic Neuralgia (PHN)
  5. Burning Mouth Syndrome
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3
Q

What is normal A&P for 1st order nociceptive neurons of the face?

A

Tactile stimulus carried A-delta and C-fibers through the ascending trigeminal sensory fibers to the medulla.

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4
Q

What is normal A&P for 2nd order nociceptive neurons of the face?

A

Synapse in the trigeminal spinal nucleus in the medulla then ascend in the trigeminal lemniscus terminating in the VPM of the thalamus

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5
Q

What is normal A&P for 3rd order nociceptive neurons of the face?

A

Synapse in the VPM of the thalamus then ascend through the ventral trigeminothalamic pathway.

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6
Q

What is the VTT pathway divided into?

A

Paleo-TT Tract

Neo-TT Tract

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7
Q

What does the Paleo-TT tract do?

A

Carry the affective aspect of pain to the Frontal Lobe, Anterior Cingulate Gyrus, and Prefrontal Cortex

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8
Q

What does the Neo-TT tract do?

A

Carry the sensory discriminative aspects of pain to the VPM of the Thalamus, Somatosensory Cortex, Anterior Insular Cortex

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9
Q

What is Trigeminal Neuralgia previously known as?

A

Tic Douloureux

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10
Q

What was the first documented description of TN?

A

Auretias of Cappadocia in 100CE

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11
Q

What is TN characterized by?

A

Lancinating attacks of severe facial pain

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12
Q

What is the diagnostic criteria for TN?

A

The sweet criteria.

There is no objective criteria.

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13
Q

What is the sweet criteria?

A 
Pain in TN is:
Paroxysmal
Provoked by light touch
Confined to the Trigeminal Zone
Unilateral
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14
Q

In TN, what does the Clinical Sensory Exam show?

A

Normal

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15
Q

What is Paroxysmal pain?

A

Pain that is sudden in onset, severe in intensity, and results in a facial grimace.

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16
Q

Define Paroxysmal.

A

A fit, attack, or sudden recurrence.

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17
Q

What is common in TN?

A

Trigger Zones

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18
Q

What are Trigger Zones in TN?

A

Small areas of sensitivity that result in a allodynic type response triggering an attack.

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19
Q

Where are trigger zones usually found in TN?

A

The perioral or Nasolabial fold regions.
More common in V2 & V3
Rare in V1

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20
Q

(T/F)

In TN, there is a short delay between the stimulus and the evoked pain.

A

True

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21
Q

What happens after a trigger zone is “triggered?”

A

It becomes relatively refractory for a few seconds, in which it is ineffective

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22
Q

In TN, where is pain confined to?

A

Pain is confined to the distribution of the Trigeminal Sensory System

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23
Q

What does it mean if you find pain outside of the CNV distribution?

A

Any pain outside excludes the Dx of TN

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24
Q

Where is pain in TN most common?

A

V3 with radiation along the mandible

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25
Q

(T/F) Painful attacks in TN is always unilateral

A

True

Any pain crossing midline excludes TN

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26
Q

If the pain is on both sides of the face, what could that indicate?

A

Bilateral face pain is indicative of MS.

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27
Q

What does it mean if there is a sensory deficit associated with the facial pain in TN?

A

There is an underlying disease process.

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28
Q

What would a theory for TN need to explain?

A
  1. Stereotypical CN V attacks
  2. Absence of motor sensory findings between attacks
  3. Trigger Zones
  4. Association of TN with benign tumors, MS, and root compression by vasculature
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29
Q

What is the leading theory for TN?

A

Chronic compression injury

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30
Q

What are possible causes of chronic compression injury in TN?

A

Meningiomas
Acoustic Neuromas
Benign Tumors of the Trigeminal ganglion

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31
Q

In TN, why chronic and not acute compression injury?

A

Acute does not account for TN symptomatology, chronic might create axonal injury and demyelination that may create Sx of TN

32
Q

What is the Ignition Hypothesis of TN?

A

Partial injury to the CN V roots or ganglion makes hyper excitation of functionally linked sensory neurons. Based on this, spontaneous discharge of individual neurons may quickly spread to an entire population of adjacent neurons resulting in sudden lancinating pain

33
Q

What are the problems with the current theories for TN?

A

No objective testing for TN
No clinical sensory abnormality
Does not reproduce in animal studies

34
Q

What are medication Tx therapies for TN?

A 
Anticonvulsants
Phenytoin
Carbamazepine
Clonazepam
GABApentin
Anti-arrhythmic Meds
Baclofen
35
Q

What are surgical Tx therapies for TN?

A

Percutaneous RTR
Glycerol Injection
Balloon Compression of Gasserian Gangion
Stereotactic Radiosurgery

36
Q

What are examples of Stereotactic Radiosurgery?

A

Gamma Knife

Cyberknife

37
Q

What are examples of surgery or injury induced Neuralgia Orofacial Pain (NOP)

A

Atypical Trigeminal Neuralgia
Atypical Orofacial Pain
Phantom Tooth Pain with Hx of Deafferentation

38
Q

How is the pain characterized in surgery/injury induced NOP?

A

Spontaneous or Evoked with prolonged aftersensation

39
Q

In Post-Herpetic Neuralgia, what is pain associated with?

A

Herpetic lesions causing burning and tingling affecting the V1 division of the trigeminal nerve

40
Q

What may be present with Post-Herpetic Neuralgia?

A

Small vesicles and scarring
Loss of Skin Coloring
Corneal Ulcerations

41
Q

What is Burning Mouth Syndrome (BMS) also known as?

A

Glossodynia

42
Q

Where is the pain localized to in BMS?

A

The mucous membranes of the Tongue, Mouth, Hard Palate, and Lips

43
Q

What subjective clues are noted in BMS?

A

Gradual onset with no apparent causation

44
Q

What other Sx are noted in BMS?

A

Dysgeusia

Dry Mouth

45
Q

Which conditions are associated with Oral Motor Disorders?

A 
Oromandibular Dystonia
Bruxism
Tardive Dystonic Extrapyramidal
Hemifacial Spasm
Synkinesis
Tongue Hyperactivity
HMS
Oromandibular Dyskinesia
Masseter/Temporalis Hypertrophy
Orofacial Motor Tics
46
Q

What is Oromandibular Dystonia?

A

Involuntary, repetitive and sometimes sustained muscle contraction of the perioral and jaw musculature.

47
Q

In Oromandibular Dystonia, what is clinically seen?

A

Present at rest
Worsens with Stress, Fatigue, or Movement
Disappears with Sleep

48
Q

Which muscles are associated with Oromandibular Dystonia?

A 
Lateral Pterygoids
Anterior Digastrics
Tongue mm.
Orbicularis Oris
Buccinator
Platysma
49
Q

What is a dystonia?

A

A co-contraction of antagonistic mm. resulting in abnormal posturing

50
Q

What is dystonia due to, in part?

A

Aberration in the superior collicular maps that allow us to activate the appropriate groups of mm. for any given moment, perturbation, etc.

51
Q

What is Bruxism?

A

A non-functional jaw movement

52
Q

What non-functional jaw movements are associated with Bruxism?

A

Clenching
Grinding
Clicking
Gnashing of Teeth

53
Q

When does Bruxism usually occur?

A

During sleep, but can occur consciously with brain abnormalities

54
Q

What patterns are seen with Bruxism?

A

Rhythmic, side to side motions

Prolonged maximal isotonic contraction

55
Q

What clinical indicators are seen with Bruxism?

A

Bilaterally sore Master and Temporals mm.
TMJ pain
Jaw locking upon waking

56
Q

What is the current theory of Bruxism?

A

A neuromotor dysregulation resulting in decreased inhibition of jaw motor activity.

57
Q

What is the current Tx for Bruxism?

A
  1. Occlusal appliance
  2. Clonazepam
  3. Gabitril
  4. Dopamine Agonist
58
Q

What are Tardive Dystonic Extrapyramidal Reactions (TDER)?

A

Drug induced oral motor hyperactivity that does not fit into the dyskinesia category

59
Q

Which drugs are associated with TDER?

A 
Anti-depressants
Anti-psychotics
Anti-emetics
SSRIs
Stimulant Medications
Recreational Drugs
60
Q

What are the three presentations of TDER?

A

Dystonia
Akathisia
Parkinsonism

61
Q

What is the Dystonic form of TDER?

A

Involuntary tonic contractions of the head, face, and jaw

62
Q

What is the Akathisia form of TDER?

A

Subjective feeling motor restlessness

63
Q

What is the Parkinsonism form of TDER?

A

Tremor
Rigidity
Akinesia

64
Q

What is the Tx for TDER?

A

Removal of the causative agent

65
Q

What is Hemifacial spasm?

A

Hyperkinetic, spastic contraction of unilateral facial muscles

66
Q

How does Hemifacial spasm start and progress?

A

Periorbital twitching and progress to a sustained contraction of half the face including the platysma muscle

67
Q

Which cranial nerve is involved with Hemifacial Spasm?

A

CN VII

68
Q

How is Hemifacial Spasm characterized?

A

Sudden, unilateral synchronous contraction

69
Q

What pathological reflex is present in Hemifacial Spasm?

A

“Other Babinski Sign”

70
Q

What is the “Other Babinski Sign?”

A

When orbiculares oculi contracts and the eye closes, the internal part of the frontal contracts at the same time, the eyebrow rises during eye occlusion

71
Q

(T/F) Is it possible to reproduce the “Other Babinski Sign” at will.

A

False

72
Q

What is the Tx for Hemifacial Spasm?

A 
Carbamazepine
Anticholinergics
Baclofen
Clonazepam
Haloperidol
GABApentin
Microvascular decompression of CN VII (PICA)
73
Q

What is Synkinesis?

A

A variation of hemifacial spasm in which a vial or traumatic paralysis of CN VII occurs

74
Q

What is sprouting in relation to Synkinesis?

A

New motor connections causing aberrant facial contractions

75
Q

What autonomic finding is sometimes seen with Synkinesis?

A

Lacrimation

76
Q

In Medication Overuse Headaches, what is the appropriate use of medications?

A

Simple Analgesics - >5 days/wk
Triptans and Combination Analgesics - > 3 days/wk
Opioids and Ergotamine - > 2 days/wk

Head and Face Pain (8 decks)

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