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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
(T/F) Painful attacks in TN is always unilateral
True | Any pain crossing midline excludes TN
26
If the pain is on both sides of the face, what could that indicate?
Bilateral face pain is indicative of MS.
27
What does it mean if there is a sensory deficit associated with the facial pain in TN?
There is an underlying disease process.
28
What would a theory for TN need to explain?
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
29
What is the leading theory for TN?
Chronic compression injury
30
What are possible causes of chronic compression injury in TN?
Meningiomas Acoustic Neuromas Benign Tumors of the Trigeminal ganglion
31
In TN, why chronic and not acute compression injury?
Acute does not account for TN symptomatology, chronic might create axonal injury and demyelination that may create Sx of TN
32
What is the Ignition Hypothesis of TN?
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
What are the problems with the current theories for TN?
No objective testing for TN No clinical sensory abnormality Does not reproduce in animal studies
34
What are medication Tx therapies for TN?
``` Anticonvulsants Phenytoin Carbamazepine Clonazepam GABApentin Anti-arrhythmic Meds Baclofen ```
35
What are surgical Tx therapies for TN?
Percutaneous RTR Glycerol Injection Balloon Compression of Gasserian Gangion Stereotactic Radiosurgery
36
What are examples of Stereotactic Radiosurgery?
Gamma Knife | Cyberknife
37
What are examples of surgery or injury induced Neuralgia Orofacial Pain (NOP)
Atypical Trigeminal Neuralgia Atypical Orofacial Pain Phantom Tooth Pain with Hx of Deafferentation
38
How is the pain characterized in surgery/injury induced NOP?
Spontaneous or Evoked with prolonged aftersensation
39
In Post-Herpetic Neuralgia, what is pain associated with?
Herpetic lesions causing burning and tingling affecting the V1 division of the trigeminal nerve
40
What may be present with Post-Herpetic Neuralgia?
Small vesicles and scarring Loss of Skin Coloring Corneal Ulcerations
41
What is Burning Mouth Syndrome (BMS) also known as?
Glossodynia
42
Where is the pain localized to in BMS?
The mucous membranes of the Tongue, Mouth, Hard Palate, and Lips
43
What subjective clues are noted in BMS?
Gradual onset with no apparent causation
44
What other Sx are noted in BMS?
Dysgeusia | Dry Mouth
45
Which conditions are associated with Oral Motor Disorders?
``` Oromandibular Dystonia Bruxism Tardive Dystonic Extrapyramidal Hemifacial Spasm Synkinesis Tongue Hyperactivity HMS Oromandibular Dyskinesia Masseter/Temporalis Hypertrophy Orofacial Motor Tics ```
46
What is Oromandibular Dystonia?
Involuntary, repetitive and sometimes sustained muscle contraction of the perioral and jaw musculature.
47
In Oromandibular Dystonia, what is clinically seen?
Present at rest Worsens with Stress, Fatigue, or Movement Disappears with Sleep
48
Which muscles are associated with Oromandibular Dystonia?
``` Lateral Pterygoids Anterior Digastrics Tongue mm. Orbicularis Oris Buccinator Platysma ```
49
What is a dystonia?
A co-contraction of antagonistic mm. resulting in abnormal posturing
50
What is dystonia due to, in part?
Aberration in the superior collicular maps that allow us to activate the appropriate groups of mm. for any given moment, perturbation, etc.
51
What is Bruxism?
A non-functional jaw movement
52
What non-functional jaw movements are associated with Bruxism?
Clenching Grinding Clicking Gnashing of Teeth
53
When does Bruxism usually occur?
During sleep, but can occur consciously with brain abnormalities
54
What patterns are seen with Bruxism?
Rhythmic, side to side motions | Prolonged maximal isotonic contraction
55
What clinical indicators are seen with Bruxism?
Bilaterally sore Master and Temporals mm. TMJ pain Jaw locking upon waking
56
What is the current theory of Bruxism?
A neuromotor dysregulation resulting in decreased inhibition of jaw motor activity.
57
What is the current Tx for Bruxism?
1. Occlusal appliance 2. Clonazepam 3. Gabitril 4. Dopamine Agonist
58
What are Tardive Dystonic Extrapyramidal Reactions (TDER)?
Drug induced oral motor hyperactivity that does not fit into the dyskinesia category
59
Which drugs are associated with TDER?
``` Anti-depressants Anti-psychotics Anti-emetics SSRIs Stimulant Medications Recreational Drugs ```
60
What are the three presentations of TDER?
Dystonia Akathisia Parkinsonism
61
What is the Dystonic form of TDER?
Involuntary tonic contractions of the head, face, and jaw
62
What is the Akathisia form of TDER?
Subjective feeling motor restlessness
63
What is the Parkinsonism form of TDER?
Tremor Rigidity Akinesia
64
What is the Tx for TDER?
Removal of the causative agent
65
What is Hemifacial spasm?
Hyperkinetic, spastic contraction of unilateral facial muscles
66
How does Hemifacial spasm start and progress?
Periorbital twitching and progress to a sustained contraction of half the face including the platysma muscle
67
Which cranial nerve is involved with Hemifacial Spasm?
CN VII
68
How is Hemifacial Spasm characterized?
Sudden, unilateral synchronous contraction
69
What pathological reflex is present in Hemifacial Spasm?
"Other Babinski Sign"
70
What is the "Other Babinski Sign?"
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
(T/F) Is it possible to reproduce the "Other Babinski Sign" at will.
False
72
What is the Tx for Hemifacial Spasm?
``` Carbamazepine Anticholinergics Baclofen Clonazepam Haloperidol GABApentin Microvascular decompression of CN VII (PICA) ```
73
What is Synkinesis?
A variation of hemifacial spasm in which a vial or traumatic paralysis of CN VII occurs
74
What is sprouting in relation to Synkinesis?
New motor connections causing aberrant facial contractions
75
What autonomic finding is sometimes seen with Synkinesis?
Lacrimation
76
In Medication Overuse Headaches, what is the appropriate use of medications?
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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