Headache 24-02: Facial Pain

Question 1

Who does trigeminal neuralgia affect more?

Answer 1

Women
*pain is due to an anomalous artery or vein impinging on the trigeminal nerve

Question 2

What are the clinical findings of trigeminal neuralgia

Answer 2

1. Sudden lancinating facial pain on one side of the mouth and shot toward the ipsilateral eat, eye or nostril

Question 3

How will a patient try to lessen the likelihood of triggering further attacks of trigeminal nerve

Answer 3

They will try to hold the face still while talking

Question 4

What is the treatment for trigeminal neuralgia

Answer 4

1. Oxcarbazepine
2. Carbamazepine
3. Phenytoin
4. Baclofen
5. Topiramate
6. Lamortrigine
7. Gabapentin

Question 5

What does atypical facial pain consist of

Answer 5

1. Facial pain without the typical features of trigeminal neuralgia
   *constant burning pain that may have a restricted distribution at its onset

Question 6

Where does atypical facial pain spread to?

Answer 6

1. Neck
2. Back of the head

Question 7

What is glossopharyngeal neuralgia

Answer 7

1. Pain that is similar in quality to that in trigeminal neuralgia occurs in the throat, Tonsillar fossa and sometimes deep in the ear and back of the tongue

Question 8

What should be used for the treatment of glossopharyngeal neuralgia

Answer 8

1. Oxcarbazepine
2. Carbamazepine

Question 9

When will postherpetic neuralgia develop

Answer 9

In patient who have herpes zoster (shingles)
*in elderly and immunocompromised
*first division of the trigeminal nerve is affected

Question 10

What is the treatment of postherpetic neuralgia

Answer 10

1. Acyclovir
2. Valacyclovir
   *when given within 72 hours of rash onset

Question 11

Do systemic corticosteroids help prevent posterhreptic neuralgia

Answer 11

No

Question 12

What will reduce the likelihood of herpes zoster

Answer 12

Administration of recombinant zoster vaccine
*patients over the age of 50 years

Question 13

If a patient has TMJ tenderness what muscle will the pain be over

Answer 13

Masticatory muscles
*begins at the onset of chewing

Question 14

What could suggest a dental disturbance that causes facial pain?

Answer 14

1. Facial pain due to chewing or temperature changes

Question 15

What is a principal manifestation of angina pectoris

Answer 15

Pain in the jaw
*precipitation by exertion and radiation to more typical areas suggests a cardiac origin