Lecture 11: Pain associated with the head Flashcards
What are some painful conditions of the trigeminal system
- Trigeminal Neuralgia - chronic pain affecting trigeminal nerve
- Headache
- Migraine
- Dental pain
In the trigeminal system where are first order neuron send signals to and from?
- From the face to the trigeminal ganglion (in cranial cavity and has sensory nerve bodies
- Then project to pars interpolaris and pars caudalis of the medulla
In the trigeminal system where do second order neurons send signals to and from?
- 2nd order neurons reside in trigeminal nucleus caudalis
- Ascend contralaterally to thalamus via trigemino-thalmic tract
- They project to the ventral posteromedial nucleus (VPM) of the thalamus, which relays sensory information to the somatosensory cortex.
In the trigeminal system where do third order neurons send signals to and from?
- They primarily reside in the ventral posteromedial nucleus (VPM) of the thalamus.
- Neurons send signals to: Primary Somatosensory Cortex: specifically to the postcentral gyrus, where sensory information from the face is processed.
- Secondary Somatosensory Cortex: Some fibers may extend for further processing.
- They play a crucial role in relaying and processing sensory information from the face, integrating it into conscious perception and response.
What is the pathophysiology of a migraine?
- Cortical spreading depression has a wave of neuronal activation that spreads across brain’s cortex can lead to aura
- Triggers trigeminovascular system activation and peripheral mechanisms. Triggers release if neuropeptides CGRP and substance P
- Seretonin signif in headache. In attack. Levels decrease. Vasodilation
What are some causes of headache?
- Traction or dilation of intracranial and extracranial arteries
- Compression, traction or inflammation of cranial and spinal nerves
- Spasm/trauma to cranial and cervical muscles
- Meningeal irritation and raised intracranial pressure
What is the frequency, type of pain, duration and location of migraines?
- Frequency: 1/2 year - 2/3 week
- Pain: Moderate - severe, pulsating, throbbing
- Duration: 4hrs-3days
- Location: 1 sided but side can swap
What are the migraine stages?
- Prodrome: symptoms occur days before actual pain hits. Characterised by symptoms of light & sound sensitivity, irritability
- Aura: Occur 1hr before. Changes in visual perception. Flashing lights, geometric patterns, loss of half visual range
- Headache: Moderate-Severe lasts up to 3 days.
- Postdrome: Symptoms can last several days. Migraine hangover. Irritable and fatigued
What are some migraine triggers?
- Foods: spices, wine
- Sleep
- Stress
- Family history
- Medications
What are some positive neurological symptoms of migraines?
- Symptoms that represent an excess or addition of neurological activity
- Visual flashes, spots, tingling sensations
What are some negative neurological symptoms of migraine?
- Negative symptoms, which indicate a loss or absence of normal function.
- Visual blindspots, numbness, speech problems
What is allodynia?
- Condition when person experiences pain from stimuli normally shouldnt hurt
- Results from central sensitization, nervous system becomes more sensitive to stimuli.
- Associated with migraine, fibromyalgia, and other chronic pain conditions.
How long does tension headache last for, and symptoms
Lasts for: 30mins-7days
Symptoms: Pressing/tightening (band), bilateral location, no aggravation by walking stairs, no aura, no N&V
What is the frequency, pain, duration and location of cluster headaches?
- Frequency: Every time each year or season
- Pain: Excrutiating, penetrating, non-throbbing
- Duration: 15mins-3hrs, same clock time each day, several episodes
- Location: Always the same side
What are some of the symptoms of cluster headaches?
- Watering eyes, nasal stuffiness, runny nose, red eye
