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MS 2 > Oral-Facial Pain > Flashcards

Oral-Facial Pain Flashcards

1
Q

Primary HA

A

Migraine, tension-type, cluster

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2
Q

Secondary HA

A

Trauma, cranial/cervical vascular disorder, non vascular intracranial disorder, substance use/withdrawal, infection, homeostasis disturbance, psychiatric disorder

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3
Q

HA Red Flags

A
  • 50+
  • unilateral
  • new onset, change, progressively worsening
  • thunderclap
  • new pain level
  • brought on by physical exertion, coughing, sneezing, straining
  • seizures, confusion, clumsiness, change in alertness, bowel/bladder sx, weakness
  • eye pain / visual changes
  • fever
  • weight loss
  • vomiting
  • temporal artery tenderness
  • cancer, HIV, HTN
  • head/neck injury
  • anticoagulant use
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4
Q

When to perform CT on HA patients

A
  • Before LP in all patients with suspected sub-arachnoid hemorrhage
  • sudden onset of HA, worst HA of life, thunderclap HA
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5
Q

VBI Pain Distribution

A

Back/side of neck from occipital protruberance to just below top of scapula

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6
Q

ICA Pain Distribution

A
  • Forehead above eyes

- back/side of neck from occipital protruberance to just above scapula

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7
Q

Vertebral Artery Compromise

A
  • Mostly between C1 & C2
  • Rotation to R compromises L artery
  • co-existing atherosclerosis increases risk
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8
Q

Tension-Type HA

A
  • Most common type
  • Bilateral, mild-moderate intensity, pressing quality, not aggravated by PA
  • 30 min to 7 days
  • Women > Men
  • TrP likely source
  • Frequent: 10 episodes on 2-15 days per month for 3+ months
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9
Q

Migraine HA

A
  • nausea, photophobia, photophobia, exacerbated by PA

- POUND - pulsation, duration 4-72 hours, unilateral, nausea/vomiting, disabling intensity

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10
Q

Cluster HA

A
  • rare
  • 15-180 minutes
  • Frequency ranges from 1 every other day to 8/day
  • severe pain associated with ipsilateral autonomic symptoms
    • conjunctival injection/lacrimation, nasal congestion, rhinorrhea, eyelid edema, facial sweating, miosis/ptosis, restlessness
  • onset before 30 years old
  • unilateral orbital, temporal pain 15-180 minutes
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11
Q

Cervicogenic HA

A
  • Cervical ROM restriction, ipsilateral neck/shoulder/arm pain, pressure over upper c-spine/occipital region
  • confirmed by diagnostic block of C2
  • unilateral
  • moderate-sever, non-throbbing, starting in neck, varying duration, fluctuating continuous pain, marginal effects, female, not infrequent hx of Head trauma
  • impairment in flexors synergy
  • joint Dysfunction O-C3
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12
Q

Intervention for Cervicogenic HA

A
  • joint dysfunction: manipulative therapy
  • MS impairment: therapeutic exercise
  • Neural system: tx of articular system 1st, gentle neural mobilization
  • Ergonometrics: correction of work practices
  • pressure BFB helps retrain DNF
  • Patient participation in home program is essential
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13
Q

DNF

A
  • longus coli and capitulation, rictus capitulation anterior & longus
  • segmental support
  • allow stability during compression
  • lose endurance with dysfunction
  • become more fatiguable in chronic neck pain
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14
Q

Trigeminal neuralgia

A
  • Cranial Nerve V is irritated
  • intense, stabbing, shock-like pain
  • 1-2 minutes
  • unilateral
  • usually 6 month remission
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15
Q

Occipital Neuralgia

A
  • pain in 1+ nerves caused by compression and/or irritation of GON or LON
  • paroxysmal shooting/stabbing pain in dermatology of greater/lesser occipital nerve
  • vision impairments, ocular pain, tinnitus, dizziness, nausea, congestion
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16
Q

Muscular Referral of Earache

A
  • SCM
  • Masseter
  • Lateral Pterygoid
17
Q

Muscular Referral of Temporal HA

A
  • SCM
  • Temporalis
  • Trapezius
18
Q

Muscular Referral of Suboccipital HA

A
  • Trapezius

- Posterior Cervical Ms

19
Q

Muscular Referral of Occipital HA

A
  • Trapezius
  • SCM
  • Posterior Temporalis
20
Q

Muscular Referral of Jaw Pain & Toothache

A
  • Masseter
  • Temporalis
  • SCM
21
Q

Muscular Referral of HA behind eye

A
  • Temporalis
  • Trapezius
  • SCM
  • Splenius Cervicis
22
Q

Muscular Referral of HA above eye

A
  • SCM
  • Temporalis
  • Frontalis
  • Masseter
23
Q

HA Differentiation Chart (Picture saved on iPad)

A
  1. Cervicogenic
  2. Migraine
  3. Tension
24
Q

Whiplash Associated Disorders (WAD)

A

Common, disabling, & costly conditions that occur as a consequence of MVA

25
Q

WAD 0

A
  • no complaint about neck pain

- no physical signs

26
Q

WAD I

A
  • complaint of neck pain, stiffness, or tenderness

- no physical signs

27
Q

WAD IIA

A
  • neck pain
  • motor impairment: decreased ROM, altered muscle recruitment pattern (craniocervical flexion test)
  • sensory impairment: local muscle hyperalgesia
28
Q

WAD IIB

A
  • neck pain
  • motor impairment: decreased ROM, altered muscle recruitment patterns
  • sensory impairment: local cervical mechanical hyperalgesia
  • psychological impairment: elevated psychological distress
29
Q

WAD IIC

A
  • neck pain
  • motor impairment: decreased ROM, CCFT, increased joint position error
  • sensory impairment: local cervical mechanical hyperalgesia, generalized sensory hypersensitivity, some sympathetic NS disturbance
  • psychological impairment: elevated psychological distress, post-traumatic stress
  • chance of full recovery decreases
30
Q

WAD III

A
  • neck pain
  • motor impairment: decreased ROM, CCFT, JPE
  • sensory impairment: local cervical mechanical hyperalgesia, generalized hypersensitivity, sympathetic NS disturbances
  • psychological impairment: elevated psychological distress, post-traumatic stress
  • neuro signs of conduction loss: decreased DTR, muscle weakness, sensory deficits
31
Q

WAD IV

A

Fracture/dislocation

32
Q

Intervention for WAD

A
  • 2-3 months (fibroblastic activity)
  • education (stay active)
  • manual Therapy (no grade V)
  • sensorimotor control
  • proprioception
  • PNE
33
Q

Retraining Principles of WAD

A
  • low load, tonic holding capacity of specific target ms
  • precision required
  • exercises should be pain-free
  • short of fatigue
  • appropriate movement pattern
  • multiple reps
34
Q

Therapeutic Exercise Program for WAD

A
  • activating DNF & girdle ms
  • retrain tonic endurance
  • co-contraction exercises of flexors & extensor
  • retrain kinesthetics, balance, eye movement control
  • re-education of movement patterns
  • low level endurance training
  • integrate into function
35
Q

TMD / TMJ

A
  • number of related disorders affecting TMJ, mastication muscles, & associated structures
  • common, but not many seek treatment
36
Q

Precipitating Factors of TMD

A
  • macro trauma to head
  • repeated low-grade trauma to head (extrinsic or intrinsic)
  • stress that passes a certain threshold
37
Q

Subjective Findings of TMD

A
  • restricted jaw function
  • limited mouth opening
  • joint noises
  • locking
  • orofacial pain

MS 2 (2 decks)

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