Pain associated with the head

Question 1

what is orofacial pain?

Answer 1

pain arising in the mouth, jaw and face

Question 2

what are the painful conditions of the trigeminal system?

Answer 2

1. Trigeminal Neuralgia
2. Headache
3. Migraine
4. Temporomandibular disorders
5. Myofascial pain
6. Dental pain

Question 3

what is the effect of injury to the brain?

Answer 3

-causes an altered brain function rather than pain itself

Question 4

what do the 1st order neurones in the trigeminal system do?

Answer 4

-they travel from the face to the pars interpolaris and pars caudalis of the medulla/upper cervical cord

Question 5

what do the 2nd order neurones in the trigeminal system do?

Answer 5

ascend contralaterally to the thalamus via the trigemino-thalamic tract

Question 6

what do the 3rd order neurones in the trigeminal system do?

Answer 6

project to the cortex

Question 7

what do 1st 2nd and 3rd order neurones (aka the 5th cranial nerves) innervate?

Answer 7

specialised structures i.e.

-tooth pulp

Question 8

what are the 6 causes of headaches?

Answer 8

1. Traction or dilatation of intracranial or extracranial arteries.
2. Traction of large extracranial veins
3. Compression, traction or inflammation of cranial and spinal nerves
4. Spasm and trauma to cranial and cervical muscles.
5. Meningeal irritation and raised intracranial pressure
6. Disturbance of intracerebral serotonergic projection

Question 9

what is the role of serotonin?

Answer 9

• it is a neurotransmitter for transmitting pain signals.

- unstable transmission lowers the threshold of the migraine

Question 10

there are 7 classes of serotonin (5-HT) receptors. How many of these are involved in migraine pain?

Answer 10

2

Question 11

during a migraine are serotonin levels high or low in the blood?

Answer 11

low due to low blood pH

Question 12

what is sinus pain?

Answer 12

pain behind the forehead and cheekbones

Question 13

what is cluster pain?

Answer 13

pain in and around one eye

Question 14

what is tension pain?

Answer 14

pain like a band squeezing the top of the head

Question 15

what is migraine pain?

Answer 15

pain, nausea and visual changes

Question 16

how long does acute tension pain last?

Answer 16

less than 15days per month

Question 17

what part of the head do migraines affect?

Answer 17

half of the head

Question 18

how long do migraines last?

Answer 18

between 4hrs-3days

Question 19

what are the symptoms of migraines?

Answer 19

• aura
• nausea
• vomiting-light, sound and smell sensitivity

Question 20

what triggers a migraine?

Answer 20

1. food
2. food additives
3. sleep
4. stress
5. female hormones
6. family history
7. medications
8. noise, light
9. exertion

Question 21

what is an aura?

Answer 21

events that happen before actual migraine pain develops

Question 22

what are examples of aura’s?

Answer 22

• scotoma (blind spots)
• Fortification (zig-zag patterns)
• Scintilla (flashing lights)
• Unilateral paresthesia/weakness
• Hallucinations
• Hemianopsia (blindness in one half of the visual field)

Question 23

what are positive neurological symptoms of a migraine?

Answer 23

• Visual flashes, spots, or zig-zag lines

* Travelling tingling sensations

Question 24

what are negative Neurological Symptoms of migraine?

Answer 24

• Visual blind spots
• Numbness
• Speech or word finding problems
• Trouble thinking

Question 25

what is allodynia?

Answer 25

when a painful stimulus hurts more than it usually would

Question 26

how long do cluster headaches last?

Answer 26

15mins-3hrs and happens at around the same time each day on the same side

Question 27

what are symptoms of cluster headaches?

Answer 27

• watering eyes
• nasal stuffiness,
• runny nose
• red eye,
• swollen eyelids
• sweating

Question 28

what group of people are migraines more common in?

Answer 28

young females

Question 29

what group of people are cluster headaches more common in?

Answer 29

male middle-aged smokers

Question 30

what does a cluster headache feel like?

Answer 30

a stabbing pain

Question 31

what group of people typically experience trigeminal neuralgia?

Answer 31

middle aged/elderly women

Question 32

what is the characteristics of trigeminal neuralgia?

Answer 32

• electric-shock-like pain on one or both sides of the face.

- sharp stabbing or burning sensation

Question 33

what effect does MS have on trigeminal neuralgia?

Answer 33

-MS destroys the myelin sheath protecting the nerve fibres making them less responsive aka dead

Question 34

what are the branches of the trigeminal nerve?

Answer 34

1. ophthalmic nerve
2. maxillary nerve
3. mandibular nerve

Question 35

what drugs work solely for the prophylactic therapy of migraines?

Answer 35

1. antiepileptic drugs e.g. gabapentin
2. alpha1 and beta1 receptor antagonists
3. amitriptyline

Question 36

what drugs work solely for the acute therapy of migraines?

Answer 36

1. triptans (serotonin reuptake inhibitors i.e. 5-HT receptor agonists)
2. Gepants (calcitonin gene-related peptide)

Question 37

what drugs work for both the prophylactic and acute therapy of migraines?

Answer 37

1. NSAIDs - naproxen for prophylactic, ibuprofen and diclofenac for acute
2. Ergot derivatives - Methysergide for prophylactic and ergotamine for acute

Question 38

how do triptans work?

Answer 38

1. Intracranial vasoconstriction
2. Inhibition of neurotransmission in the trigeminocervical complex
3. Inhibition of release of pro-inflammatory and vasoactive mediators therefore decrease pain transmission
4. Potentially cross blood-brain-barrier
5. Relieve from pain and nausea associated with migraine