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Oral Medicine BDS4 > Trigeminal Neuralgia and Cephalalgias > Flashcards

Trigeminal Neuralgia and Cephalalgias Flashcards

1
Q

what is pain like in neuralgia

A

intense stabbing pain
brief
extending along nerve

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2
Q

what is neuralgia caused by

A

irritation or damage to a nerve

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3
Q

what nerves mediate sensation in the head which could be involved in neuralgia

A

trigeminal
glossopharyngeal
vagus
nervus intermedius
occipital

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4
Q

what are the classifications of trigeminal neuralgia

A

idiopathic
classical - vascular compression of nerve
secondary - disease causes it

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5
Q

how does trigeminal neuralgia present

A

unilateral maxillary or mandibular division pain
stabbing pain
5-10 seconds
by itself or with continuous pain
remission and relapse

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6
Q

what triggers trigeminal neuralgia

A

cutaneous
wind, cold
touch
chewing

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7
Q

what does the typical trigeminal neuralgia patient look like

A

older
mask like face
excruciating pain
no obvious pathology

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8
Q

what are the red flags of patients with trigeminal neuralgia

A

younger then 40yrs
sensory deficit in facial region (hearing loss)
other cranial nerve lesions

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9
Q

what tests are done for trigeminal neuralgia

A

cranial nerve test
give MRI

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10
Q

what are the first line drugs for trigeminal neuralgia

A

carbamazepine MR
oxcarbazepine
lamotrigine

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11
Q

what are the second line drugs for trigeminal neuralgia

A

gabapentin
pregabalin
phenytoin
baclofen

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12
Q

how do you manage trigeminal neuralgia

A

carbamazepine
maximise efficacy and minimise side effects
pain diary

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13
Q

what are the side effects of carbamazepine

A

blood dyscrasias
electrolyte imbalance
neurological deficits
liver toxicity
skin reactions

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14
Q

when would you consider surgery for trigeminal neuralgia

A

when approaching maximum tolerable medical management
younger patients with significant drug use

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15
Q

what are the surgical options for trigeminal neuralgia

A

microvascular decompression
stereotactic radiosurgery
destructive central procedures
destructive peripheral neurectomies

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16
Q

what are the complications after surgery for trigeminal neuralgia

A

local effects
sensory loss
motor deficits
reversible/irreversible

17
Q

what are the causes of painful trigeminal neuropathy

A

herpes zoster
trauma
idiopathic

18
Q

what are the characteristics of trigeminal neuropathy

A

localised to distribution of trigeminal nerve
burning/squeezing/pins and needles
primary pain continuous but brief spontaneous pain
accompanied by cutaneous allodynia

19
Q

what is a trigeminal autonomic cephalalgias

A

unilateral head pain - V1 region
severe

20
Q

what are the prominent cranial parasympathetic autonomic features

A

conjunctival injection
nasal congestion
eyelid oedema
ear fullness
miosis and ptosis

21
Q

what does a cluster headache present as

A

pain orbitally and temporally
unilateral
rapid onset
last 15mins - 3 hrs
restless and agitated during attack
ipsilateral autonomic symptoms
migrainous symptoms present

22
Q

what is a bout of cluster headaches

A

attack every other day to 8 per day
continuous pain behind attacks

23
Q

what can trigger a cluster headache attack during a bout

A

alcohol

24
Q

what is paroxysmal hemicrania

A

pain orbitally and temporally
unliteral
rapid onset
lasts 2-30mins
2-40 attacks per day

25
Q

what does paroxysmal hemicrania respond to

A

indomethacin

26
Q

what is given for an attack of cluster headache

A

subcutaneous sumatriptan 6mg
nasal zolmitriptan 5mg
100% oxygen 7-12l/min with non-rebreathing mask

27
Q

what is given during a bout of cluster headaches

A

occipital depomedrone/lidocaine injection
tapering course of prednisolone (oral)

28
Q

what medications are used preventatively for cluster headaches

A

verapamil
lithium
methysergide
topiramate
monoclonal antibodies

29
Q

what medications are given for paroxysmal hemicrania

A

prophylactic indomethacin
cox2 inhibitors, topiramate

Oral Medicine BDS4 (28 decks)

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