Trigeminal Neuralgia and Cephalalgias Flashcards
what is pain like in neuralgia
intense stabbing pain
brief
extending along nerve
what is neuralgia caused by
irritation or damage to a nerve
what nerves mediate sensation in the head which could be involved in neuralgia
trigeminal
glossopharyngeal
vagus
nervus intermedius
occipital
what are the classifications of trigeminal neuralgia
idiopathic
classical - vascular compression of nerve
secondary - disease causes it
how does trigeminal neuralgia present
unilateral maxillary or mandibular division pain
stabbing pain
5-10 seconds
by itself or with continuous pain
remission and relapse
what triggers trigeminal neuralgia
cutaneous
wind, cold
touch
chewing
what does the typical trigeminal neuralgia patient look like
older
mask like face
excruciating pain
no obvious pathology
what are the red flags of patients with trigeminal neuralgia
younger then 40yrs
sensory deficit in facial region (hearing loss)
other cranial nerve lesions
what tests are done for trigeminal neuralgia
cranial nerve test
give MRI
what are the first line drugs for trigeminal neuralgia
carbamazepine MR
oxcarbazepine
lamotrigine
what are the second line drugs for trigeminal neuralgia
gabapentin
pregabalin
phenytoin
baclofen
how do you manage trigeminal neuralgia
carbamazepine
maximise efficacy and minimise side effects
pain diary
what are the side effects of carbamazepine
blood dyscrasias
electrolyte imbalance
neurological deficits
liver toxicity
skin reactions
when would you consider surgery for trigeminal neuralgia
when approaching maximum tolerable medical management
younger patients with significant drug use
what are the surgical options for trigeminal neuralgia
microvascular decompression
stereotactic radiosurgery
destructive central procedures
destructive peripheral neurectomies
what are the complications after surgery for trigeminal neuralgia
local effects
sensory loss
motor deficits
reversible/irreversible
what are the causes of painful trigeminal neuropathy
herpes zoster
trauma
idiopathic
what are the characteristics of trigeminal neuropathy
localised to distribution of trigeminal nerve
burning/squeezing/pins and needles
primary pain continuous but brief spontaneous pain
accompanied by cutaneous allodynia
what is a trigeminal autonomic cephalalgias
unilateral head pain - V1 region
severe
what are the prominent cranial parasympathetic autonomic features
conjunctival injection
nasal congestion
eyelid oedema
ear fullness
miosis and ptosis
what does a cluster headache present as
pain orbitally and temporally
unilateral
rapid onset
last 15mins - 3 hrs
restless and agitated during attack
ipsilateral autonomic symptoms
migrainous symptoms present
what is a bout of cluster headaches
attack every other day to 8 per day
continuous pain behind attacks
what can trigger a cluster headache attack during a bout
alcohol
what is paroxysmal hemicrania
pain orbitally and temporally
unliteral
rapid onset
lasts 2-30mins
2-40 attacks per day
what does paroxysmal hemicrania respond to
indomethacin
what is given for an attack of cluster headache
subcutaneous sumatriptan 6mg
nasal zolmitriptan 5mg
100% oxygen 7-12l/min with non-rebreathing mask
what is given during a bout of cluster headaches
occipital depomedrone/lidocaine injection
tapering course of prednisolone (oral)
what medications are used preventatively for cluster headaches
verapamil
lithium
methysergide
topiramate
monoclonal antibodies
what medications are given for paroxysmal hemicrania
prophylactic indomethacin
cox2 inhibitors, topiramate
