WEEK 3: Headache and Facial Pain Syndromes Flashcards
What are the pain sensitive structures in the head?
- Trigeminal
- Facial
- Glossopharyngeal
- Vagus
- Upper three cervical roots
(10, 9 , 7, 5, C1 to C3)
The brain is pain sensitive. T or F?
F. the brain is not pain sensitive
Sensory supply of the anterior and middle fossa?
V1 V2 V3
sensory supply of the posterior fossa?
C1 C2 C3
what are intracranial pain sensitive areas?
- Venous sinuses and afferent veins
- Arteries of the dura mater and pia-arachnoid
- Arteries of the base of the brain and their major branches
- Parts of the dura mater near the large vessels
What are the extracranial pain sensitive structures?
- Sinuses
- Eyes/orbits
- Ears
- Teeth
- TMJ
- Blood vessels
- 5,6,7,9,10 cranial nerves carry pains from these structures
Intracranial pain sensitive areas?
- Arteries of circle of Willis and proximal Dural arteries
- Dural Venous sinuses, veins
- Meninges
- Dura
Characterized by recurring paroxysmal severe pain, brief duration (seconds) in the territory of the trigeminal nerve, spontaneously or initiated by chewing, talking touching the affected side of the face.
Trigeminal neuralgia
Causes of trigeminal neuralgia?
gender predisposition?
Unknown etiology, an arterial loop pushing on the sensory root in the posterior fossa
Females affected more than males
management of trigeminal neuralgia?
Analgesics, surgery, destruction of the sensory neuron, division of nerve root.
IHS Diagnostic Criteria for Trigeminal Neuralgia
A. Paroxysmal attacks of facial or frontal pain which last a few seconds to less than 2 mins
B. Pain has at least 4 of the following charactereistics:
1. distributions along one or more distributions of the CN V
2. Sudden internse sharp superficial stabbing or burning in quality
C. No neurological deficit
D. Attacks are stereotyped in the individual patient
E. exclusion of other causes of facial pain by history, physician examination and special inestigations when necessary.
Severe, sudden episodes of pain in the tonsil region one side only, ipsilateral ear
o Pain - severe for 1-2 hours, recur daily
Glossopharyngeal Neuralgia
CN 9 neuralgia: cause and genetic predisposition
o Unknown cause
o Equal both sexes
What can be some causes of irritation in the CN 9?
blood vessels pressing on CN 9
Growth at the base of the skull pressing on CN 9
Tumors or infections of the throat and mouth pressing on CN 9
o Intractable pain in the nose, eye, cheek and lower jaw
o Could be due to lesion of the sphenopalatine ganglion, or vidian nerve
Sluder’s neuralgia, Vidian Neuralgia
managed by : Analgesics, vidian neurectomy
characterized by unilateral paroxysms of intense pain in the region of the eyes, the maxilla, the ear and mastoid, base of the nose and beneath the zygoma.
these paroxysms of pain have a rapid onset, persist for about 15 mins to several hours, and then disappear as rapidly as then began. there is no triugger zone
Sphenopalatine neuralgia
aslo refereed to as alarm clock headache
Sphenopalatine Neuralgia aka Vidian nerve neuralgia, periodic migrainous neuralgia, sluder’s headache
Sphenopalatine Neuralgia aka
Vidian nerve neuralgia, periodic migrainous neuralgia, sluder’s headache
What type of neuralgia? o Neuroma
o Parietal & occipital
o 90% recovery
Post traumatic neuralgia
Pain felt over the cheek, nose, upper lip or lower jaw
• Usually bilaterally symmetrical
• Aching, shooting, burning, accompanied by reddening of the skin and lacrimation or watering of the nose
• Lasts for hours, days or weeks
• Psychological consultation, analgesics
Atypical neuralgaia / symptomatic facial pain
Atypical neuralgaia / symptomatic facial pain may be associated wiht?
o Carotid dissection
o Giant cell (“temporal” arteritis)
This is common in the elderly people
This is an inflammation in the temporal artery
If you palpate this in the temporal area, it will feel hard and bouncing
o Acute V-Z & post herpetic neuralgia
o Tolosa-Hunt syndrome
Extracranial lesions that may cause atypical neuralgia or symptomatic facial pain?
sinus disease
Dental neuralgia
TMJ joint pain
If there are point tenderness in the sinuses, it is?
Sinusitis
Due to acute inflammation of the artery, the cause unknown,
affects men and women over the age of 60.
- Pain over the temples and frontal region, intense, throbbing,
tenderness over the scalp, swelling and redness of the
overlying skin with general malaise, partial or complete loss
of vision.
ESR Elevated
temporal arteritis
Tx for symptomatic facial pain?
Cortisone, analgesics
Headache that is not secondary to focal or structural brain lesion
Primary headache
what are the primary headaches? (3)
Migraine
Tension type headache
Trigeminal autonomic cephalalgias