2.Facial Pain

7/30/2019 2.Facial Pain

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HEADACHE &

FACIAL PAIN

Anwar Wardy W

Dept. Neurology FKK UMJ

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INTRODUCTION

Major reason for seeking medical

care. 90% is vasculr headache.

10% is mixture of

inflammation,traction or dilatationof pain sensitive structure.

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Facial Pain SyndromeTrigeminal Neuralgia

Paroxysms of intense, stabbing pain in thedistribution of the mandibular and maxillary

divisions of the 5th

cranial nerve Pain is initiated by the stimulation of certain

areas of the face, lips or gums- the so-calledtrigger zones

Other associated symptoms include more or lesscontinuous discomfort, itching and sensitivity ofthe face


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Facial Pain SyndromeTrigeminal Neuralgia

Usually a spatial and temporal summation ofimpulses is necessary to trigger a paroxysm of

pain, followed by a refractory period of up to 2-3minutes

Most cases are idiopathic

Anticonvulsant drugs such as phenytoin, valproic

acid, clonazepam, carbamazepine, alone or incombination, suppresses or shorten the durationof attacks


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Facial Pain SyndromeGlossopharyngeal Neuralgia

Much less common than the trigeminal neuralgia

Pain is intense and paroxysmal; originates in the throatand is provoked most commonly by swallowing

The only craniofacial neuralgia that maybe accompaniedby bradycardia and syncope


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Facial Pain SyndromePostherpetic Neuralgia

Neuralgia associated with a vesicular eruption due toinfection with the herpes zoster virus

Eruption will appear within 4-5 days after the onset of

pain In the region of cranial nerves, 2 syndromes are

frequent: herpes zoster auricularis and ophthalmicus


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Facial Pain SyndromePostherpetic Neuralgia

Ramsay-Hunt syndrome: herpes of the external auditory

meatus and pinna and sometimes of the palate and

occipital region- with or without deafness, tinnitus,

vertigo combined with facial paralysis


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Facial Pain SyndromeOccipital Neuralgia

Paroxysmal pain may occasionally occur in the

distribution of the greater and lesser occipital nerves

There may be tenderness where the nerves cross thesuperior nuchal line


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Facial Pain SyndromeCarotidynia

Special type of cervicofacial pain that could be elicited by

pressure on the common carotid arteries of patients with

atypical facial neuralgia, or the so-called lower half

headache of Sluder


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Facial Pain SyndromeCoster Syndrome (TMJ Pain)

-A form of craniofacial pain consequent upondysfunction of the TMJ

- diagnosis is supported by findings of tenernessover the joint , crepitus on opening the mouth,limitation of jaw opening

- Mgt. Consists of careful adjustment of the sit by

a dental specialist and should be undertakenonly when the patient meets the diagnosticcritetria for this condition


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Facial Pain SyndromeTMJ Pain Syndrome

pain localized to the muscles of mastication, preauricular area

or the TMJ

Innervation: auriculotemporal nerve common initial symptom: otalgia

Deviation of the mandibular midline to one side is usually due

to a failure of the condyle to slide forward on the side to

which the chin is deviating


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PATHOPHYSIOLOGY

Pain

Referred painoPattern of referred pain

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CLINICAL ASSESSMENT

HistoryoHx of present illness

oPast medical hxoFamily hx

oSocial hx

Physical examination

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CLINICAL ASSESSMENT Clinical features suggesting serious cause

o Crescendo

o Early morning

o Vomitingo Fever

o Seizures & other neurological symptomes

o Worst headache in my life

o Known malignancy

o Tenderness

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Facial painTypical Neuralgias1) Trigeminal neuralgia

Characterized by recurring paroxysmalsevere pain, brief duration (seconds) in theterritory of the trigeminal nerve, spontaneouslyor initiated by chewing, talking, touching theaffected side of the face.

Unknown aetiology, an arterial loop pushingon the sensory root in the posterior fossa.

Females affected more than males Analgesics, surgery, destruction of the sensoryneuron, division of nerve root.

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Facial painTypical Neuralgias2) Glossopharyngeal neuralgia

Unknown cause

Equal both sexes Severe, sudden episodes of pain in the

tonsil region one side only, ipsilateralear.

Pain - severe for 1-2 hours, recur daily Treated like trigeminal

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Facial painTypical Neuralgias3) Sluders neuralgia and Vidian neuralgia

Intractable pain in the nose, eye,

cheek and lower jaw.Could be due to lesion of the

sphenopalatine ganglion, or vidian

nerve.

Analgesics, vidian neurectomy

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Facial pain Posttraumatic neuralgia

oNeuroma

oParietal & occipital

o90% recovery

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Facial Pain

Atypical facial pain Pain felt over the cheek, nose, upper lip

or lower jaw

Usually bilaterally symmetrical Aching, shooting, burning, accompanied

by reddening of the skin and lacrimationor watering of the nose

Lasts for hours, days or weeks Psychological consultation, analgesics

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SymptomaticNeuralgias

Intracranial lesions1) Central lesions

Tumours of the brain stem, M.S., thromboticlesions, metastasis, occult naso-pharyngealca.

No precipitant, sensory loss.

2) Post herpetic neuralgia Herpes zoster may affect trigeminal nerve

ganglion

Vesicular rash covers one division commonlythe 1st with severe pain.

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HeadacheHeadache is one of the commonest

symptoms in medical practice.

Aetiology:

1) Raised intracranial pressure Due to tumours, abscesses, subdural

haematoma, brain haemorrhage.

2) Inflammation of the brain and meninges

e.g. meningitis, cerebritis, others

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Headache3) Migraine

Congenital predisposition Triggered by hunger, certain foods, sleep - toomuch or too little, hormonal variations, stress.

Pathology-vascular dilatation Females affected more than males ? Proceeded by aura usually visual, paraesthesiae

of hands, weakness Headache is unilateral or bilateral, affects anyarea of the head, aching or throbbing oftenaccompanied by nausea and vomiting

Diagnosis - by history alone Treatment - prevention by avoiding precipitating

factors, appropriate medication.

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Headache

4) Tension headache More common in adult females

Positive family history (40%)

Maybe associated with migraine

Produced by persistent contraction of themuscles of the neck, head and face

Caused by emotional tension, secondaryto other headaches, posture habit

Treated by analgesics, muscle relaxants,physiotherapy

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Headache

5) Cluster headache

90% are men

Age 20 - 30

Attacks occur in groups, no aura

Caused by vascular dilatation ofbranches of external carotid

Triggered by histamines, alcohol

Treated by analgesics, anti-histamine,steroids

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Pains from head and neck muscles

Pain from temporalis muscles Can arise from grinding teeth at night (bruxism), impacted wisdom

teeth, temporomandibular joint dysfunction, anxiety when the

patient clenches the jaws too tightly

Treatment: Refer to interested dental surgeon.

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PAINS FROM HEAD AND NECK


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PAINS FROM HEAD AND NECK

MUSCLES

Pain from upper neck muscles Can radiate over the head

Treatment by physio-therapist or rheumatologist

Pain from frontalis muscles Usually due to bad posture at work or while driving

Treatment: physio-therapy

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Cervical spondylosis

Pain mediates upwards from the neck to the

occiput or vertex to the front of the head,

down to the shoulders Due to cervical discs prolapse

Diagnosis - x-ray

Treatment: Physio-therapy, referral torheumatologist

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Temporal arteritis Due to acute inflammation of the artery, the cause

unknown, affects men and women over the age of60

Pain over the temples and frontal region, intense,throbbing, tenderness over the scalp, swelling andredness of the overlying skin with general malaise,partial or complete loss of vision.

ESR Elevated

Treatment: Cortisone, analgesics

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Psychologic headache

Usually accompanied by

depression, anxiety No organic lesion

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Wassalam,

Jakarta, 8 Maret 2013

Anwar Wardy w

anwar wardyfkk umj

2.Facial Pain

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