Transcript Facial pain
HEADACHE & FACIAL PAIN Ahmed Alarfaj,MD INTRODUCTION • Major reason for seeking medical care. • 90% is vasculr headache. • 10% is mixture of inflammation,traction or dilatation of pain sensitive structure. PATHOPHYSIOLOGY • Pain • Referred pain – Pattern of referred pain CLINICAL ASSESSMENT • History – – – – Hx of present illness Past medical hx Family hx Social hx • Physical examination CLINICAL ASSESSMENT • Clinical features suggesting serious cause – – – – – – – – Crescendo Early morning Vomiting Fever Seizures & other neurological symptomes Worst headache in my life Known malignancy Tenderness Facial pain Typical Neuralgias 1) Trigeminal neuralgia • 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. • Unknown aetiology, an arterial loop pushing on the sensory root in the posterior fossa. • Females affected more than males • Analgesics, surgery, destruction of the sensory neuron, division of nerve root. Facial pain Typical Neuralgias 2) Glossopharyngeal neuralgia • Unknown cause • Equal both sexes • Severe, sudden episodes of pain in the tonsil region one side only, ipsilateral ear. • Pain - severe for 1-2 hours, recur daily • Treated like trigeminal Facial pain Typical Neuralgias 3) Sluder’s 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 Facial pain • Posttraumatic neuralgia – Neuroma – Parietal & occipital – 90% recovery 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 lacrimation or watering of the nose Lasts for hours, days or weeks Psychological consultation, analgesics Symptomatic Neuralgias Intracranial lesions 1) Central lesions • Tumours of the brain stem, M.S., thrombotic lesions, metastasis, occult naso-pharyngeal ca. • No precipitant, sensory loss. 2) Post herpetic neuralgia • Herpes zoster may affect trigeminal nerve ganglion • Vesicular rash covers one division commonly the 1st with severe pain. Symptomatic Neuralgias Extracranial lesions 1) Sinus disease • Infective and neoplastic lesions of the paranasal sinus. • Facial pain & dental pain, loss teeth. • Clinical suspicion. • Treatment 2) Dental neuralgia • Dental carries • Dental extraction 3) Temporomandibular joint pain Headache Headache 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 Headache 3) Migraine Congenital predisposition Triggered by hunger, certain foods, sleep too much 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 any area of the head, aching or throbbing often accompanied by nausea and vomiting Diagnosis - by history alone Treatment - prevention by avoiding precipitating factors, appropriate medication. Headache 4) Tension headache More common in adult females Positive family history (40%) Maybe associated with migraine Produced by persistent contraction of the muscles of the neck, head and face Caused by emotional tension, secondary to other headaches, posture habit Treated by analgesics, muscle relaxants, physiotherapy Headache 5) Cluster headache 90% are men Age 20 - 30 Attacks occur in groups, no aura Caused by vascular dilatation of branches of external carotid Triggered by histamines, alcohol Treated by analgesics, anti-histamine, steroids 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. 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 Pains from head and neck muscles 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 to rheumatologist Pains from head and neck muscles Temporal arteritis 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 Treatment: Cortisone, analgesics Pains from head and neck muscles Psychologic headache Usually accompanied by depression, anxiety No organic lesion