Headache and facial pain

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  • 1. HEADACHE & FACIAL PAIN Ahmed Alarfaj,MD
  • 2. INTRODUCTION• Major reason for seeking medical care.• 90% is vasculr headache.• 10% is mixture of inflammation,traction or dilatation of pain sensitive structure.
  • 3. PATHOPHYSIOLOGY• Pain• Referred pain – Pattern of referred pain
  • 4. CLINICAL ASSESSMENT• History – Hx of present illness – Past medical hx – Family hx – Social hx• Physical examination
  • 5. CLINICAL ASSESSMENT• Clinical features suggesting serious cause – Crescendo – Early morning – Vomiting – Fever – Seizures & other neurological symptomes – Worst headache in my life – Known malignancy – Tenderness
  • 6. Facial painTypical Neuralgias1) 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.
  • 7. Facial painTypical Neuralgias2) 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
  • 8. Facial painTypical Neuralgias3) 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
  • 9. Facial pain• Posttraumatic neuralgia – Neuroma – Parietal & occipital – 90% recovery
  • 10. Facial PainAtypical 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
  • 11. Symptomatic NeuralgiasIntracranial lesions1) 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 1 st with severe pain.
  • 12. Symptomatic NeuralgiasExtracranial lesions1) Sinus disease • Infective and neoplastic lesions of the paranasal sinus. • Facial pain & dental pain, loss teeth. • Clinical suspicion. • Treatment2) Dental neuralgia • Dental carries • Dental extraction3) Temporomandibular joint pain
  • 13. 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
  • 14. Headache3) 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 .
  • 15. Headache4) 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
  • 16. Headache5) 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
  • 17. Pains from head and neckmusclesPain 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 .
  • 18. Pains from head and neckmusclesPain from upper neck muscles  Can radiate over the head Treatment by physio-therapist or rheumatologistPain from frontalis muscles  Usually due to bad posture at work or while driving Treatment: physio-therapy
  • 19. Pains from head and neckmusclesCervical 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
  • 20. Pains from head and neckmusclesTemporal 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
  • 21. Pains from head and neckmusclesPsychologic headache  Usually accompanied by depression, anxiety  No organic lesion