Ice pick Ice cream Exertional Cough Chronic paroxysmal hemicrania SUNCT(Short-lasting unilateral neuralgiform head ache with conjunctival injection and tearing)
Intracerebral bleeding Raised intracranial pressure Infection Inflammatory disease Post-herpetic neuralgia Referred pain from other structures
Stimulation of primary nociceptors Lesions in pain-producing pathways of PNS&CNS
Scalp Middle meningeal artery, Dural sinuses, Falx cerebri & Proximal segments of the large pial arteries
The ventricular ependyma, choroid plexus, pial veins, and much of the brain parenchyma are not pain-producing.
Key structures involved Large intracranial vessels and dura mater Peripheral terminals of the trigeminal nerve that innervate these structures Caudal portion of the trigeminal nucleus, which extends into the dorsal horns of the upper cervical spinal cord and receives input from the first and second cervical nerve roots (the trigeminocervical complex) Pain modulatory systems in the brain that receive input from trigeminal nociceptors
Trigeminal nerve First 3 cervical nerves Fascial nerve Glossopharyngeal and vagus nerve
Distension,traction or dilatation of i/c or e/c arteries. Traction or displacement of large intracranial veins or their envelope. Meningial irritation & raised ICT.
Compression ,traction or inflammation of cranial or spinal nerves. Spasm ,inflammation & trauma to cranial & cervical muscles. Disturbance of intracerebral serotonic projection/activtn of brain stem structures.