Headache Facial Pain Headache l 3 Main Headache

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Headache & Facial Pain

Headache & Facial Pain

Headache l 3 Main Headache Syndromes l Migraine l Cluster headache l Tension headache

Headache l 3 Main Headache Syndromes l Migraine l Cluster headache l Tension headache

Sinogenic Headache Non sinogenic

Sinogenic Headache Non sinogenic

Trigeminal Nerve

Trigeminal Nerve

Sinogenic headache ( International Headache Society Criteria) l l Frontal headache accompanied by pain

Sinogenic headache ( International Headache Society Criteria) l l Frontal headache accompanied by pain in one or more regions of the face, ears, or teeth Clinical, nasal endoscopic, or CT and/or MRI and/or laboratory evidence of acute or acute-onchronic rhinosinusitis Headache and facial pain that develop simultaneously with the onset or acute exacerbation of rhinosinusitis Headache, facial pain, or both that resolve within 7 days of remission or successful treatment of acute or acute-on-chronic rhinosinusitis

Localisation of Pain Frontal sinus - Frontal, vertex, and retroorbital pain l Maxillary sinus

Localisation of Pain Frontal sinus - Frontal, vertex, and retroorbital pain l Maxillary sinus - Malar region and upper teeth pain l Ethmoid sinus - Nasion and retro-orbital pain and pain that radiates to the temporal area l Sphenoid sinus - Vertex, occipital, frontal, and retro-orbital pain l

Sinogenic headache l Co-existing symptoms l Endoscopic evidence l Radiographic l Treat evidence sinusitis

Sinogenic headache l Co-existing symptoms l Endoscopic evidence l Radiographic l Treat evidence sinusitis

Mucosal Contact Points

Mucosal Contact Points

Primary Headache Syndromes l Tension headache l Migraine l Cluster headache

Primary Headache Syndromes l Tension headache l Migraine l Cluster headache

Tension Headache l Triggered by stress l Bilateral, non pulsatile l Relaxation therapy l

Tension Headache l Triggered by stress l Bilateral, non pulsatile l Relaxation therapy l Stress management l Counselling l Psychotherapy

Cluster headache Severe unilateral temporal headache grouped attacks over weeks to months l Males>

Cluster headache Severe unilateral temporal headache grouped attacks over weeks to months l Males> females l 30 -40 years l Subcutaneous sumatriptan l Ergotamine l Corticosteroids l

Migraine Typical throbbing unilateral pain l > women l Nausea, aura, photophobia l Triggers

Migraine Typical throbbing unilateral pain l > women l Nausea, aura, photophobia l Triggers l Flunarizine l Ergotamine l Beta blockers l Tricyclic antidepressants l Anticonvulsants l

Secondary Headache subarachnoid hemorrhage l meningitis l ICP too high or low l cerebral

Secondary Headache subarachnoid hemorrhage l meningitis l ICP too high or low l cerebral sinus thrombosis l pituitary apoplexy l TIA l Carotid artery dissection l Pain of dental origin l TMJ pain l …. many more l

Clues to Secondary Headache fever, seizure, behavioral change, etc l age >55 l posterior

Clues to Secondary Headache fever, seizure, behavioral change, etc l age >55 l posterior location l neurological deficit l abrupt onset/severe intensity: “thunderclap” l

Facial Pain l typical” vs. “atypical” l “symptomatic” vs. “primary”

Facial Pain l typical” vs. “atypical” l “symptomatic” vs. “primary”

Trigeminal Neuralgia: Diagnosis Table 1 Trigeminal Neuralgia: IHS Diagnostic Criteria A. B. C. D.

Trigeminal Neuralgia: Diagnosis Table 1 Trigeminal Neuralgia: IHS Diagnostic Criteria A. B. C. D. E. Paroxysmal attacks of facial or frontal pain which last a few seconds to less than two minutes Pain has at least 4 of the following characteristics: (1) distribution along one or more distributions of the trigeminal nerve. (2) sudden, intense, sharp, superficial, stabbing or burning in quality. No neurologic deficit Attacks are stereotyped in the individual patient. Exclusion of other causes of facial pain by history, physician examination and special investigations when necessary.

Trigeminal Neuralgia: Treatment l pharmacologic l “procedural” l anesthesia dolorosa

Trigeminal Neuralgia: Treatment l pharmacologic l “procedural” l anesthesia dolorosa

Glossopharyngeal Neuralgia Paroxysmal pain l Originates in tongue base or tonsillar fossa l Provoked

Glossopharyngeal Neuralgia Paroxysmal pain l Originates in tongue base or tonsillar fossa l Provoked by swallowing, chewing or yawning l Hypotension, bradycardia, syncope l Carbamazepine l Glossopharyngeal neurectomy l