What is Migraine & Facial Pain

 



Objectives

·         To learn about definition, triggers and phases of Migraine

·         To learn about pathophysiology, diagnosisinvestigation, treatment, quality of life and management of Migraine.

 

Migraine

 

Definition

·         Migraine is a familial disorder.

·         Characterized by recurrent attacks of headache widely variable in intensity, frequency and duration. Attacks are commonly unilateral and are usually associated with anorexia, nausea and vomiting.

 

Migraine Triggers

·         Disturbed sleep pattern

·         Hormonal changes

·         Drugs

·         Weather changes

·         Hunger

·         Olfactory visual and auditory stimuli

 

Phase

1.   Prodrome

2.   Aura

3.   Headache

4.   Postdrome

1 -Prodrome

·         Vague premonitory symptoms that begin from 12 to 36 hours before the aura and headache

·         Symptoms: Excitation, depression, craving or distance for various foods.

·         Duration:15 to 20 min.

 

2-Aura

·         Aura is a warning or signal before onset of headache.

·         Symptoms: Flashing of light, zig-zag lines, difficulty in focusing

·         Duration: 15 to 30 min

3-Headache

·         Headache is generally unilateral and is associated with symptoms like:

·         Anorexia, nausea, vomiting, photophobia, phonophobia

·         Duration: 4- 72hrs

4-Postdrome

·         Following headache, patient complains of fatigue, depression, severe exhaustion, some patient feel unusually fresh

·         Duration: Few hours or up to 2 days

Pathophysiology

Vascular theory:

  Intracranial/extracranial blood vessel vasodilation --- headache.

  Intracerebral blood vessel vasoconstriction ----------- aura.

Serotonin theory:

 Decreased serotonin levels linked to migraine.

 Specific serotonin receptors found in blood vessels of brain.

Diagnosis

Medical history, headache diary, migraine triggers,

Investigations:

ECG, CT brain, MRI

Treatment Quality Of Life

Reducing the attack frequency and severity.

Avoiding escalation of headache medication.

Educating and enabling the patient to manage the disorder.

Improving the patient’s quality of life.

 

 

 

Management

Non-pharmacological treatment:

Identification of triggers

Medication,  relaxation training, psychotherapy

Pharmacotherapy:

Abortive therapy, preventive therapy

 

Aborative Therapy

Non specific treatment:

Aspirin

Paracetamol

Ibuprofen

Naproxen

Specific treatment:

Ergotamine

Dihydroergotamine

Sumatriptan

Rizatriptan

 

Preventive Treatment

Betablockers.  

  Propranolol

Calcium channel

  Flunarizine

  Verapamil

TCAS

   Amitriptyline

SSRI

    Fluoxetine   

 

 


 


Facial Pain

Objectives

To understand about introduction , etiology, trigger factors and treatment of Facial pain

Introduction

·         The pain felt in any part of the face including the mouth and eyes

·         Its normally due to any injury or a headache occasionally facial pain can also be due to neurological or vascular causes but equally well may be dental in origin.

Causes of facial pain

Major causes

·         Trigeminal neuralgia

·         Migranous neuralgia

·         Post herpetic neuralgia

·         Temporomandibular arthritis

Other causes of facial pain

·         Dental [tooth abscess] – one side, jaw, sensitive to touch.

·         Cluster headache – one side, stuffy nose, tearing around the eyes, 30 minutes to 2 hours.

·         Sinusitis – dull pain around the eyes and the cheekbones worse bending forward.

·         Miragine –  aura, pain on one aur both sides, nausea, throbbing or pounding headache.

·         Post stroke pain – constant, moderate, or serve pain caused by damage to the brain. This means that after the a stroke, your brain does not understand the normal messages sent from the body in response to touch, warmth, cold, and other stimuli. Instead, the brain may register even slight sensations on your skin as painful.

 

TRIGEMINAL NEURALGIA

·         A disorder of the trigeminal nerve that causes episodes of sharp, stabling pain in the cheek, lips, gums, or chin on one side of the face.

·         People with this pain often wince or twitch, which is where trigeminal neuralgia gets.

·         Commonly in middle aged or elderly people.

·         Female\ Male

 

MIGRANOUS NEURALGIA

·         An exquisitely painful affiliation of the mid face and upper face, particularly in and around the eye.

·         The name is derived from the fact that the headache occurs in temporal groups or ‘clusters’ with extended periods of remission between attacks.

POST-HERPETIC NEURALGIA

·         If the pain is caused by the shigles continues and persists for more than 90 days[ 3 months] after the bount of shingles is over it is known as post-herpetic neuralgia.

·         Post-herpetic neuralgia is a painful condition that affects the nerve fibers and skin.

TEMPOROMANDIBULAR  ARTHRITIS

·         It is known as COSTEN’S SYNDROME.

·         Pain is serve aching.

·         Gets intensified by chewing, movement of jaw.

·         Occurs at the temporomandibular joint.

·         Usually unilateral.

TRIGGER FACTORS

·         Shaving

·         Touching your face

·         Eating

·         Drinking

·         Brushing teeth

·         Talking

·         Putting on makeup

·         Smiling

·         Washing face

 

 

 

TREATEMENT

·         MEDICAL TREATEMENT

·         Carbamazepine [ Tegretol / Cartail ]

·         Phenytoin sodium

·         Valporic acid

·         SURGICAL TREATEMENT

·         Microvascular decompression 

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