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BDS4 Oral Medicine > Neuralgia > Flashcards

Neuralgia Flashcards

1
Q

What is neuralgia

A

nerve pain

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2
Q

How does neuralgia present

A
  • usually brief but severe
  • pain extends along course of affected nerve
  • usually caused by irritation/damage
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3
Q

What are the commonly effected nerves

A
  • trigeminal
  • glossopharyngeal and vagus
  • nervus intermedius
  • occipital
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4
Q

What is nervus intermedius

A
  • branch of the facial
  • supplies submandibular and sublingual glands
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5
Q

What does the occipital nerve branch from

A

c2 and c3
supplies scalp

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6
Q

What is the epiemiology of trigeminal neuralgia

A
  • uncommon
  • F>M
  • usually elderly px >60 YO
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7
Q

What are the types of trigeminal neuralgia

A
  • idiopathic - no known cause
  • classical
  • secondary
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8
Q

What is classical TN

A
  • vascular compression - aka vascular trigeminal conflict
  • MRI will demonstrate close relationship between vessel and nerve as well as vascular compression
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9
Q

What can cause secondary TN

A
  • multiple sclerosis
  • intra-cranial lesions e.g tumour (benign/malignant)
  • skull base deformity
  • connective tissue disease
  • arterial venous malformation
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10
Q

What is the presentation of trigeminal neuralgia

A
  • unilateral pain
  • usually along maxillary or mandibular division
  • stabbing pain
  • 5-10 second duration
  • remission and relapse
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11
Q

What can trigger TN

A
  • cutaneous
  • touch
  • chewing
  • wind
  • cold
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12
Q

What do px experience between TN attaacks

A

may be no pain - purly paroxysmal
may be continuous pain on which the attacks are superimposed

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13
Q

How may TN present as a hybrid of other cranial nerve pain disorders

A
  • may be >1 division effected
  • may be bilateral
  • may have burning component
  • may have vasomotor component
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14
Q

What are TN red flags

A
  • young px - <40
  • sensory deficit - more associated with trigeminal neuropathy
  • presence of hearing loss may indicate acoustic neuroma
  • other cranial nerve deficits = urgent imaging
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15
Q

What should every px recieve

A

full cranial nerve exam
MRI

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16
Q

What is the mangement of TN

A
  • drug therapy
  • pain diary
  • LA
  • surgery
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17
Q

What is the first line drugs for TN management

A

carbamazepine - prolonged release
oxycarbazepine
lamotrigine

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18
Q

What type of drugs are carbamazepine and oxycarbazepine

A

anti-epileptics

19
Q

What are the side effects of carbamazepine

A
  • blood dyscrasias
  • electrolyte imbalances (hyponatraemia)
  • neurological defects e.g paraesthesia
  • liver toxicity
  • skin reactions
20
Q

What are the blood dyscrasias that carbamazepine may result in

A
  • thrombocytopenia
  • pancytopenia
  • neutropenia
21
Q

What is the gold standard monitoring of carbamazepine

A

blood tests weekly for first month then monthly after
FBC, U&E, LFT

22
Q

When should lamotrigine be used

A

if other 2 arent tolerated
slow onset of action

23
Q

What are second line drugs for TN

A
  • gabapentin
  • pregabalin
  • phenytoin
24
Q

When is surgery not recommended for TN

A
  • px managing with drugs
  • little side effects
25
Q

When is surgery indicated for TN

A

reaching max dosage, even if pain controlled
younger px - years of drug usage would be needed

26
Q

What are the surgical options for trigeminal neuralgia

A
  • microvascular decompression
  • destructive central procedures
  • stereotactic radiosurgery
  • destructive peripheral neurectomies
27
Q

What are complications of surgery for TN

A
  • sensory loss
  • motor deficit
  • may be reversible or irreversible
28
Q

What are causes of trigeminal neuropathy

A
  • herpes zoster virus
  • trauma
  • idiopathic
29
Q

What is trigeminal neuropathy caused by herpes zoster virus called

A
  • post herpetic neuralgia
  • pain is present where previous shingles infection was
30
Q

What are the characteristics of trigeminal neuropathy

A
  • pain localized to distribution of trigeminal nerve
  • described as a ‘burn’ or similar sensation to pins and needles
  • primary pain usually continous
  • may experience superimposed brief pain paroxysms - not predominant pain type
  • accompanied by clinically evidence cutaneous allodyna
  • may have sensory deficit
31
Q

What is allodyna

A

pain to stimuli that doesnt normally produce pain

32
Q

What are the key features of trigeminal autonomic cephalalgias

A
  • unilateral head pain, predominantly v1
  • very severe
  • usually prominent carnial parasympathetic autonomic features (ipsilateral to headache)
  • attack frequency and duration differ
33
Q

What are the parasympathetic autonomic features that may be seen in TAC

A
  • conjunctival injection (redness) and lacrimation (tearing)
  • nasal congestion
  • eyelid oedema
  • ear fullness
  • miosis/ptsosis - Horner’s syndrome
34
Q

What are the different types of TACs

A
  • cluster headache
  • paroxysmal hemicrania
  • SUNCT
35
Q

Compare the different types of TAC

A
36
Q

What are the features of cluster headache

A
  • pain mainly orbital and temporal
  • attacks are strictly unliateral
  • rapid onset and cessation
  • duration 15 min - 3 hr
  • pain excrutiating
  • px restless and agitated
  • migraine symptoms often present
37
Q

What are the different types of bouts of TAC

A
  • episodic
  • chronic
38
Q

What are episodic bouts

A
  • most common
  • attacks cluster into bouts typically 1-3 months with remission lasting at least one month
  • frequency 1-8 per day
  • may have continous background pain inbetween
  • alcohol triggers attacks during bouts but not during remission
39
Q

What are chronic bouts (TACs)

A
  • bouts last >1 yr without remission
  • remission lasts <1 month

most common type in paroxysmal hemicranial

40
Q

What is circadian periodicity

A
  • attacks same time each day
  • bouts same time each year
41
Q

Do cluster headaches have circadian periodicity

A

yes

42
Q

What is the treatment for cluster headaches

A
  • for attack - drug therapy and oxygen 7-12L/min with non rebreathing mask
  • for bout - lidocaine injection and oral prednisolone
  • preventative - verapamil and lithium
  • CGRP monoclonal antibody for non responsive tx
43
Q

What is the presentation of paroxymal hemicrania

A
  • Pain mainly orbital and temporal
  • unilateral only
  • rapid onset and cessation
  • duration 2-30 minutes
  • frequenct 2-40 attacks per day adn no circadian rhythm
  • migraine symptoms may be present
  • may be precipitated by bending head
44
Q

What is tx for paroxymal hemicrania

A

no abortive tx
prophlyaxis with indomethacin - absolute response

BDS4 Oral Medicine (17 decks)

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