chronic orofacial pain Flashcards by Abigail Cook

breakdown of neuropathic orofacial pain

trigemnial neuralgia (TN)

glossopharyngeal neuralgia (GN)

post-herpetic neuralgia (PHN)

atypical odontalgia (AO)

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neurovascualr disorder breakdown

migraine

neurovascular orofacial pain - facial migraine

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trigeminal autnomic cephalgias break dwn

cluster headache

paraxysmal hemicranias

SUNT - short lasting unilateral neuralgiform headache with conjunctival injection and tearing

hemicrania continua (HC)

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peripheral sensitization

increased responsiveness and reduced threshold of nociceptors

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allodynia

painful sensation caused by innocuous stimuli (non painful) such as light touch

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when there is prolonged pain?

general

there is a second order neuron in CNS that can be HYPERSENSITIVE – CENTRAL SENSITIZATION

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T/F pain is unresponsive to NSAIDs and low dose opioids

TRUE

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all neuropathic pain begins with

nerve injury

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compression in pain

blood vessel compression with trigeminal neuralgia

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viral insult example

postherpetic neuralgia

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what is trigeminal neuralgia

from seconds to 2 mins

UNILATERAL
INTENSE SHARP STABBING
- effecting on or more divisions of TN (v1, v2, v3)
- opthalamic (V1 is least effected branch)
- max and mand occuring together

periods of REMISSION (long time b/w)

PEAK AT 50-60 YEARS

MALE TO FEMALE (1:2)
- higher in female

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causes of TN?

compressino of the trigemnical root at or near the dorsal root entry zone (DREZ) by blood vessel

seen with demyelinating lesions in brainstem caused by multiple sclerosis

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trigger areas for TN?

talk chew touch - lip and gingiva

tic dolorex - tic like cramps / involuntary spasms

during day more

get MRI over CT

because of its location and paroxysmal (sudden) nature - TN has often been confused with dental pathologies, leading to unnecessary dental treatments

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Treatment for TN?

pharmocological agents - anticonvulsants

surgery - microvascular decompression

medical conditions like MS should be treated as well

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medications used for pain relief in TN?

Carbamazepine - 100 mg 2x daily max 1200 mg
INACTIVATE NA+ CHANNELS

alternatives
oxarcabezepine
gabapentine – blocks release of neurotrasnmitter by blocking Ca+ channels

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glossopharyngeal neuralgia

unilateral

two branches affected

tympanic (auricular)
pharyngeal

SWALLOWING, CHEWING, TALKING, COUGHING, YAWNING, COLD WATER, TONGUE MOVEMT

onset 40-50

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dx of glossopharyngeal neuralgia

confused with TMD due to triggers of swallowing, tongue movment, mand function - triggering

so IMMOBILIZE THE MANDIBLE and block masticatory function - give cold water and if pain percipitates more likely to be GN and not TMD

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what is postherpetic neuralgia

viral disease characterized with painful skin rash with blisters due to reactivation of varciella zoster

rash can heal within 2-4 weeks but can have ongoing pain lasting for months to years

MAIN CHARACTERISTIC = CUTANEOUS ALLODYNIA - like non noxious stimulus to normal skin causing pain

OPTHALMIC BRANCH (80%) and worst prognosis

UNILATERAL - LASTING FOR AT LEAST 3 MONHTS

DEEP BURNING, ACHING, ITCHING can be constant or intermittent / fast

risk factors for reactivation is old age, poor immune functino

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PHN treatment?

gabapentine 100-300 mg / max is 1800-3600 mg/ day

tricylic antidepressant

combination

antivials against herpes
- if less than 72 hours from onset of rash – decrease incidence of PHN
acyclovir - 800 mg , 5x 7-10 days
valacyclovir 1000mg 3x day 7 days

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atypical odontalagia

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persistent pain in apparently normal teeth or adjacent oral tissues
- alveolar bone, gingiva

common complaint with atypical odontalagia

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” i have seen multiple dentists and have had multiple procedures and still have pain on the tooth”

pathophyiology of atypical odontalagia

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deafferentation - partial or total loss of an afferent nerve supply from a particular area

transection or crush

new term - peripheral painful traumatic trigeminal neuropathy

criteria for atypical odontalagia

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PAIN DEVELOPS WITHIN 3 MONTHS OF A CLEAR TRAUMATIC EVENT

CONTINOUS or almost continous in a tooth or tooth site
(reoccuring daily for over 2 hours per day over 3 months)

DYSESTHESIA - a abnormal feeling accompanied by pain

no obvious local etiology / normal raiogrpahs

hyperesthesia - tooth tender to finger pressure

WOMAN 40-50’S

diagnostic block with AO vs TN?

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wont do anything to help with AO

- it will eliminate the pain in TN

tx for atypical odontalagia

stop all dental - even prophys tricylclic anti-depressants

aura

sensory disturbances can include flashes of light, blind spots and other vision changes or tingling in your hand or face migraine with aura is 30%

migraine without aura

idiopathic 4-72 hours if left untreated at least 5 attaacks in 4-72 hours UNILATERAL - pulsating throbbing pain, increases with routine physical activity occurs with - nausea / vomit - phonophobia / photophobia

attacks of migraine mostly

upon ARISING

migraine with auro

reversible develop gradually over 5-20 mins and last for less than 60 minutes at least 2 attacks with one or more fully reversible visual, sensory, motor aura

migraines occur more in? triggers?

women > men | weather, loud noise, stress, foods, alcohol, sleep, TMJ pain, masitcaory

aura last

5-60 minutes

peak migraine time

4-72 hours and pain intensity increases with time

rpid screening for migraine

1. nauseated or sick to stomach with headache? 2. has HA liited activitied for a day or more in last 3 months? 3. when you have HA does light bother a lot more than when dont have HA?

pathophysiology of migraine

trigemniovascular system - neurons - mostly from opthalmic and blood vessels -- usually cerebral DILATED BLOOD VESSELS - CALCITONIN GENE RELATED PEPTIDE -- highly potent vasodilator -- the swollen dilated and inflammed blood vessels are believed to be responsible for the throbbing pain and migraine

midface / facial migrain / neurovascular orofacial pain dx with irreversible pulpitis

V2 and V3 - throbbing pain in the mid facial regions -- can CHANGE LOCATIONS TOO both hypersensitive to cold! but NVOP - midfacial is NOT tender to percussion and no sign of carious lesion, no response to endo tx and no diagnostic anesthesia with pulpitis - no change in location and diagnostic anesthesia can be used, tender to percussion

onset age of migraine

20-40 years old | 1:2 male : female

migraine vs mifaial migraine

LOCATION onset age migrain is 20-40 and it is 40-50 in midfacial migraine midfacial -- triggered by cold both more female

sumatriptan

25 mg tid considered confirmaotry evdence of a migraine pain disorder -- diagnostic causing vasoconistriction of dilated cranial blood vessels preventing neurogenic inflammation by blocking the release of neurotransmitter CGRP

trigeminal autonmoic cephalgias

pain in trigemnial area on one side with AUTONOMIC SYMPTOMS - tearing, redness, ptosis (drooping) , myosis - constriction 1. trigemnial pain 2. autonomc signs 3. rhythmicity - particualr in cluster headache -- relation between headache attacks and biological clock - circadian rhythm - HYPOTHALAMUS INVOLVMENT -- REM SLEEP

which has more prediliction in male?

cluster headache 30-40 years 5:1 male to female + SUNCT is 9:1 (short lasting unilateral neuralgiform headache) - attacks with conjunctival injection and tearing

suicide headache

cluster headache - lasting usually 90 minutes after wake up refers out but in the eye lacrimal usually

paroxysmal hemicrania

fronto orbital area unilateral conjuctiva and lacrimation SHORTEST ONE - max is 4 minutes

gabapentine for

tx for cluster

sumatriptan

indomethacrine responsive?

this is an NSAID | - can be used to treat paroxysmal hemicrania and hemicrania continua

peripheral sensitization increases or decreases the pain?

increases

if seems like TN but it is bilateral what are you assuming?

that there is a mass or tumor

midfacial gets confused with

sinusitis and dental pain

anticonvulsant / lamotrogine with?

SUNCT | - inactivated Na

chronic orofacial pain Flashcards

(49 cards)