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orofacial pain - Coggle Diagram

- - - - CLINICAL FEATURES
        
        Occurs in cyclic attacks, which last less than an hour
        
        Often awakes the patients at night
        
        Is unilateral
        
        Is burning in character
        
        Is localized around the eye
        
        Watering of the eye, nasal discharge and obstruction in the affected side.
      - PERIOCITY OF CRISES
        
        Recurrences in outbreaks
        
        Two main types
        
        ECH: Episodic cluster headache
        
        crisis of pain last between 4-8 weeks
        
        episodes 15 days pain-free
        
        CRH: chronic cluster headache
        
        Daily crisis of pain during more than a year
        
        1-3 daily attacks
      - PATHOGENESIS
        
        Unknown
        
        Related to vascular changes
        
        Alcohol, cocaine
      - DIAGNOSIS
        
        Clinical and neurologic examination
        
        Diagnostic tests:CT/MRI: no pathological findings
        =>VASCULAR DISORDER
      - EPIDEMIOLOGY
        
        10 to 25 cases per 100000 inhabitants per year
        
        20 – 30 years
        
        Men predilection (3,6/1)
      - TREATMENT
        HEADACHE
        
        DURING A CRISIS
        
        Ergotamine 2mg oral
        
        Oxygen inhalations 7l/min for 15 minutes
        
        Sumatriptan 6 mg subcutaneously
        
        PROPHYLACTIC TREATMENT
        
        ONE DAILY CRISIS: Ergotamine 2mg , 2 hours before the expected crisis
        
        NIGHT CRISIS: Ergotamine 2mg , before going to bed
        
        TWO OR MORE DAILY CRISIS
        
        Ergotamine 1mg/8h/2 month
        
        Verapamil 80mg/8h
        
        Indomethacin 25mg/8h
        
        Propanolol 40mg/12h
      - concept
        
        Location: eye/periocular
        
        Short duration
        
        Severe, one-sided pain
        
        Autonomic homolateral signs
        
        HORTON ́S HEADACHE
        
        Pain usually occurs al the same time of the day
    - - DIAGNOSIS
        
        Clinical features are indicative.
        
        Discard and organic diseases
      - TREATMENT
        
        Control predisposal factors
        
        Acute attacks
        
        Salicylic acid 900mg
        
        Paracetamol 1000mg
        
        Ergotamine 2 mg + Cafeine 200 mg
        
        Sumatriptan 50-100 mg orally max 300 /mg d o 6 mg subcutaneous max12 mg day,
      - CLINICAL FEATURES
        
        It increases with physical activity or with head movement’s.
        
        Preceding warning symptoms of visual, sensory, motor or speech
        disturbances
        
        Recurrent, severe, unilateral, headache that last for hours or days (4- 72 hours).
        
        Photophobia
        
        Nausea or vomiting
      - AETIOLOGY
        
        arterial dilatation
        
        predisposal factors
        
        stress
        
        tyramine containing foods: banana, chocolate ...
        
        alcohol
        
        contraceptive pill
      - concept
        
        Uncommon
        
        Adult, female predilection
        
        Severe headache with nausea and photophobia
        
        20 years-old, (± 10y)
- - - - Unclear
      - Atherosclerotic blood vessel pressing on the roots of the trigeminal nerve
    - - Paroxysmal pain
      - Restricted to the trigeminal nerve
      - Pain is triggered by chewing, talking, swallowing, smiling or exposure to temperatures change
      - Unilateral pain
      - Normal sensory examination
    - - Uncommon
      - Elderly: 50 years
      - Orofacial neuralgia
      - Female predilection
    - - CLASSICAL OR ESSENTIAL: with not known cause
        
        TRIGGER AREAS
        
        Trigger areas are not always presented.
        
        When a trigger area is presented, is usually an area of a few millimetres in diameter and located either in the infraorbitar or menton area.
        
        Area of the face, that after slightly touch triggers the pain
        
        PAIN CHARACTERISTICS
        
        High intensity
        
        The pain last between 2 second and 2 minutes time
        
        Sudden onset
        
        When the pain disappears, the patient is with no pain during the intercrisis periods.
        
        Paroxysmal, electric shock-like pain
        
        PAIN LOCATION
        
        Restricted to the trigeminal nerve,
        
        The most common site is the mandibular branch
        
        Trigger areas: gums, teeth
        
        Unilateral, never crosses the midline
        
        INDIVIDUAL PAIN CHARACTERISTICS
        
        Each patient has a characteristic pattern
        
        Painful crises are similar in intensity, location....
        
        CLINICAL FEATURES
        
        Periods of time with no pain, that varies from person to person
        
        Restricted to the trigeminal nerve, one or more branches
        
        Pain periods between 2 second and 2 minutes
        
        In some patients triggered by chewing, talking, swallowing, smiling or exposure to temperatures change
        
        Electric shock-like pain of abrupt onset and termination
        
        Normal sensory examination
        
        UNILATERAL pain
        
        No pathological findings in complementary test
        
        分類
        
        Typical : with classic features
        
        Atypical: with atypical features
        
        SENSORY EXAMINATION：No pathological findings
      - SYMPTOMATIC: Due to trauma, viruses, tumor....
        
        Sweet ́s criteria
        
        Other associated diseases
        
        Multiple sclerosis
        
        Traumatism
        
        Herpes viruses
        
        Tumors
        
        Clinical features = classical trigeminal neuralgia
    - - Clinical and neurologic examination
      - Additional tests.
        
        Blood analysis: autoimmune process
        
        Lumbar puncture
        
        Evoked potentials: records of brain potential by stimuli
        
        CT/MRI: multiple sclerosis, tumors
    - - Amitriptyline (Tryptizol ®, Norbitol ®, Deprelio ®): 30-75mg/d in three doses.
        It causes dryness of mouth and urinary retention
      - Hydontoins ( Phenytoin ®): 300- 500 mg/d
      - Carbamacepine (Tegretol ®): start with 100mg/12 h, increasing by 100mg every three days until 400-1200mg/daily.
        Good results
      - Clonacepan ( Rivotril ®): 1,5 – 6 mg/d in three doses.
      - Baclofen (Lioseral ®): start with 5mg/d increasing 5-10 mg/d every three days up to 60 mg/d