Published on March 12, 2014
DR MOHAMED ALMAGHRABY PROF OF INTERNAL MEDICINE
Headache affects most people at least occasionally. Headache denotes pain or discomfort from the level of the brows back to the suboccipital region.
Pain sensitive structures leading to headache are: Cranial venous sinuses with afferent veins Arteries at base of the brain and their major branches Arteries of the dura Dura near base of brain and large arteries All extracranial structures
Primary headache It is a condition in which headache is a primary manifestation with no underlying disease. It is usually benign and recurrent Secondary headache It is a condition in which headache is a secondary manifestation of an underlying disease process. It is usually sudden and progressive
Migraine Tension type headache Cluster headache Other benign headache
It is the most common of the primary headache disorders It is due to pain from vascular structures and muscular sources More common in women Episodic and chronic forms Pain characteristics: pressing/tightening quality, mild to moderate severity, bilateral location and no aggravation by routine physical activity
It is an idiopathic recurring headache disorder Attacks last 4-72 hours Typically headache is unilateral, have a pulsating quality, moderate to severe in intensity Aggravated by routine physical activity Associated with nausea, vomiting, photophobia and phonophobia May be preceded by visual, sensory, motor or autonomic manifestations (AURA)
Symptomatic therapy: analgesics such as paracetamol and non steroidal anti- inflammatory drugs Specific abortive therapy: given to shorten the attack or decrease the severity of headache as ergotamine and sumatriptan Prophylactic (preventive) therapy: beta blockers, calcium channel blockers and tricyclic antidepressants.
It is extremely severe headache Unilateral headache that produce pain in the area around and above the eye Attacks lasts 15 minutes to 3 hours Occurring as often as 8 times daily and lasts from weeks to months
Aneurysms, arteriovenous malformation [AVMs] and subarachnoid hemorrhage Meningitis Stroke Trigeminal neuralgia Temporal arteritis Hypertension Benign intracranial hypertension Lumbar puncture headache Referred headache: due to diseases of the eye, ear, nasal sinuses, mouth and teeth Psychogenic headache: in cases of depression and anxiety states, usually in the form of sense of pressure or bandage around the head
Onset after age 50 Sudden onset Increased frequency and severity New onset with risk factors for HIV or cancer Associated with systemic illness (fever, rash) Altered consciousness Significant trauma
Facial pain must be distinguished from headache. The most common cause of facial pain by far is dental; provocation by hot, cold, or sweet foods is typical. Trigeminal and, less commonly, glossopharyngeal neuralgia are frequent causes of facial pain. Neuralgias are painful disorders characterized by paroxysmal, fleeting, often electric shock–like episodes that are frequently caused by demyelinating lesions of nerves. Vague, poorly localized, continuous facial pain is characteristic of nasopharyngeal carcinoma.
Function: smell Its lesion causes anosmia Bilateral anosmia is usually due to local cause in the nose as common cold
Function: vision Its lesion causes total blindness in one eye if there is complete section of one optic nerve
Function: it is purely motor and is responsible for lifting the upper eyelid, turning the eye upward, downward and medially, constricting the pupil and accommodating the eye Its lesion causes squint, diplopia and ptosis (drooping of the upper eyelid) with dilated pupil and loss of accommodation
3rd NERVE PALSY
Function: purely motor turning the eye downward and laterally Its lesion causes squint and diplopia
Function: it contains both sensory and motor fibers It carries sensation from the face through three divisions; optic, maxillary and mandibular nerves It supplies motor fibers to muscles of mastication Its lesion causes: A- sensory affection: loss of the sensation on the corresponding side of the face with loss of corneal reflex B- motor affection: weakness of the muscles of mastication on the same side of the lesion
It is severe stabbing pain along one or more of the sensory branches of trigeminal nerves over the face It is of unknown cause The attack may be precipitated by movements of the jaws as chewing, laughing, brushing of the teeth Between the paroxysms of pain, the patient is asymptomatic Treatment: analgesics, anticonvulsant as carbamazepine, lesioning of the gasserian ganglion (either by radiofrequency or glycerol injection) or posterior fossa craniotomy to releive the compression of trigeminal nerve
Function: supply the lateral rectus muscle of the eye ball, responsible for turning the eye laterally Its lesion causes squint, diplopia on looking outwards towards the paralysed side
Function: both motor and sensory a- supplies the muscles of facial expression, the auricular muscles, the stapedius, the posterior belly of the digastric, and the styloid muscle b- recieves taste fibers of the anterior 2/3 of the tongue, the floor of the mouth and the palate c- supplies the submandibular and sublingual salivary glands and the lacrimal gland The upper part of its motor nucleus is bilaterally supplied from the pyramidal tracts of both sides, while the lower part is unilaterally supplied from the pyramidal tracts of the opposite side only
Facial nerve lesion The lesion may be UMNL affecting the pyramidal tracts above the facial nucleus LMNL affecting the facial motor nucleus or the nerve itself
In UMNL: The angle of the mouth will sag Obliteration of the nasolabial fold on the affected side Saliva will dribble from the corner of the mouth Inability to expose the teeth fully on the affected side Inability to blow the teeth on the affected side
In LMNL: There are in addition: Inability to close the eye Inabilty to raise the eye brows with absence of wrinkles of the forehead on the affected side
Definition: unilateral facial paralysis of sudden onset and unknown cause Etiology: it is due to ischemia and edema of the facial nerve caused by cold exposure, secondary to viral and/or autoimmune reactions Clinical picture: acute onset of pain behind the ear, complete paralysis of the facial muscles on the affected side of LMN nature, impairment of taste sensation of the anterior 2/3 of the tongue on the same side
Treatment: Measures to prevent corneal drying as natural tears, isotonic saline and methyl cellulose drops Medical: corticosteroids, vitamins and antiviral (acyclovir) Physiotherapy Surgical: hypoglossal facial nerve anastomosis if no improvement after 6-12 months
Function: the cochlear division conducts nerve impulses concerned with sound, while the vestibular division conducts nerve impulses concerning the position and movements of the head Its lesion causes tinnitus, deafness, vertigo, ipsilateral incoordination and spontaneous nystagmus
Function: motor to the stylopharyngeus and superior constrictor muscles of the pharynx, sensory from the pharynx, tonsils and posterior 1/3 of the tongue and taste sensation from posterior 1/3 of the tongue Its lesion causes loss of taste and common sensations from the posterior 1/3 of the tongue and loss of pharyngeal reflex on the same side of the lesion
Function: 1. motor to the soft palate, pharynx and larynx 2. sensory from the skin over the external auditory meatus and the mucous membrane lining the gastrointestinal tract and respiratory tract 3. autonomic fibers to the heart, the gastrointestinal tract and the bronchial tree Its lesion causes hoarseness or absence of voice
Function: the cranial part joins the vagus nerve and shares in the innervation of the soft palate pharynx and larynx. The spinal part supplies strenomastoid and trapezius muscles Its lesion causes weakness of the sternomastoid and trapezius muscles
Function: carries motor fibers to the muscles of the tongue Its lesion causes unilateral deviation of the tongue
Migraine and the trigeminal nerve. ... (the fifth cranial nerve, ... Migraine and the trigeminal nerve Individuals can experience facial pain when they ...
The presentation of headache and ptosis will most likely unveil a painful cranial nerve III palsy ... headache and other pain ... facial nerve palsy ...
paretic convergence squint with bilateral sixth nerve palsy, ... catastrophe.1,2 The International Headache Society ... cranial neuralgia, and facial pain.
Cranial nerve palsy and Pain (67 causes) Cranial nerve palsy and ... 88 causes of Cranial nerve palsy . 1. ... types of Cranial nerve palsy: Cranial nerve ...
... Sixth cranial nerve palsy; ... and pain around the eye. Sixth nerve palsy may be ... Zuker RM. Cranial nerve defects in congenital facial ...
Sixth nerve palsy, ... VIth cranial nerve palsy; Abducens nerve palsy; Characteristics ... plus facial pain and paralysis, ...
Bell's Palsy (facial paralysis) information sheet compiled by the National Institute of Neurological Disorders and Stroke (NINDS).
... facial pain along the trigeminal nerve divisions. The trigeminal nerve is a paired cranial nerve ... trigeminal neuralgia. Chronic pain can ...
What are cranial neuralgias, facial pain, ... Many patients equate severe headache ... Neuralgia means nerve pain (neur=nerve + algia=pain). Cranial ...
The Trigeminal and Facial ... nerve is idiopathic facial nerve paralysis, or Bell’s palsy. ... The facial nerve is the 7th cranial nerve innervating the ...