Documente Academic
Documente Profesional
Documente Cultură
Objectives
1.
2.
3.
Pre-test
Q1: choose best answer
{
Convergence theory
Neuro-glial signaling theory
Hyperexcitability theory
Gating theory
Pre-test
Q2: choose best answer
{
Cervicogenic headache
Jaw pain with angina pectoris
Forehead pain with carotid dissection
Sharp, localized pain
All of the above
A,B, and C only
Pre-test
Q3 : True or false statements
{
Pre-test
Q4 : True or false statements
{
Pre-test
Q5: Best match
1.
2.
3.
4.
5.
Extension of
trigeminal nucleus
caudalis
Sensory nucleus of
cranial nerve V
Ophthalmic branch of
cranial nerve V
Cranial nerve X
C2-3 sensory
branches
A.
B.
C.
D.
E.
Subnucleus
interpolaris
Auricular nerve
Posterior head and
upper neck
Forehead innervation
Substantia gelatinosa
Discussion
10
Referred pain
{
{
{
{
Definition
Mechanisms
Manifestations
Management
11
Definition
MW dictionary: a pain subjectively
localized in one region though due
to irritation in another region
{ Pain felt in undamaged area of
body, away from actual injury;
sclerotomic in distribution, felt
distant from its origin
{
12
Cranial structures,
z
Facial structures,
z
Neck structures,
z
13
14
Sensitization sites
15
Expression of hyperexcitability
{
Viscero-sensory, sensory-visceral
z
z
Sensory-special sensory
z
Sensory-sensory
z
NTS= nucleus tractus solitarius; TNC= trigeminal subnucleus caudalis; NO= nucleus olivarius
16
Neural-glial signaling
{
{
{
17
Anatomical/physiological substrates
Relevance to head pain
{
STT= spinal trigeminal tract; STN= spinal trigeminal nucleus; TNC= trigeminal subnucleus caudalis;
SG= substantia gelatinosa
18
Anatomical/physiological substrates
Relevance to head pain
{
Prominent internuclear
connections between all
trigeminal sensory nuclei
exist
http://thalamus.wustl.edu/course/face.html
STN= spinal trigeminal nucleus; TNO,I,C= trigeminal subnucleus oralis, interpolaris, caudalis
19
Migraine
Migrainous vertigo
z
Illustrative case #2
illustrative case #1
Illustrative case #3
Illustrative case #4
20
21
22
1-3
23
Coincidental
Co-morbid (e.g., BRPV, motion sickness)
Shared genetic
Mechanistic:
z
z
z
24
Pharmacological management
{
{
{
Lempert et al., 2009. 2Ahn et al, 2009. SORT= strength of recommendation taxonomy; CGRP=
calcitonin gene related peptide
25
26
27
Radiological finding
28
Features
II
III
IV
Cerebellar hypoplasia
29
30
General features
{
{
{
31
Clinical manifestations
{
{
{
{
{
{
Dysphonia
Frequent respiratory tract infections
Coughing when swallowing foods and fluids
Headaches of CMI
{
Chiari distinctive
z
z
Occipital/suboccipital
Aggravated by Valsalva-like maneuvers,
physical exertion and sudden postural changes
Could be
z
z
33
Diagnostic criteria
ICHD 7.7
A.
B.
34
35
Management
{
{
{
Quite controversial
Individualized
Medical if no signs or symptoms of
brainstem or spinal cord compression
Posterior fossa decompression +
laminectomy
z
37
{
{
{
{
38
Radiological findings
Early Lateral
view
Late Lateral
view
AP
view
39
Pain in distribution
of V1 with middle
cerebral artery
territory stroke
Pain in distribution
of C2 with
vertebral artery
proper or PICA
distribution stroke
40
41
B.
C.
42
B.
C.
D.
43
Varied phenotypes
z
z
z
Mitsias et al.
Migraine-like
Tension-type like
Trigeminal autonomic cephalgia like
44
Pharmacological management
{
{
{
45
46
47
III.a. Arthralgia
III.b. Osteoarthritis of the TMJ
III.c. Osteoarthrosis of the TMJ
48
Female gender
Increasing age
Systemic joint hyperlaxity
Bruxism
Psychosocial (stress,
anxiety)
49
{
{
{
50
Pharmacological management
{
51
52
53
Post-test
Q1: choose best answer
{
54
Post-test
Q2: choose best answer
{
Migraine
Chest pain with abdominal distention
Forehead pain with giant cell arteritis
All of the above
A and C only
55
Post-test
Q3 : True or false statements
{
56
Post-test
Q4 : True or false statements
{
57
Post-test
Q5: Best match
1.
2.
3.
4.
5.
TMJ pain
Sensory nucleus of
cranial nerve V
Ophthalmic branch of
cranial nerve V
Basilar invagination
Pain with abdominal
distention
A.
B.
C.
D.
E.
Viscero-somatic
reflex
Cervicogenic
headache
Subnucleus oralis
Referred pain in face
and head
M1 segment of
middle cerebral
artery
58