Neuralgia and Trigeminal Neuralgia
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Questions and Answers

What is the primary characteristic of trigeminal neuralgia?

  • Recurring paroxysmal severe pain of brief duration (correct)
  • Severe pain lasting for hours
  • Pain in the tonsil region only
  • Intractable pain in the nose, eye, and cheek

    • Which of the following is a common cause of symptomatic neuralgia?

  • Infective and neoplastic lesions of the paranasal sinus
  • Tumours of the brain stem (correct)
  • Glossopharyngeal neuralgia
  • Sluder's neuralgia

    • What is the typical treatment for trigeminal neuralgia that does not respond to medical therapy?

  • Phenytoin
  • Surgery (correct)
  • Analgesics
  • Baclofen

    • Which of the following neuralgias is characterized by intractable pain in the nose, eye, and cheek?

    <p>Sluder's neuralgia</p> Signup and view all the answers

    Which of the following is a characteristic of glossopharyngeal neuralgia?

    <p>Severe, sudden episodes of pain in the tonsil region</p> Signup and view all the answers

    What is the primary cause of post herpetic neuralgia?

    <p>Herpes zoster affecting the trigeminal nerve ganglion</p> Signup and view all the answers

    What is the minimum duration of a headache for it to be considered a migraine?

    <p>4 hours</p> Signup and view all the answers

    Which of the following is NOT a common migraine trigger?

    <p>Frequent exercise</p> Signup and view all the answers

    How many of the following criteria must be fulfilled for a migraine diagnosis: nausea and/or vomiting, photophobia and phonophobia?

    <p>At least one</p> Signup and view all the answers

    What is the recommended approach to caffeine consumption in the migraine lifestyle?

    <p>Maintain a minimum daily dose of caffeine</p> Signup and view all the answers

    Which of the following medications may make migraines worse?

    <p>Oral contraceptives</p> Signup and view all the answers

    What is the treatment approach for moderate and severe migraine attacks?

    <p>Selective Serotonin antagonists</p> Signup and view all the answers

    What is the most common premonitory symptom of migraine?

    <p>Visual symptoms</p> Signup and view all the answers

    Which type of headache is often accompanied by nausea and vomiting?

    <p>Migraine</p> Signup and view all the answers

    What is the pathology behind migraine?

    <p>Vascular dilatation</p> Signup and view all the answers

    What is the characteristic of migraine that is often unilateral or bilateral?

    <p>Headache</p> Signup and view all the answers

    What is the hereditary component of migraine?

    <p>Herido-familial predisposition</p> Signup and view all the answers

    What is the distinguishing feature of classic migraine?

    <p>Migraine with aura</p> Signup and view all the answers

    What is the minimum diastolic blood pressure required to avoid visual loss from severe papilledema with macular edema?

    <p>140</p> Signup and view all the answers

    Which type of headache is often accompanied by a congested feeling with nasal drainage and worsened by changing posture?

    <p>Nasal sinus headache</p> Signup and view all the answers

    What is the primary cause of pain in patients with cervical spondylosis?

    <p>Prolapsed cervical discs</p> Signup and view all the answers

    Which of the following is NOT a symptom of pheochromocytoma?

    <p>Cervical pain</p> Signup and view all the answers

    What is the primary treatment for TMJ syndrome?

    <p>Dental devices and analgesics</p> Signup and view all the answers

    What is the most important step in headache work-up?

    <p>Review of HISTORY</p> Signup and view all the answers

    In a patient with a suspected brain tumor, what is the next step in the evaluation?

    <p>Brain scan</p> Signup and view all the answers

    What is the typical presentation of Bell's Palsy?

    <p>Abrupt onset with maximal weakness by 48 hours</p> Signup and view all the answers

    What is the purpose of electromyography in Bell's Palsy?

    <p>To assess the severity of the paralysis</p> Signup and view all the answers

    What is the incidence of Bell's Palsy?

    <p>1 in 60 or 70 persons</p> Signup and view all the answers

    What is a clinical feature suggesting a serious cause of headache?

    <p>All of the above</p> Signup and view all the answers

    What is the primary goal of treatment in Bell's Palsy?

    <p>To protect the eye during sleep</p> Signup and view all the answers

    Study Notes

    Neuralgias

    • Trigeminal neuralgia:
      • Characterized by recurring paroxysmal severe pain, brief duration (seconds) in the territory of the trigeminal nerve
      • Spontaneously or initiated by chewing, talking, touching the affected side of the face
      • Unknown aetiology, females affected more than males
      • Treated with pharmacologic therapy (Carbamazepine, Phenytoin, Baclofen) and surgery (in case of failure of medical therapy)
    • Glossopharyngeal neuralgia:
      • Unknown cause, equal incidence in both sexes
      • Severe, sudden episodes of pain in the tonsil region (one side only), ipsilateral ear
      • Pain severe for 1-2 hours, recurs daily
      • Treated like trigeminal neuralgia
    • Sluder's neuralgia:
      • Intractable pain in the nose, eye, cheek, and lower jaw
      • May be due to lesion of the sphenopalatine ganglion
      • Treated with analgesics, neurectomy

    Symptomatic Neuralgias

    Intracranial Lesions

    • Central lesions:
      • Tumors of the brain stem
      • Multiple Sclerosis
      • Thrombotic lesions
      • Metastasis
      • Occult naso-pharyngeal carcinoma
    • Post-herpetic neuralgia:
      • Herpes zoster may affect trigeminal nerve ganglion
      • Vesicular rash covers one division commonly the 1st with severe pain

    Extracranial Lesions

    • Sinus disease:
      • Infective and neoplastic lesions of the paranasal sinus
      • Facial pain and dental pain, loss of teeth

    Migraine

    • Criteria for migraine:
      • At least 5 attacks fulfilling the following:
        • Headaches lasting 4 to 72 hours
        • During headache, at least one of the following:
          • Nausea and/or vomiting
          • Photophobia and phonophobia
      • At least 2 of the following criteria:
        • Unilateral location
        • Pulsating quality
        • Moderate or severe intensity
        • Aggravated by physical activity
    • Quick Screening Tool for Migraine:
      • Light sensitivity with headache
      • Nausea with headache
      • Decreased ability to function with headache
      • Any 2 out of 3 = Migraine
    • Common migraine triggers:
      • Irregular meals
      • Caffeine, chocolate, nuts, bananas, etc.
      • Irregular sleep (particularly excessive sleep)
      • Stress
      • Flickering lights
      • Air travel, change in barometric pressure
      • Menstrual period
      • Medications that may make migraines worse
    • The Migraine Lifestyle:
      • Timing of meals, balance of diet
      • Sleep (don't oversleep or undersleep)
      • Caffeine (minimum daily dose)
      • Exercise (the more aerobic exercise the better)
    • Treatment:
      • Simple analgesics in mild attacks
      • Moderate and severe attacks are treated with selective Serotonin antagonists during the attack of headache

    Other Headaches

    • Dental neuralgia:
      • Dental caries
      • Dental extraction
    • Temporomandibular joint pain
    • Nasal sinus:
      • Acute pain is almost always present
      • Chronic pain is almost always absent
    • TMJ:
      • Pain in trigeminal and facial nerve areas
      • Age 15-40, F>M
      • Originates from the jaw joint and is worse with chewing
      • Manage with dental devices and analgesics

    Headache Work-up

    • Review:
      • HISTORY, HISTORY, HISTORY!
      • CN evaluation
      • Neurological work-up when indicated
      • Blood pressure
      • Refraction
      • Binocular/accommodation testing
      • Sinus evaluation
    • Complete ocular health assessment:
      • Visual field testing
    • Correct referral to a neurologist
    • Consider brain scan if suspect brain tumor, hx of seizures, recent head trauma, significant changes in HA, abnormal neurological signs

    Bell's Palsy

    • The most common form idiopathic
    • Incidence: 1 in 60 or 70 persons
    • Pathogenesis unknown
    • Clinical Presentation:
      • Onset: abrupt, maximal weakness by 48 hours
      • Pain behind the ear
      • Taste sensation may be lost unilaterally (80% of patients recover)
    • Treatment:
      • Protection of the eye during sleep
      • Massage of the weakened muscles
      • Splint
      • Prednisone

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    Description

    This quiz covers the basics of neuralgia, with a focus on trigeminal neuralgia, including its symptoms, causes, and treatments. Learn about the characteristics of this condition, such as recurring severe pain in the face, and how it is diagnosed and managed.

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