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Headache & Facial Pain. John F. Rothrock, M.D. Professor & Vice Chair, UAB Neurology. Headache Diagnosis: Primary vs Secondary. When is “migraine” really migraine?.

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headache facial pain

Headache & Facial Pain

John F. Rothrock, M.D.

Professor & Vice Chair, UAB Neurology

headache diagnosis primary vs secondary

Headache Diagnosis: Primary vs Secondary

When is “migraine” reallymigraine?

slide3

19 yo Female university coed reports 10 years of episodic, unilateral, pulsatile headache, often heralded by “sparkles & blind spots” in the right periphery of vision. Midrin no long helps.

secondary headache
“Secondary” Headache
  • subarachnoid hemorrhage
  • meningitis
  • ICP too high or low
  • cerebral sinus thrombosis
  • pituitary apoplexy

… and many more

clues to secondary headache
Clues to Secondary Headache
  • fever, seizure, behavioral change, etc
  • age >55
  • posterior location
  • neurological deficit
  • abrupt onset/severe intensity: “thunderclap”
primary headache
“Primary” Headache
  • tension-type
  • migraine
  • cluster
  • all the rest
recurrent disabling headache
Recurrent Disabling Headache
  • it’s usually migraine
what is migraine
What is Migraine?
  • prevalence
  • cost
  • clinical definition
  • clinical phenotypes/ “chronification”
what causes migraine
What Causes Migraine?
  • vascular theory
  • trigeminovascular theory
  • central theory
facial pain
Facial Pain
  • typical” vs. “atypical”
  • “symptomatic” vs. “primary”
trigeminal neuralgia diagnosis
Trigeminal Neuralgia: Diagnosis

Table 1 Trigeminal Neuralgia: IHS Diagnostic Criteria

A. Paroxysmal attacks of facial or frontal pain which last a few seconds to less than two minutes

B. Pain has at least 4 of the following characteristics:

(1) distribution along one or more distributions of the trigeminal nerve.

(2) sudden, intense, sharp, superficial, stabbing or burning in quality.

C. No neurologic deficit

D. Attacks are stereotyped in the individual patient.

E. Exclusion of other causes of facial pain by history, physician examination and special investigations when necessary.

trigeminal neuralgia treatment
Trigeminal Neuralgia: Treatment
  • pharmacologic
  • “procedural”
  • anesthesia dolorosa
atypical symptomatic facial pain
“Atypical” / Symptomatic Facial Pain
  • carotid dissection
  • giant cell (“temporal” arteritis)
  • acute V-Z & post-herpetic neuralgia
  • Tolosa – Hunt syndrome