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    Facial Pain, Headache, and Otalgia: Khristine T. Girado - Pizarro, MD, FPSO-HNS

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    Aria Jean Mostajo
    This document discusses various types of facial pain, headaches, and ear pain (otalgia). It categorizes 15 major categories of headaches and describes characteristics of specific types such as migraines, muscle contraction headaches, headaches due to nasal vasomotor reaction, and headaches caused by diseases of the eyes, ears, nose, sinuses, teeth or neck. It provides details on evaluating headaches and diagnosing underlying causes, which may involve imaging tests, neurological exams, and psychological evaluations.

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    Facial Pain, Headache, and Otalgia: Khristine T. Girado - Pizarro, MD, FPSO-HNS

    Uploaded by

    Aria Jean Mostajo
    37 views18 pages
    This document discusses various types of facial pain, headaches, and ear pain (otalgia). It categorizes 15 major categories of headaches and describes characteristics of specific types such as migraines, muscle contraction headaches, headaches due to nasal vasomotor reaction, and headaches caused by diseases of the eyes, ears, nose, sinuses, teeth or neck. It provides details on evaluating headaches and diagnosing underlying causes, which may involve imaging tests, neurological exams, and psychological evaluations.

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    This document discusses various types of facial pain, headaches, and ear pain (otalgia). It categorizes 15 major categories of headaches and describes characteristics of specific types such as migraines, muscle contraction headaches, headaches due to nasal vasomotor reaction, and headaches caused by diseases of the eyes, ears, nose, sinuses, teeth or neck. It provides details on evaluating headaches and diagnosing underlying causes, which may involve imaging tests, neurological exams, and psychological evaluations.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    37 views18 pages

    Facial Pain, Headache, and Otalgia: Khristine T. Girado - Pizarro, MD, FPSO-HNS

    Uploaded by

    Aria Jean Mostajo
    This document discusses various types of facial pain, headaches, and ear pain (otalgia). It categorizes 15 major categories of headaches and describes characteristics of specific types such as migraines, muscle contraction headaches, headaches due to nasal vasomotor reaction, and headaches caused by diseases of the eyes, ears, nose, sinuses, teeth or neck. It provides details on evaluating headaches and diagnosing underlying causes, which may involve imaging tests, neurological exams, and psychological evaluations.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 18

    Facial Pain, Headache,

    and Otalgia
    Khristine T. Girado - Pizarro, MD, FPSO-HNS
    Major Categories
    1. Vascular headache of migraine type

    2. Muscle - contraction headache

    3. Combined Headache: Vascular + Muscle-contraction

    4. Headache of Nasal Vasomotor Reaction

    5. Headache of delusional, conversion, or hypochondriacal


    states
    Major Categories
    6. Nonmigrainous Vascular Headaches

    7. Traction Headache

    8. Headache due to overt cranial inflammation

    9 - 13. Headache due to disease of ocular, aural, nasal and


    sinus, dental, or other cranial or neck structures

    14. cranial neuritides

    15. cranial neuralgias


    Vascular Headache of
    Migraine Type
    A. “classic” migraine

    B. “common” migraine

    C. “cluster” headache

    D. “hemiplegic” and “ophthalmoplegic” migraine

    E. “lower half” headache


    “classic” migraine

    • sharply defined, transient visual and other sensory or


    motor prodromes or both
    “common” migraine

    • without striking prodromes

    • also known as “sick headache” or atypical migraine

    • “menstrual” or “pre-menstrual” headache, “summer”,


    “Monday”
    “cluster” headache
    • predominantly unilateral facial and head pain occurs primarily in
    men

    • sudden onset and abrupt cessation

    • most excruciating vascular headache

    • no prodrome; 1 to 3 attacks/day; 45 mins to 1 hour, occurs in


    clusters during a period of up to 3 months

    • focus of pain is usually entered behind one eye, with radiation to


    involve the entire side of the face and neck

    • flushing, sweating, rhinorrhea, and increased lacrimation


    “cluster” headache
    • mechanism: dilatation of extracranial and dural arteries

    • treatment:

    1. 100% oxygen inhalation

    2. Ergotamine inhalation - most effective

    3. lidocaine nose drops

    4. Methysergide - prophylaxis; Propranolol - preventive

    5. during attacks - ergotamine, methysergide, corticosteroids, lithium


    carbonate, Ca channel blocker

    6. psychotherapy
    Muscle-Contraction
    Headache

    • chronic in nature

    • ache or sensations of tightness, pressure or constriction;


    “hat band”

    • frontal, temporal, occipital and sub occipital regions

    • tension, psychogenic and nervous headaches


    Headache of Nasal
    Vasomotor Reaction
    • Nasal obstruction, with or without rhinorrhea, tightness or
    burning

    • recurrent and resulting from congestion and edema of nasal


    and paranasal mucus membrane

    • not proven to be due to allergens, infectious agents or local


    gross anatomic defects

    • predominantly anterior in location and mild to moderate in


    intensity

    • “vasomotor rhinitis”
    Sinusitis

    • Maxillary - anterior facial with radiation into teeth, orbital


    and malar region

    • Ethmoids - interocular with spread into frontal location

    • Frontal - forehead, interocular, and temporal areas

    • Sphenoid - retro-orbital, radiation towards vertex and


    occasionally mastoid areas
    Causes of Otalgia
    Causes of Otalgia
    Evaluation of Headache
    • Age of patient at onset

    • Duration of problem

    • Duration single attacks

    • Frequency of attacks

    • more frequent occurrence at a certain time of day

    • onset following trauma or development of another


    medical problem
    Evaluation of Headache
    1. prodromal or associated symptoms (if any)

    2. location

    3. quality

    4. precipitating factors

    5. factors intensifying pain

    6. response to medication

    7. recent or previous dental work

    8. psychosocial history
    Clinical Examination
    • auscultation for bruit

    • eye examination

    • evaluation of CN function

    • palpation for arterial tenderness

    • palpation for muscle spasm and tenderness

    • evaluation for nuchal rigidity

    • complete ORL examination including evaluation of occlusion

    • palpation of TMJ
    Diagnostics
    • PNS, Skull, dental, cervical spine, TMJ radiographs

    • Head CT Scan

    • Head MRI

    • Lumbar puncture

    • EEG

    • Personality profile

    • Thermography

    minnesota multiphase personality inventory

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