Headache

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Headache

One of the most common of all human physical complaint

Is actually a symptom rather than a disease entity
It may indicate
 Organic disease (neurologic or other disease)

 Stress response

 Vasodilatation (migraine)

 Skeletal muscle tension (tension headache) or

 Combination of factors.

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Headache----
Classification
1. Primary headache
Is one for which no organic cause can be identified.
Includes :
 Migraine headache
 Tension headache and
 Cluster headache

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Headache----

2. Secondary headache
 Symptom associated with an organic cause, such as
 Brain tumor or
 An aneurysm.
 Most headaches do not indicate serious disease
 Persistent headaches require further investigation.
 Serious disorders related to headache include:-
 Brain tumor
 Subarachnoid hemorrhage
 Stroke
 Severe hypertension
 Meningitis
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 Head injuries
 1. Migraine Headache
Periodic and recurrent attacks of severe headache.
The cause of migraine has not been clearly demonstrate
It is primarily a vascular disturbance
More commonly in women
Has a strong familial tendency.
The typical time of onset is puberty, and the incidence is
highest in
 Adults 20 to 35 years of age.
 Most patients have migraine without an aura.
Pathophysiology
 Abnormal metabolism of serotonin
 Serotonin -a vasoactive neurotransmitter
 Found in platelets and cells of the brain
 The headache is preceded by a rise in plasma serotonin

6 Dilates the cerebral vessels
Classification criteria for migraine headache
A. At least 5 attacks fulfilling criteria B-D
B. Headache attacks lasting 4-72 h (untreated)
C. Headache has 2 of the following characteristics:
1. Unilateral location
2. Pulsating quality
3. Moderate or severe pain intensity
4. Aggravation by or causing avoidance of routine
physical activity (eg, walking, climbing stairs)
D. During headache 1 of the following:
1. Nausea and/or vomiting
2. Photophobia and phonophobia

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Classification criteria for migraine headache--
o Osmophobia
o Olfactophobia
 (Osmophobia or olfactophobia (from Latin olfacto, "to smell
at") refers to a fear, aversion, or psychological hypersensitivity
to odors.)
o The pain is generally unilateral, the left side being more
frequently affected
 Migraine headache-throbbing, unilateral, and retro-orbital in
location

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1. Migraine Headache----
Triggering factors
 Stress
 Alcohol(wine)
 Foods like chocolate, cheese, etc
 Menses
 OCP
 Infection
 Trauma
 Vasodilators
 Excitement
 Bright vision

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1. Migraine Headache----
Clinical manifestations
o The migraine with aura can be divided into four phases:
 Prodrome
 Aura
 Headache
 Recovery
1.The prodrome phase
o Experienced by 60% of patients
o Occur hours to days before a migraine headache.
o Symptoms include
 Depression
 Irritability
 Feeling cold
 Food cravings
 Anorexia, change in activity level, increased urination, diarrhea,
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or constipation.
1. Migraine Headache----
2. Aura phase
o Occurs in up to 31% of patients.
o The aura usually lasts less than an hour.
o This period is characterized by focal neurologic symptoms.
o Visual disturbances (ie, light flashes and bright spots)
Other symptoms include;
o Numbness and tingling of the lips, face, or hands
o Mild confusion
o Slight weakness of an extremity
o Drowsiness; and dizziness
o Painless vasoconstriction that is the initial physiologic change
characteristic of classic migraine.
o Cerebral blood flow is reduced throughout the brain.

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1. Migraine Headache----
3. Headache Phase
 Vasodilatation
 Decline in serotonin levels
 Headache (unilateral in 60% of patients)
 This headache is severe and incapacitating often associated with
photophobia, nausea, and vomiting.
 Its duration varies, ranging from 4 to 72 hours if greater than 72
hours (untreated)
 Pallor
 Anorexia
 Sweating
 Throbbing pain that is synchronous with the pulse
 Edema and unilateral headache
4. Recovery Phase
o Pain gradually subsides.
o Muscle contraction in the neck and scalp is common,
o Any physical exertion exacerbates the headache pain.
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1. Migraine Headache----

General Management
 Propranolol 80 -240 mg/d- Most widely used or
 Amitriptyline 10–150mg/d (Nocte)
 Verapamil 120–320 mg/d or
 Ergotamine tartrate (Cafergot) 1mg/d
 Relaxation training, cognitive behavioral therapies, stress mgt
training.
 Sumatriptan (50 mg po may be repeated after 2 hrs) – More
effective than oral cafergot. Sumatriptan is a serotonin receptor
agonist
 Head slightly elevated
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General Management of migraine headache ---

 Drinking black coffee

 Analgesics, sedatives, anti-anxiety & anti-emetic
 Proper diet, adequate rest
 Identifying precipitating factors
 Regular periods of exercise and relaxation

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2.Tension headache
Is also called muscle-contraction headache
It is the most common type of headache and is also
considered the most difficult to treat, and is more chronic.
Due to irritation of sensitive nerve endings in the head, jaw,
and neck.
From prolonged muscle contraction in the face, head, and
neck
Characterized by a steady, constant feeling of pressure.
Usually begins in the forehead, temple, or back of the neck.
It is often band like or may be described as “a weight on top
of my head.”
Precipitating factors include fatigue, stress, and poor
posture.
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 Tension headache…
Tension-type headaches are divided into two main
categories. Episodic tension-type headaches
 It can last from 30 minutes to a week.
 It occur less than 15 days a month for at least three
months.
Chronic tension-type headaches
 It lasts hours and may be constant.
 It can occur 15 or more days a month for at least three
months.

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Tension-type headache
1.Infrequent episodic tension-type headache
2 .Frequent episodic tension-type headache

3.Chronic tension-type headache

4.Probable tension-type headache

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 Infrequent episodic tension-type headache
Diagnostic criteria:
A. At least 10 episodes of headache occurring on <1 day/month
on average (<12 days/year) and fulfilling criteria B-D
B. Lasting from 30 minutes to 7 days
C. At least two of the following four characteristics:
o bilateral location
o pressing or tightening (non-pulsating) quality
o mild or moderate intensity
o not aggravated by routine physical activity such as walking or
climbing stairs
D. Both of the following:
o no nausea or vomiting
o no more than one of photophobia or phonophobia
 E. Not better accounted for by another ICHD-3 diagnosis
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 Frequent episodic tension-type headache
Diagnostic criteria:
A. At least 10 episodes of headache occurring on 1-14 days/month on
average for >3 months (≥12 and <180 days/year) and fulfilling criteria
B-D
B. Lasting from 30 minutes to 7 days
C. At least two of the following four characteristics:
o bilateral location
o pressing or tightening (non-pulsating) quality
o mild or moderate intensity
o not aggravated by routine physical activity such as walking or
climbing stairs
D. Both of the following:
o no nausea or vomiting
o no more than one of photophobia or phonophobia
20E. Not better accounted for by another ICHD-3 diagnosis
 Chronic tension-type headache
Diagnostic criteria:
A. Headache occurring on ≥15 days/month on average for >3 months
(≥180 days/year), fulfilling criteria B-D
B. Lasting hours to days, or unremitting
C. At least two of the following four characteristics:
o bilateral location
o pressing or tightening (non-pulsating) quality
o mild or moderate intensity
o not aggravated by routine physical activity such as walking or
climbing stairs
D. Both of the following:
o no more than one of photophobia, phonophobia or mild nausea
o neither moderate or severe nausea nor vomiting
E. Not better accounted for by another ICHD-3 diagnosis
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 Probable tension-type headache
 Missing one of the features required to fulfill all criteria for
a type or subtype of tension-type headache coded above,
and not fulfilling criteria for another headache disorder.
 It can be further divided into three categories namely:
 Probable infrequent episodic tension-type headache: One or
more episodes of headache fulfilling criteria for Infrequent
episodic tension-type headache.
 Probable frequent episodic tension-type headache: Episodes
of headache fulfilling criteria for Frequent episodic
tension-type headache.
 Probable chronic tension-type headache: Headache
fulfilling criteria for Chronic episodic tension-type
headache.
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 Clinical manifestation
 The pain is usually bilateral, occurring most often in the back of the
neck
 It does not interfere with sleep
 Characteristic of the pain is:
 Tight, Squeezing, Band like pressure, Chronic and Dull and

persistent
Management
 Rule out any intra cranial or extra cranial diseases
Physical therapy
Massage, hot packs, cervical collars, and correction

of faulty posture.
Pharmacologic therapy
Non narcotic analgesics: Aspirin, acetaminophen
Tranquilizers or codeine
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Prophylactic agent - Amitriptyline.
3.Cluster Headache

Are unilateral and come in clusters of one to eight daily

Excruciating pain localized to the eye and orbit
Radiating to the facial and temporal regions.
Watering of the eye and nasal congestion.
The headache is often described as penetrating and
steady.
It is more frequent in men than in women by ratio of 5:1
The onset is usually between 30 and 60 years of age.
Neither the cause nor the pathophysiology of cluster
headache is fully known.

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 3.Cluster Headache----
Diagnostic criteria:
A. At least 5 attacks fulfilling criteria B-D
B. Severe or very severe unilateral orbital, supraorbital
and/or temporal pain lasting 15-180 min if untreated
C. Headache is accompanied by 1 of the following:
1. Ipsilateral conjunctival injection and/or
lacrimation
2. Ipsilateral nasal congestion and/or rhinorrhoea
3. Ipsilateral eyelid oedema
4. Ipsilateral forehead and facial sweating
5. Ipsilateral miosis and/or ptosis
6. A sense of restlessness or agitation
D.
25 Attacks have a frequency from 1/2 d to 8/days
 Clinical manifestation
There may be conjunctivitis,
Increased lacrimation (tearing).
Nasal congestion on the side of the headache.
A partial horner‟s syndrome (constriction of the pupil) and
ptosis (dropping) of the eye lid on the affected side
Intensely severe pain
Unilateral
Periorbital
15 to 180 minutes
No aura phase
Male predominance

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 Management
o 100% oxygen by face mask for 15 minutes
o Ergotamine tartrate, sumatriptan, steroids
Nursing Management of headache
 Reduce environmental stimuli: light, noise, movement, etc.
 Light massage to tight muscles in neck, scalp, back for tension
headaches
 Apply warm, moist heat to areas of muscle tension
 Teach progressive muscle relaxation to treat and prevent
tension headache
 Encourage patient to become aware of triggering factors and
early symptoms

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 Convulsive Disorders

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 Seizure

 A seizure is an electrical disturbance that interferes with normal

brain function.
 It occurs when abnormal electric signals from the brain change the

way the body functions.

 A seizure is a sudden rush of abnormal electrical activity in your

brain
 Seizure: refers to a disturbance of usual neurological functioning of

relatively abrupt onset that is due to transient disturbance of CNS

activity

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Seizure triggers
 Lack of sleep and stress can increase the risk of seizure activity.
 Missing doses of medication, stress, lack of sleep, and drug and
alcohol use are common reasons for breakthrough seizures.
 Common triggers include:
 Missed medications
 Lack of sleep
 Stress/Anxiety
 Sickness or fever
 Certain medications
 Photosensitive (flashing lights)
 Excessive noise
 Hormonal changes (menstrual cycle)
 Alcohol or drug use
 Herbal supplements
 Low blood sugar(hypoglycemia)
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The four phases of seizure

1.Prodromal phase
 It is a subjective feeling or sensation that can occur several
hours or even days before the actual seizure.
 About 20% of individuals with epilepsy experience this stage

 The most common symptoms of a prodrome include confusion,

anxiety, irritability, headache, tremor, and anger or other mood

disturbances

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The four phases of seizure-------

2.Early ictal phases (Aura)

 Remain 5 to 20 minutes and It lasts 60 minutes
Symptoms
 Bitter, acidic taste
 Déja Vu( feeling of familiarity with a person, place, or thing without
having experienced it)
 Dizziness,Flickering vision,Hallucinations ,Head, arm, or leg pain
 Jamais vu (feeling of unfamiliarity with a person, place, or thing
despite having already experienced it)
 Nausea and Numbness
 Out-of-body sensation
 Ringing or buzzing sounds
 Strange, offensive smells
 Strong feelings of joy, sadness, fear, or anger,Subtle arm or leg
twitching
 Tingling andVision loss or blurring
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The four phases of seizure-------
3.ICTAL PHASE
 This is the stage of the seizure that most people are familiar with and
would identify as a seizure.
 This stage manifests in different ways for each person with epilepsy.
 Arm or leg stiffening ,Chewing or lip-
smacking,Confusion ,Difficulty breathing ,Distractedness ,Drooling
 Eye or head twitching movement in one direction,Hearing
loss,Inability to move or speak
 Loss of bladder and/or bowel control,Memory lapses,
 Sweating,Tremors,Twitching
 Vision loss, blurring, flashing vision and Walking/running

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The four phases of seizure-------

4.Post-itcal phase
 The recovery period following a seizure is called the post-ictal phase.
 Some people recover immediately, while others may require minutes,
hours or days to feel like they’re back at their baseline.
 The length of the post-ictal stage depends directly on the seizure type,
severity, and region of the brain affected.
 Symptoms
 Arm or leg weakness
 Confusion
 Difficulty finding names or words
 Drowsiness
 Feelings of fear, embarrassment, or sadness
 General malaise
 Headaches/migraines
 Hypertension
 Memory loss or Memory lapses
38Nausea
 1.Classification
Partial ofSeizures
seizures

 Simple partial seizure (with motor, sensory, autonomic or

psychic signs)
 Complex partial seizure
 Partial seizure with secondary generalization
2. Primarily generalized seizures
 Absence (Petit mal)
 Tonic – clonic (grand mal)
 Tonic
 Atonic
 Myoclonic
3. Unclassified Seizures
 Neonatal Seizures
39 Infantile Spasms
  Occurs within discrete regions of the brain
1. Partial seizures

 Consciousness is fully preserved during the seizure

 The clinical picture is relatively simple and is termed
simple partial if consciousness is not altered
 If symptomatically more complex & the seizure is
termed complex partial seizure

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 Focal Seizure

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 A. Simple Partial Seizures
 Cause motor, sensory, autonomic or psychic symptom without
an obvious alteration in consciousness.
 Only a finger or hand may shake or the mouth may jerk
uncontrollably
 Unusual or unpleasant sights, sounds, odors or tastes but
without loss of consciousness
Three additional features of partial motor seizures are
1) - The abnormal motor mov’t may begin in very restricted
regions to include a larger portion of the extremity
“Jacksonian March”
2) Pt experiences a localized paresis (Todd’s paralysis) for
minutes to many hours.
3) In rare instance the seizure may continue for hours or days.
42 This condition is termed epilepsia partialis continua.
 B. Complex Partial Seizures
 Characterized by focal seizure activity accompanied by a
transient impairment of the pt’s ability to maintain
normal contact with the env’t
 - Impaired recollection or awareness of the ictal phase
 - Usually begin with an aura
Clinical Picture
 Sudden behavioral arrest or motionless stare
 Amnesia
 Automatism/chewing, lip smacking, swallowing or
“Picking” mov’t of the hands.
 Confusion following the seizure
 Postictal aphasia
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 C. Partial Seizures with secondary Generalization
 Can spread to involve both cerebral hemispheres and
produce generalized seizure
 Motionless or moves automatically but inappropriately
for time and place
 Experience excessive emotions of fear, anger, elation or
irritability
 The person does not remember the episode when it is over

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 2. Generalized
AriseSeizure
from both
/ Grand hemispheres simultaneously
mal Seizure/

(bilateral clinical and electrographic events with any

detectable focal onset)
 Intense rigidity of the entire body followed by jerky
alternations of muscle relaxation and contraction
/generalized tonic clonic contraction/

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 Generalised seizures

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 A. Generalized tonic-clonic Seizure
 Epileptic cry
 The tongue is chewed & the pt is incontinent of urine
and stool
 Convulsive mov’t subside after 1 or 2 min & the pt
relaxes and lies in deep coma, noisy breathing and
abdominal-respiration
- Confusion and hard to arouse in postictal period
- Complaining of headache & myalgia

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  Characterized by sudden, brief lapses of consciousness
B. Absence Seizures (Petit Mal)

with loss of postural control.

 Typically lasts for only few seconds
 Consciousness returns as suddenly as it was lost
 No postictal confusion
 Usually begin in childhood (4-8yrs)
 Can occur hundreds of time per day

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 C.Sudden
Atonic Seizures
loss of postural muscle tone lasting 1-2s
 Consciousness is briefly impaired
 No postictal confusion
 Very brief seizure may cause only a quick head drop or
nodding mov’t while longer seizure will cause the pt to
collapse.

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 D. Myoclonic Seizures
 Sudden and brief muscle contraction that involve one
part or the entire body
 Sudden jerking mov’t observed while falling asleep is
common physiologic form of myoclonus
 Pathologic – most commonly seen in association with
metabolic disorder degenerative CNS disease or
anoxic brain injury.

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 3. Unclassified seizures
A)Neonatal seizures: Neonatal seizures are a commonly encountered
neurologic condition in neonates.
 They are defined as the occurrence of sudden, paroxysmal, abnormal
alteration of electrographic activity at any point from birth to the end
of the neonatal period.
B) Infantile spasms: Infantile spasms, sometimes called West
syndrome, are a type of seizure that occurs in babies.
 The spasms look like a sudden stiffening of muscles, and the baby's
arms, legs, or head may bend forward.
C) Febrile seizures: A febrile seizure is a convulsion in a child
that's caused by a fever
 The fever is often from an infection. Febrile seizures occur in
young, healthy children who have normal development and haven't
had any neurological symptoms before.

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Epilepsy
 Describes a condition in which a person has recurrent seizures due to
a chronic underlying process/with evidence of reversible metabolic
cause/
 Also known as seizure disorder
 Epilepsy is a condition of the brain characterized by a susceptibility
to recurrent seizures paroxysmal events associated with abnormal
electrical discharges of neurons in the brain
 Epilepsy is a syndrome of two or more unprovoked or recurrent
seizures on more than one occasion
 A clinical phenomenon rather than a single disease
 The basic problem is an electrical disturbance

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Status epilepticus
 A continuous seizure state
 Status Epilepticus(SE) is a life-threatening condition in which the
brain is in a state of persistent seizure.
 it is defined as one continuous, unremitting seizure lasting longer
than 5 minutes, or recurrent seizures without regaining
consciousness between seizures for greater than 5 minutes.
 Status epilepticus can occur in all seizure types and is considered an
emergency.
 It can result from abrupt withdrawal of antiseizure medications,
hypoxic or metabolic encephalopathy, acute head trauma, or
septicemia secondary to encephalitis or meningitis.
 The highest incidence occurs in children and older adults.

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Diagnostic tools

 History taking, Physical examination and Blood test

 Single photo -emission computerized tomography (SPECT)
 Electroencephalogram (EEG). Paroxysmal abnormalities may
confirm the diagnosis of epilepsy by providing evidence of the
continuing tendency to have seizures.
 The EEG also helps guide the prognosis and can help to classify the
disorder.
 Computed tomography scan. This scan provides density readings
of the brain and may indicate abnormalities in internal
structures.
 Magnetic resonance imaging. This procedure helps identify the
cause of the seizure because it provides clear images of the brain in
regions.
 Other helpful tests include serum glucose and calcium studies, skull
X-rays, Lumbar puncture (LP)
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General first Aid of Seizure
 Notifying the time that the seizure starts and ends
 Ease the person to the floor.
 Turn the person gently onto one side or left lateral position . This
will help the person breathe.
 Clear the area around the person of anything hard or sharp. This can
prevent injury.
 Put something soft and flat, like a folded jacket, under his or her
head.
 Remove eyeglasses.
 Loosen ties or anything around the neck that may make it hard to
breathe.
 Time the seizure.
 Stop! Do not knowing what NOT to do is important for keeping a

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person safe during or after a seizure.
General first Aid of Seizure---
Never do any of the following things
 Do not hold the person down or try to stop his or her movements.

 Do not put anything in the person’s mouth. This can injure teeth or

the jaw. A person having a seizure cannot swallow his or her tongue.
 Do not try to give mouth-to-mouth breaths (like CPR). People

usually start breathing again on their own after a seizure.

 Do not offer the person water or food until he or she is fully alert.

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Recovery from Seizure
Reassure and provide comfort
 Talking gently to comfort and reassure the patient
 Stay with them until they are re-oriented.
Post seizure period
 Check for injuries
 Call families of the patient if necessary/as per care plan
 Allow the patient to change clothing if necessary
 Allow patient to rest or sleep
 No food or drink until the patient is fully awake and alert
 Have someone remain with patient until fully recovered

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Treatment options of Seizure

 Anti-epileptic (anticonvulsant, antiseizure) drugs.

 Anti-epileptic medications can help reduce the number of
seizures you have.
 In some people, they may eliminate seizures.
 To be most effective, the medication must be taken exactly as
your doctor prescribed.
 Vagus nerve stimulator. This device is surgically placed under
the skin on your chest and electrically stimulates the nerve that
runs through your neck to prevent seizures.
 Ketogenic diet., which is a high fat and low carbohydrate diet
and moderate protein
 Brain surgery. The area of the brain that causes seizure
activity can be removed or altered .
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 Treatment of Epilepsy

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General management for epilepsy-----
 1st rule of Rx – To protect the person from injury
 2nd rule of Rx – To treat any underlying disease
 Reduce the frequency of seizure
 Bring seizure under control
* If possible single drug should be in epilepsy to eliminate drug
interaction and adverse effects
General mgt
 Position patient, maintain airway, suction, assist ventilations prevent
injury, maintain O2 therapy, transport, reassess

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Health
Provide adequate pt support by developing an understanding of
education

epilepsy
 Explain to pt & family need of compliance with prescribed drug.
 Teach the pt about S/E of medication drowsiness, lethargy,
confusion, sleep & visual disturbance hyperplasia of gums w/c is
relived by oral hygiene.
 Explain possible precipitating factors for seizure attack like:-
 Not eating regular meal - Missing dose /doubling dose or taking
extra
o Unbalanced diet.
o Decrease blood glucose level
o Some odors may trigger attack
o Sleep disturbance & excessive fatigue
o Fever
o Stress
o Trigger factors (flashing light, loud noise ,video game, TV).
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 Cranial Nerve Disorders

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Bell’s Palsy
 Bell’s palsy is an acute, usually temporary, facial paresis (or palsy)
resulting from damage or trauma of the facial nerve (CN VII).
 It usually affects only 1 side of the face, but both sides can be
affected.
 Bell’s palsy is the most common facial nerve disorder
 The peak incidence is between ages 15 and 60 years.
 There is a high incidence during pregnancy and in persons with
upper respiratory tract conditions (e.g., flu, colds), obesity, diabetes,
and hypertension

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Etiology and Pathophysiology

 Some think it is a reactivation of herpes simplex virus is form (HSV-

1) and/or herpes zoster virus (HZV).
 The viral infection causes inflammation, leading to nerve
compression and the subsequent clinical features
 Another cause may be acute demyelination similar to what happens
in Guillain-Barré syndrome.
 The prognosis for persons with Bell’s palsy is generally very good.
 The extent of nerve damage determines the extent of recovery.
 Most begin to get better within 2 weeks after the onset and recover
some or all facial function within 6 months

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Clinical Manifestation

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Diagnostic Studies

 No definitive diagnostic test exists

 By clinical examination and observing the typical pattern of onset
 Imaging, or neurophysiologic testing at first presentation of Bell’s
palsy.
 If indicated, MRI and CT can eliminate other causes for facial
paralysis.
 Blood tests can diagnose infections or other diseases.
 Electromyography (EMG) can confirm the presence of nerve
damage.

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General management

 Oral corticosteroid therapy to reduce inflammation and swelling

should be started within 72 hours of onset
 Mild analgesics can relieve pain.
 Moist heat can reduce discomfort and aid circulation.
 Electrical stimulation of the nerve
 Facial massage, and physical therapy help maintain muscle tone and
ease pain.
 A facial sling may be helpful to support affected muscles
 Improve lip alignment, and facilitate eating.
 The facial sling is usually made and fitted by a physical or
occupational therapist.
 When function begins to return, active facial muscle exercises are
done several times a day.
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Trigeminal Neuralgia

Trigeminal neuralgia (TN) (tic douloureux) is

characterized by sudden, usually unilateral, severe, brief,
stabbing, recurrent episodes of pain in the distribution of
the trigeminal nerve.
 TN affects more women than men.
 It occurs most often in people over age 50.
 TN as classic (TN 1) or atypical (TN 2).
 TN1 is characterized by sharp (also referred to as
lancinating) pain.
 TN2 -characterized by constant pain
 Patients may have both types.
 TN can cause marked physical and psychologic
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dysfunction.
Etiology and Pathophysiology

 TN most often affects the sensory (afferent) branches of the

second and third division (maxillary and mandibular branches)

of CN V.
 Most cases result from vascular compression of the trigeminal

nerve root by an abnormal loop of the superior cerebellar

artery.
 This artery compresses the nerve as it exits the brainstem.

 Constant compression appears to lead to chronic injury, causing

flattening and atrophy of the nerve and damage to the myelin

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sheath.
Clinical Manifestations

 In TN 1, the patient has an abrupt onset of waves of excruciating pain.

 It is described as a burning, knifelike, or lightning-like shock in the lips, upper or lower gums,

cheek, forehead, or side of the nose.

 Facial twitching, grimacing, and frequent blinking and tearing of the eye can occur during the

acute attack
 TN 2 manifests as constant aching, burning, crushing, or stabbing

pain. The pain has a lower intensity and does not subside completely
Diagnostic Studies
 3D reconstruction and angiography MRI

Mgt
 Antiseizure drug therapy like carbamazepin
 Tricyclic antidepressants, such as amitriptyline
 Surgical Therapy

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Nursing Management

 Acupuncture, biofeedback, and yoga.

 Protect the face against extremes of temperature
 Chew on the unaffected side
 Avoid hot foods or beverages
 Check the oral cavity after meals to remove food particles
 Practice meticulous oral hygiene and continue with semiannual dental
visits
 Use an electric razor
 Wear a protective eye shield and avoid rubbing eyes
 Examine eye regularly for symptoms of infection or irritation.
 Encourage food that is high in protein and calories and easy to
chew

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