CRANIOFACIAL PAIN

Dr.Rachakonda Rajkumar
M.B.B.S.,M.D(GEN.MED)
CONTENTS:
 INTRODUCTION
 CRANIAL NURALGIAS
 CLINICAL FEATURE OF NURALGIC PAIN
 MECHANISM OF NURALGIC PAIN
 EXAMPLES
INTRODUCTION:
 Common symptom
 Feature of primary head ache disorder
 Secondary to organic disease
 Detailed history and physical examination=dx
 Non-descript,chronic,undentifiable =atypical
 Misdiagnosis & mismanagement are common.
CRANIAL NURALGIAS:
 Neuropathy
 disturbance of function /pathologic change in a
nerve/nerves

  Lesion
 central or peripheral somatosensory nervous
system

 Head & neck pain is mediated by sensory

fibers carried by the following nerves
 Trigeminal(V)

 Nervus intermedius(Sensory & PS Di. CN VII)

 Glossopharyngeal(IX)

 Vagus(X)

 Upper cervical spinal cord roots via the occipital

nerves and great auricular nerve
CLINICAL FEATURE:
 Neuralgic pain:
 paroxysmal quality
 typically maximal at onset
 Lancinating/electrical shock–like/jabbing
 single sharp pain/ repetitive pains in succession
 Last for a fraction of a second or for several seconds
 refractory period (no pain)
 Trigger zones.
MECHANISM:
 Mechanisms are complex
 Nerve injury
 inflammation, nociceptor activation, tissue
injury
 Deafferentation = Peripheral neuropathic pain
 CNS damage=central pain

 CN V, VII, IX, X, converge on the spinal

trigeminal nucleus & tractus solitarius.
EXAMPLES:
 Exmaples of Neuralgia:
 Trigeminal neuralgia
 Painful trigeminal neuropathy
 Postherpetic neuralgia 
 Painful post-traumatic trigeminal neuropathy 
 Trigeminal trophic syndrome
 Cluster-tic syndrome 
  Glossopharyngeal neuralgia 
 Nervus intermedius neuralgia
 Occipital neuralgia

 OTHER CAUSES OF FACIAL PAIN:

 Optic neuritis
 Ischemic oculomotor nerve palsy
  Tolosa-Hunt syndrome
 Paratrigeminal oculosympathetic syndrome
 Recurrent painful ophthalmoplegic neuropathy 
 Burning mouth syndrome
 Red ear syndrome
 Persistent idiopathic facial pain 
 Central neuropathic facial pain
 Secondary cause
 Cancer pain
  Dental pain
 Temporomandibular joint syndrome
 Giant cell arteritis 
 Carotidynia
 Post-traumatic and postoperative pain

 Primary headaches:
 Migraine

 Cluster

 other headaches (paroxysmal hemicrania)

THANK YOU