Trigeminal Autonomic Cephalalgias (TACs) are highly interesting to me: This group of unilateral, excruciating primary headaches is accompanied by ipsilateral cranial autonomic symptoms and comprises of three major forms:
1. Cluster Headache (CH)
2. Paroxysmal Hemicrania (PH)
3. Short unilateral neuralgiform headache (with conjunctival injection and tearing and cranial autonomic symptoms) (SUNCT/SUNA)
The borders between the different forms are very fluid and the specific conditions are often misdiagnosed as a strong migraine, causing the patients to suffer significant pain before treatment is started. Which directly links to another problem: The treatment. Oxygen treatment seems promising, yet it is not readily available to the patients. Orally administered triptans are usually too weak and nasally administered triptans (e.g. ZOMIG) cannot be used in a sufficient frequency to relieve the pain during the whole day, especially in the case of Paroxysmal Hemicrania where attacks are generally of shorter duration yet of higher intensity. Therefore, patients still need to resort to taking a significant amount of painkillers which is medically problematic since an attack period can last up to several months or even years in the case of chronic conditions which 10-15% of cluster headache patients suffer from.
The inadequate treatment and difficult diagnosis is a results of the uncertainty around the subject of TACs: They are still quite unresearched and while the connection with the trigeminal nerve is already made, the underlying cause for TACs remains unknown. There are currently two leads for the causes: Rafael Benoliel of the Hebrew University of Jerusalem found that that during an attack there is much more activity in the hypot...
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...ests, but also electroencephalographic tests that will show me precise brain activity. Furthermore, it is highly possible and very probable that this increase in IQ is not directly caused by the chemical species of alcohol but by the personality traits that lead to a higher alcohol consumption. Again, this would be very interesting to analyse with the help of electroencephalographic tests. At Hopkins, I would be able to seek mentorship from professors Mark P. Mattson, Hey-Kyoung Lee and Jay Baraban, experts in neurodegenerative diseases, synaptic plasticity and neuronal plasticity respectively. The guidance and opinions of these scientists will provide crucial help in my process of researching this topic.
Johns Hopkins is the place to be when it comes to research and I am certain that whatever I need in order to conduct my research, it will be available at Hopkins.
“One example of acquire peripheral neuropathy is trigeminal neuralgia (also known as tic doulcunex), in which the damage to the trigeminal nerve (the largest nerve of the head and face) causes episodic attacks of excruitiating, lightning-like pain on one side of the face” (Peripheral Neuropathy Fact Sheet).
warm) in the left upper and lower extremities; decreased strength and movement of the right upper and lower extremities and of the left abdominal muscles; lack of triceps and biceps reflexes in the right upper extremity; atypical response of patellar, Achilles (hyper) reflexes in the right lower extremity; abnormal cremasteric reflex in the right groin; fracture in cervical vertebrae #7; and significant swelling in the C7-T12 region of the spinal canal (Signs and symptoms, n.d.). The objective complaint of a severe headache could also be consistent with a spinal cord injury (Headache, nausea, and vomiting,
Migraine headaches affect an estimated 36 million Americans, or about 12% of the population, surpassing asthma at 8.3% (25 million) and diabetes at 7.8% (23.6 million). Migraines are much more common in women than in men--about 3 times more common. Nearly 30% of women will experience at least one episode of migraine headaches in their lifetime, most commonly in the third and sixth decades of life. However, migraines can affect anyone at any age and from any ethnic group. In addition to indirect expenses like missed work/school and lost productivity, the American Migraine Foundation estimates that migraines cost Americans more than $20 billion annually. Migraine sufferers are also more likely to experience anxiety, depression, sleep disorders, fatigue, and other pain conditions, and those who experience visual disturbances called “auras” associated with migraines are at an increased risk of heart attack and stroke. Unfortunately, there is no cure for migraines. The best treatment options available only to seek to reduce frequency of attacks or treat an attack once one has begun, and medication use is often limited by side effects and difficulty of administration. The American Migraine Foundation itself labels current treatment options “far from perfect” and concludes, “Undoubtedly, better treatments are needed.” Filling this therapeutic void is the primary objective of NuPathe Inc. (very recently acquired by Teva Pharmaceutical Industries Ltd.) with Zecuity®, a sumatriptan iontophoretic transdermal system.
Patient is a 19-year-old right-handed white male who presents with his mother for evaluation of frequent headaches. He did not have headaches prior to two grade 1 concussions while playing football in 2012. At that time, he had a normal MRI. He has been having headaches since. He did see Kent Logan, MD in 2012, at which point he was describing weekly headaches with photophobia, phonophobia, and nausea. At that time, according to Dr. Logan's notes, there was no aura with his headaches. He noted that trying one of his mother's Imitrex helped with the headache, so he was given a prescription for 50 mg. He was also diagnosed as having a whiplash injury, at that time. He did undergo physical therapy for his neck. He also was complaining of some short-term memory problems at that time, but neuropsychology testing was negative. He has not followed up with Dr. Logan since then. More recently, his headaches have been increasing in frequency. They are located in the left retrobulbar and super orbital area, but then will spread throughout the left side of the head and then bilaterally. The pain is steady when it is milder, but throbbing when it is worse, and it is worsened with exertion. There is photophobia, phonophobia, osmophobia, nausea. They can last one to two hours. Most often, he does have
I will leave you with this: Imagine you feel a sudden pain on the left side of your head that radiates down your neck so agonizing that your vision begins to blur, making you sick to your stomach at the thought of your anguish. Would you have the knowledge to identify your ailment solely with these symptoms and pinpoint possible causes to treat or seek treatment for your suffering with the information I have given you
Patient reports tenderness when frontal sinuses palpated. Temporal arteries elastic and nontender. Temporal arteries pulse +2. Temporomandibular joint palpated with full range of motion without tenderness or clicking.
Headaches are a neurologic disorder that causes pain to any region of the head, scalp, face and neck area. Determination of the type of headache primary or secondary is necessary for proper treatment. A complete history to include age needs to be obtained to include family history, furthermore information on frequency, location, duration, time of day, precipitating factors, related factors, and types of medications used, a must be took in account to identify the specific headache.
To diagnose the main cause of TJ pain, history, physical examination, laboratory tests, and imaging studies must be
Purpose- To identify the functions of the cranial nerve of the peripheral nervous system such as the olfactory, optic, oculomotor, trochlear, trigeminal, abducens, facial, vestibulocochlear, glossopharyngeal, vagus, accessory, and the hypoglossal nerves. I will examine these functions with a series of behavior tests on my partner who is Jazmine Cooley to see if all nerves are functioning properly and if they are not, then this will be considered an identified dysfunction of a cranial nerve which is a diagnosis.
Patients who endured moderate to severe migraines were interviewed a physician and had to complete a migraine diary for one month and a migraine headache information form. Patients who met the criteria were then offered to participate in the study followed by completing several questionnaires. Before undergoing the surgery, the patients were then injected botulinum toxin type A in the area where they felt the most pain from their migraine. Depending on where the patients
...ure anesthesia, auricular needling is often used. By stimulating sensory receptors at auricular points, signals inputted into the body are transmitted through the trigeminal lemniscuses instead of the spinal cord. There were studies demonstrated anterior and posterior portions of the nucleus of spinal tract of trigeminal nerve had similar feedback effects to the gate system in the posterior horn of spinal cord, which could be used to modulate transmissions of pain impulses. This might be able to explain why auricular acupuncture has analgesia effects on surgical or painful irritation on the head and face. However, anesthesia effects of auricular acupuncture during thoracic and abdominal surgeries cannot be explained by any hypotheses about the gate control occurring at either posterior horns of the spinal cord or the nucleus of spinal tract of trigeminal nerve [27].
Researchers monitored patients in both inpatient and outpatient surgeries, and looked at how many had stokes then how many were readmitted to a hospital over 30 days. Within the 30 day period, results showed patients with migraines were more likely to have a stoke compared to patients without migraines. The patients who did have migraines with aura were at higher risk to those with regular migraines. The readmission rates was 1.3
Headaches occur when the trigeminal nerve that originates on the bottom of the brain that reaches the face, ears, and eyes. It has pain receptors called nociceptors that carry the signals of pain to the thalamus which then can be triggered by hunger, curtain foods, odors, and stress. The thalamus then sends a message to the brain that initiates the pain, and now the individual feels that they have a headache (Pray, 2014). The vast array of headache types are believed to be a whopping one-hundred fifty different types, but the NINDS has categorized them into four different classifications that have specific traits. Such as vascular headaches, tension headaches, traction headaches, and inflammatory headaches (Pray,
PDAP can present in a broad range of fashion. Diagnosis should not rely on pain characteristics only, as it may mislead the clinician towards other diagnoses such as tooth pain, myofascial pain or even trigeminal neuralgia (11). We summarized features of PDAP pain quality from studies of level 3 and 4 evidence (11) (35) (36). Among the most common descriptors for the baseline pain we find terms as aching, dull, pressing, heavy and cramping. Some patients report an itchy and tingly sensation other than a real pain. Pain exacerbations can be described even more variably and the most reported one is pain felt as intense heat. Clinicians must be aware of possible misleading descriptors for pain exacerbations such as throbbing and stabbing, that can lead towards a vascular
Migraines can be triggered by lights, smells, or sounds. During changes of these senses, nociceptors are releases in the brain that relax and dilate blood vessels and muscle tissues to increase blood flow. This causes swelling in the area from cranial vessels leaking due to the neuropeptides released by the nociceptors, the brain cells that release pain. Being as no definitive test exists for finding migraines or the true cause of them, MRIs or CT scans are used to rule out possible other factors of the head pains such as blood clots in the blood veins or tumors within the