Steven B. Graff-Radford

Management of Chronic Head and Neck Pain: Effectiveness of Altering Factors Perpetuating Myofascial Pain

SYNOPSIS

Lingual nerve injury.

Lingual nerve injury is a common complication following dental and medical procedures. The clinical presentation of lingual nerve injury, its epidemiology, predisposing factors, and anatomy are explored in an attempt to identify those patients at risk for developing neuropathic pain. Nonsurgical and surgical therapies also are discussed.

Obstructive Sleep Apnea and Cluster Headache

A patient with cluster headache often wakes from sleep. The relationship to sleep apnea has been described. This study sought to confirm the relationship cluster may have with sleep apnea.

High‐Pressure Headaches, Low‐Pressure Syndromes, and CSF Leaks: Diagnosis and Management

Headache resulting from idiopathic intracranial hypertension (IIH) in a population of moderately to obese women of childbearing age. The causes overall remain unclear. With this review, we provide an overview of clinical treatment and management strategies.

Is there hope for chronic pain and headache

Currently the clinical needs for pain and headache management are not met. Despite the numerous and exciting recent advances in understanding the molecular and cellular mechanisms that originate pain, we cannot yet fully explain the mechanism underlying the biology of chronic pain. Pain is a natural mechanism preserving our species survival; however, when the protective quality is lost, physiologic changes to the peripheral and central nervous systems result in the formation of chronic pain states. Once we understand how this chronic pain state is created, either through genetic, environmental, therapeutic, or other triggers we may be able to enhance our species existence, limiting maladaptive pain and suffering. The future therapeutic targets will need to address the genetics, neurophysiologic changes of the neurons and brain as well as help control immune systems including the glia. The key to successful headache and pain therapy is research aimed at prevention and minimizing the plastic changes triggering chronic pain.

Trigeminal Neuralgia and Facial Pain Imaging

The trigeminal nerve or fifth cranial nerve has an extensive distribution in the head and face. It is the source for pain conduction and thereby is often implicated in a variety of disorders including inflammatory and neoplastic diseases. To determine the disease source, understanding the trigeminal nerve anatomy is essential, and further being able to image the trigeminal nerve provides insight into the location and type of pathology. The best approach to imaging is to consider the nerve in segments. The nerve segments may be divided into the brainstem, cisternal, Meckel’s cave, cavernous sinus, and peripheral divisions. This review utilizes these segments to explore imaging options to help understand trigeminal neuralgia and pain in the trigeminal nerve distribution.

Headache or facial pain attributed to disorders of cranium, neck, eyes, ears, nose, sinuses, teeth, mouth, or other facial or cranial structures.

Publisher Summary This chapter discusses the chronic headache attributed to disorder of cranium, neck, eyes, ears, nose, sinuses, teeth, mouth, or other facial or cranial structures. Management of the cranial disorders is primarily surgical and may require a variety of different specialties depending on the location. Often surgery is accompanied by pharmacological therapy. Cervical blockade, whether peripheral nerve block with steroid, facet block, or selective nerve root block, usually produces transient relief. The primary therapy for cervical dystonia has been botulinum toxin. Trigeminal dysesthesia or deafferentation is managed pharmacologically with tricyclic antidepressants, selective serotonin/norepinephrine reuptake inhibitors, antiepileptic agents, antidepressants, and alpha-blockers. treatment outcome studies of headache related to temporomandibular disorders (TMD) use various methods of assessing pain reduction, seldom with the same outcome variables. One of the greatest problems is the generalization that if headache is decreased by treatment of TMD then the etiology of the pain is the TMD. Physical therapy modalities provide a popular and safe approach to the management of TMDs.

Treatment options for glossopharyngeal neuralgia

Glossopharyngeal neuralgia is a rare but painful affliction creating pain in the distribution of the nerve. It is an intermittent pain often provoked by non-noxious stimulation such as talking, swallowing or head movement. Glossopharyngeal neuralgia is best evaluated with a careful history, appropriate imaging and treated with pharmacologic approaches as well as surgery.

An Unusual Challenge in Performing Sphenopalatine Ganglion Block with Enlarged Coronoid Process: Jacob's Disease

OBJECTIVES Sphenopalatine ganglion block for the treatment of cluster headache has been well-described for medically refractory cases. Technical challenges in performing this procedure via the mandibular notch can be found in patients with elongation of the coronoid process. Objectives include correlation of physical exam findings and computed tomography (CT) imaging, followed by recommendations for future treatment. METHODS Case report. RESULTS Patient had a history of cluster headache and a 35 mm interincisal opening. Initially, sphenopalatine ganglion block could not be performed via standard mandibular notch approach due to the inability to advance past superficial tissues. Subsequent CT scan revealed a congenitally enlarged coronoid process with a shortened ramus. Usage of a bite block facilitated completion of the sphenopalatine block on subsequent visit. CONCLUSIONS Patients with diminished oral interincisal opening and deviation of the jaw to one side are consistent with Jacobs disease. Using a bite block in these patients may be critical to completion of the procedure.

Perspectives on psychogenic versus biogenic factors in pain

T he focus article has served well to point out the ambiguity and controversy of psychogenic pain. It is far too often that a diagnosis of “psychogenic pain” is made by exclusion rather than the appropriate inclusive criteria. Keeping this in mind, it is understandable that the author has focused on establishing what psychogenic pain refers to (i.e., what is the “concept” and its implications). I address the central positions taken in the focus article separately. Psychogenic pain is a theoretical possibility that can stimulate new ways of thinking about pain. Dworkin theorizes that if the psychological process allowed the body to yield pain that in turn motivated pain behavior, this would allow for research to define which brain process caused the reaction. Fordyce has pointed out that too often a patient’s pain experiences are labeled “psychogenic” when repeated failures using the biomedical model result in persistence of pain.* This and the broad exclusionary criteria often related to treatment failure or the inability to uncover an obvious cause described in the American Psychiatric Association’ and the International Association for the Study of Pain5 classification systems solidifies the conclusion that pain of unknown origin implies our need to reexamine our limited understanding of pain, rather than leaping to the conclusion that such pains must be psychogenic. Table 1 of the focus article further enhances the view that in orofacial pains where the pathophysiologic mechanism is unclear, the suspected psycho-