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Author: Steven J. Scrivani
Differential Diagnosis of Craniofacial Pain Differential Diagnosis of Craniofacial Pain
International Headache Society International Headache Society
The Primary Headaches The Primary Headaches
The Secondary Headaches The Secondary Headaches
Headache attributed to head and/or neck trauma Headache attributed to head and/or neck trauma
Headache attributed to cranial or cervical vascular disorders Headache attributed to cranial or cervical vascular disorders
Headache attributed to a substance or its withdrawal (8.1-4) Headache attributed to a substance or its withdrawal (8.1-4)
Headache or facial pain attributed to Headache or facial pain attributed to
Cranial neuralgias, central and primary facial pain and other headaches Cranial neuralgias, central and primary facial pain and other headaches
Cranial neuralgias, central and primary facial pain and other headaches, cont. Cranial neuralgias, central and primary facial pain and other headaches, cont.
Unusual Causes of Headache Unusual Causes of Headache
“Red Flags” in the Headache History “Red Flags” in the Headache History
“SSNOOPP” for Secondary HA “SSNOOPP” for Secondary HA
The Primary Headaches (1-4) The Primary Headaches (1-4)
What is Migraine? What is Migraine?
How Migraine Stacks Up Against Other Common Diseases How Migraine Stacks Up Against Other Common Diseases
Most Patients’ Headaches Are Severe or Extremely Severe Most Patients’ Headaches Are Severe or Extremely Severe
Migraine Takes Quality Time Out From Your Life Migraine Takes Quality Time Out From Your Life
Migraine Takes Time Out From Your Life Migraine Takes Time Out From Your Life
Unnecessary Suffering Unnecessary Suffering
Migraine Pathophyisology Migraine Pathophyisology
How Migraine Works How Migraine Works
Migraine Pathophysiology: Phases Migraine Pathophysiology: Phases
Protective Factors Protective Factors
Triggers and Risk Factors Triggers and Risk Factors
Triggers: Changes in Daily Cycles Triggers: Changes in Daily Cycles
Triggers: Environment or Diet Triggers: Environment or Diet
Triggers: Mental Triggers: Mental
What You Might Feel Before or During an Attack What You Might Feel Before or During an Attack
What You Might Experience During an Attack What You Might Experience During an Attack
Migraine without Aura Migraine without Aura
Migraine with Aura Migraine with Aura
Migraine Aura Migraine Aura
Tension-Type Headache Tension-Type Headache
Tension-Type Headache Tension-Type Headache
Cluster HA and Other TACs Cluster HA and Other TACs
Cluster Headache Cluster Headache
Paroxysmal Hemicrania Paroxysmal Hemicrania
Chronic Daily Headache Chronic Daily Headache
Chronic Daily Headache Chronic Daily Headache
Chronic Daily Headache Chronic Daily Headache
Headache Attributed to As Substance or Its /Withdrawal Headache Attributed to As Substance or Its /Withdrawal
Analgesic Rebound Headache / Medication-Induced Headache Analgesic Rebound Headache / Medication-Induced Headache
Common Medications Associated with MOH Common Medications Associated with MOH
Pharmacotherapy for Migraine Pharmacotherapy for Migraine
Headache Treatments Headache Treatments
Self Treatment Efforts: What You Can Do For Your Migraines Self Treatment Efforts: What You Can Do For Your Migraines
Pharmacologic Management of Headache: Symptomatic Therapies Pharmacologic Management of Headache: Symptomatic Therapies
Pharmacologic Management of Migraine: Prophylactic Therapies Pharmacologic Management of Migraine: Prophylactic Therapies
Pharmacologic Management of Headache: Prophylactic Therapies Pharmacologic Management of Headache: Prophylactic Therapies
Medicines to Stop a Migraine Attack Medicines to Stop a Migraine Attack
Other Factors Involved in the Choice of Medication Other Factors Involved in the Choice of Medication
Fast Relief vs. Long-lasting Relief Fast Relief vs. Long-lasting Relief
Options for Preventive Treatment Options for Preventive Treatment
Pharmacological Therapy Pharmacological Therapy
Acute (Abortive) Medication Therapy Acute (Abortive) Medication Therapy
DHE DHE
Acute Therapy for Migraine Acute Therapy for Migraine
Acute Therapy for Migraine Acute Therapy for Migraine
Acute Therapy for Migraine Acute Therapy for Migraine
Acute Therapy of Migraine Acute Therapy of Migraine
Acute Therapy of Migraine Acute Therapy of Migraine
Triptans Triptans
Triptans: Efficacy Headache Relief at 2 hours Triptans: Efficacy Headache Relief at 2 hours
Triptans Triptans
Preventive Therapies for Migraine Preventive Therapies for Migraine
Daily scheduled opioids for intractable head pain Daily scheduled opioids for intractable head pain
Daily scheduled opioids for intractable head pain Daily scheduled opioids for intractable head pain
Nonpharmacologic Management of Headache Nonpharmacologic Management of Headache
Other CAM Therapies Other CAM Therapies
Topical Agents Topical Agents
Magnesium Magnesium
Magnesium for Headache Magnesium for Headache
MigraHealth and MigraLief MigraHealth and MigraLief
Vitamin B2 (Riboflavin) Vitamin B2 (Riboflavin)
Vitamin B2 (Riboflavin) Vitamin B2 (Riboflavin)
Coenzyme Q 10 (ubiquinone) Coenzyme Q 10 (ubiquinone)
CoQ 10 CoQ 10
Feverfew Feverfew
Feverfew Feverfew
St. John’s Wort (Hypericum perforatum) St. John’s Wort (Hypericum perforatum)
Butterbur (Petasites hybridus) Butterbur (Petasites hybridus)
Women’s Issues and Headache Women’s Issues and Headache
Pure Menstrual Migraine & Menstrually Associated Migraine Pure Menstrual Migraine & Menstrually Associated Migraine
Oral Contraceptives and Migraine Oral Contraceptives and Migraine
Pregnancy and Headache Pregnancy and Headache
Pregnancy and Headache Pregnancy and Headache
Menopause and Migraine Menopause and Migraine
Botulinum Toxin – A (BTX-A) Botulinum Toxin – A (BTX-A)
Headache and Craniofacial Pain Disorders I: Slide 90 Headache and Craniofacial Pain Disorders I: Slide 90
BTX-A BTX-A
BTX-A BTX-A
Side Effects Side Effects
Antibody Formation & Resistance Antibody Formation & Resistance
Contraindications and Cautions Contraindications and Cautions
How Does BTX Decrease Pain?? How Does BTX Decrease Pain??
Mechanisms of Analgesic Activity?? Mechanisms of Analgesic Activity??
Mechanisms of Analgesic Activity?? Mechanisms of Analgesic Activity??
Mechanisms of Analgesic Activity?? Mechanisms of Analgesic Activity??
Mechanisms of Analgesic Activity?? Mechanisms of Analgesic Activity??
Mechanisms of Analgesic Activity?? Mechanisms of Analgesic Activity??
FDA Approval (1989) FDA Approval (1989)
Other Common Uses Other Common Uses
Chronic Headaches Chronic Headaches
Chronic Headache (Migraine, Tension-type, CDH) Chronic Headache (Migraine, Tension-type, CDH)
Botulinum Toxin Botulinum Toxin
Botulinum Toxin Botulinum Toxin
Botulinium Toxin and EMG Botulinium Toxin and EMG
Botulinum Toxin Type A Botulinum Toxin Type A
Botulinum Toxin Botulinum Toxin
Botulinum Toxin, cont. Botulinum Toxin, cont.
Botulinum Toxin, cont. Botulinum Toxin, cont.
Botox CDH Botox CDH
Botox CDH, cont. Botox CDH, cont.
Botox CDH, cont. Botox CDH, cont.
Differential Diagnosis of Craniofacial Pain Differential Diagnosis of Craniofacial Pain
Trigeminal Neuralgia Trigeminal Neuralgia
Characteristics of Patients Characteristics of Patients
Classification of TN Classification of TN
Etiology?? Etiology??
Trigeminal Neuralgia Therapeutic Options Trigeminal Neuralgia Therapeutic Options
Headache and Craniofacial Pain Disorders I: Slide 122 Headache and Craniofacial Pain Disorders I: Slide 122
Anticonvulsants (AEDs) Anticonvulsants (AEDs)
Pharmacological Effect and Mechanism of Pain Relief Pharmacological Effect and Mechanism of Pain Relief
AEDs for TN – RCTs AEDs for TN – RCTs
Pharmacological Therapy for Trigeminal Neuralgia Pharmacological Therapy for Trigeminal Neuralgia
Pharmacological Therapy Pharmacological Therapy
Surgical Interventions Surgical Interventions
Acute Therapy Acute Therapy
Differential Diagnosis of Craniofacial Pain Differential Diagnosis of Craniofacial Pain
Neuropathic Facial Pain “Old & New Names” Neuropathic Facial Pain “Old & New Names”
Persistent Idiopathic Facial Pain Persistent Idiopathic Facial Pain
Chronic Neuropathic Facial Pain Chronic Neuropathic Facial Pain
CRPS of the Head and Neck CRPS of the Head and Neck
Burning Mouth/Tongue (Oral Burning) Burning Mouth/Tongue (Oral Burning)
Treatment of Neuropathic Craniofacial Pain Treatment of Neuropathic Craniofacial Pain
Pain Management Pain Management
Voltaire’s Cynicism Voltaire’s Cynicism
Prudent Polypharmacy!!! Prudent Polypharmacy!!!
Pharmacological Therapy Pharmacological Therapy
Pharmacological Therapy Pharmacological Therapy
NMDA-Receptor Antagonists NMDA-Receptor Antagonists
Topical Agents Topical Agents
Advances in Neuropathic Pain Advances in Neuropathic Pain
CAM Use for Headache & Facial Pain CAM Use for Headache & Facial Pain
Complementary and Alternative Medicine (CAM) Complementary and Alternative Medicine (CAM)
Local Anesthetic Nerve Block Injections Local Anesthetic Nerve Block Injections
Electrical Stimulation Electrical Stimulation
The Spectrum of Pain in Herpes Zoster The Spectrum of Pain in Herpes Zoster
PHN: Clinical Presentation PHN: Clinical Presentation
Vasculitides with Headache & Facial Pain Vasculitides with Headache & Facial Pain
Temporal Arteritis Temporal Arteritis
Superficial Temporal Artery Superficial Temporal Artery
Temporal Ateritis Temporal Ateritis
Temporal Arteritis Temporal Arteritis