1/5. trigeminal neuralgia: a diagnostic challenge.A 38-year-old white woman came to the emergency department complaining of severe, unilateral jaw pain. She had consulted her primary care physician and dentist without achieving the correct diagnosis or significant relief of her symptoms. The emergency physician made the diagnosis of trigeminal neuralgia by obtaining a history of severe paroxysmal ipsilateral facial pain activated by numerous facial stimuli. A light stimulation of the trigger point precipitated the pain. Her pain relief from carbamazepine lent further credence to the diagnosis of trigeminal neuralgia and appropriate referral to a neurosurgeon. Pain relief was ultimately achieved for the last 8 months by a neurectomy of the right infraorbital nerve.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/5. Chronic daily headache: a rational approach to a challenging problem.Chronic daily headache (CDH) is a significant public health problem with 3 to 5% of the population worldwide experiencing daily or near-daily headaches. patients with CDH can be particularly challenging, and clinicians require a systematic approach to help guide investigations and management. The revised 2004 International Headache Society classification Criteria introduces formalized criteria for several CDH disorders including chronic migraine and medication overuse headache as well as new daily persistent headache, hemicrania continua, hypnic headache, and sunct syndrome. Medication overuse is common in patients with CDH who present to physicians. Familiarity and comfort with drug-withdrawal and detoxification strategies is therefore essential. patients with chronic migraine and chronic cluster experience significant disability and diminished quality of life. The ability to manage these patients effectively is a rewarding clinical experience.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
3/5. cluster headache with trigeminal neuralgia. An uncommon association that may be more than coincidental.cluster headache and trigeminal neuralgia (tic douloureux) share a common pattern of exacerbation and remission of pain that is described in similar terms by patients. Although the treatment of these conditions is markedly different, the results of adequate prophylaxis can be extremely impressive in both. The physician who treats headache patients should be aware of the common characteristics of each condition and of the possibility of their concomitant occurrence.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
4/5. Microvascular decompression in glossopharyngeal neuralgia.Glossopharyngeal neuralgia is a rare and often controversial cause for odynophagia and otalgia. The otolaryngologist, head and neck surgeon may be the primary physician called upon to diagnose and treat this entity. In this study, vascular decompression, or more specifically, elimination of contact between the ninth cranial nerve and the posterior inferior cerebellar artery, was employed as treatment in three patients. All achieved relief of their symptoms with this intervention. A review of the neurosurgical literature and the experience with vascular decompression in trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia is presented. The authors conclude that vascular decompression is effective in carefully selected patients, and the role of the skull base surgeon in managing this problem is expanding.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
5/5. trigeminal neuralgia: sudden and long-term remission with transcutaneous electrical nerve stimulation.OBJECTIVE: To discuss a case of trigeminal neuralgia that responded to an accidental high-intensity discharge of electrical current delivered by a transcutaneous electrical nerve stimulator (TENS). CLINICAL FEATURES: A 36-yr-old man suffering from a 5-month history of worsening paroxysmal pain of the left facial and temporal regions was referred to a neurologist by his family physician. A clinical diagnosis of trigeminal neuralgia was made; before committing to pharmaceutical treatment, however, the patient sought chiropractic consultation. INTERVENTION AND OUTCOME: A trial of self-applied TENS was recommended for pain control. Initial application to patient tolerance provided transient pain relief until an accidental, intense discharge resulted in immediate remission of symptoms, lasting now for three years. CONCLUSION: As an initial treatment of choice, TENS can be a safe and effective therapy for trigeminal neuralgia. The unique effect of this accidental application leads us to speculate that diffuse noxious inhibitory controls may have been the pain inhibitory pathway responsible for the resolution of symptoms in this case. Although firm conclusions are difficult to draw from one incident, using TENS at an intense, noxious level may improve its therapeutic efficacy by decreasing treatment time and frequency and eliciting long-lasting effects. This case suggests the need for further investigation of TENS in the treatment of trigeminal neuralgia and related pain syndromes.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |