Table of Contents

My Web Stats Until Dec 2008

Pain-Sensitive Structures

• Intracranial
  • Arteries at the base of the brain and their major branches
  • Periarterial dura mater
  • Venous sinuses
• All Extracranial structures
• Cranial nerves : 5,7,9,10

Pathway

Supratentorium : Trigeminal nerve

Infratentorium : Glossopharyngeal nerve, Vagus nerve, Cervical spinal root (2)

Gate-Control System

• Substantia gelatinosa
• Descending pain control system : periaqueductal gray, locus ceruleus, medulla, dorsolateral fasciculus, dorsal horn

Neurotransmitter

PNS

• substance P
• histamine, 5-HT, bradykinin, PG
• ANS change
• Drugs : NSAIDs

CNS

• Substance P
• Inh : encephaline
• Drugs : Mo

Mechanism

Organic Headache

• Traction-inflammatory headache
• Neurogenous pain

Functional Headache

• Vascular headache
• Muscke pain
• Psychogenic pain
• Multiple mechanism

Traction-Inflammatory

Pain sensitive structure

IICP, meningeal irritation

Giant cell arteritis

Neurogenous Pain

Paroxysmal neuralgia pain

May not along dermatome

Cranial neuralgia

Symptomatic or idiopathic

Demyelination of axon from compression (vv)

Neuritic Neuralgia

Along dermatome, consistent

Post-herpetic neuralgia

Inflammation, metabolic, toxic

Traumatic Neuroma

Post-trauma or Sx

Abnormal growth of extraneural, intraneural tissue and Schwann cell

Deafferentation pain

Anesthesia dolorosa, causalgia, phanthom limb

Anbnormal growth of nerve and dorsal root ganglion dysfunction

Vascular Headache

Migraine

• Neurogenic or vasculogenic
• Biochemical change

Cluster Headache

• Hypothalamic dysfunction

Muscular Headache

Myofascial pain

Less spasm, normal EMG

Trigger point

Muscle spasm pain

Change in proprioceptive and sensory input or CNS dysfunction

Psychogenic Pain

Migraine

Myofascial pain

Conversion, depression

Multiple Mechanism

Post-traumatic headache

Summarized By Thirayost Nimmanon

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