• Headache and facial pain
    • Migraine
      • Causes neurological, abdominal and autonomic symptoms
      • Can have migraine with aura or migraine without aura
      • Can be unilateral (60%) or bilateral (40%)
      • Triggers
        • Stress
        • Relaxation
        • Menstruation
        • The 'C's'
          • Caffeine
          • Cereals
          • 'Claret'
          • Chocolate
          • Cheese
      • Treatments
        • Acute
          • Aspirin, paracetamol, antiemetics (dopamine antagonists)
          • Sumatriptan, ergotamine
        • Prophylaxis
          • β-blockers
          • Amitriptyline
          • Valproate
          • Gabapentin, methylsergide
          • Pizotifen, clonidine, verapamil, fluoxetine
    • Tension type headache TTH
      • Episodic
      • Chronic
      • Characterised by pressure or tightness in the head. Nausea & photophobia are not prominent features
      • Analgesic overuse headache can co-exist if chronic
      • Amitriptyline is the drug of choice
    • Chronic facial pain
      • TMJ pain
      • TGN
        Link:publications.nice.org.uk/neuropathic-pain-pharmacological-management-cg173/list-of-all-research-recommendations#carbamazepine-for-treating-trigeminal-neuralgia
        • 5th-6th decades, agonising, lancing pain. Non-noxious stimulus commonly triggers pain. Detailed imaging of the CPA can show a cause. 80% are due to vascular compression.
        • Treatment with carbamazepine, gabapentin, lamotrigine
        • Surgical treatment with MVD (90% short term pain relief, 60% long term relief)
      • PHN
        • Occurs in 15% of herpes zoster
        • Can be assd with loss of pigmentation and hair, allodynia. Severity usually improves within a year. Amitriptyline, gabapentin, lidocaine patches, capsaicin and opioids have all been tried
      • Atypical facial pain (idiopathic)
        • Close association with IBS
        • Sometimes responds to amitriptyline, but long term support may be required.
    • Cluster headaches and trigeminal cephalgias
      • Signs of cranial autonomic hyperactivity (eg Horner's syndrome)
      • CH occur over a period of weeks and then remit. Respond to O₂.
      • Nausea and vomiting uncommon
      • Prophylaxis with verapamil, methylsergide, ergotamine, lithium and prednisolone
      • Paroxysmal hemicrania is similar to CH but doesn't respond to standard treatment but does respond to indomethacin
      • Short lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT) can be misdiagnosed as TGN
    • CEACCP
      Link:ceaccp.oxfordjournals.org/content/8/4/138.full.pdf