Neuropatska bol u glavobolji
| Autor: | DAVOR JANČULJAK |
|---|---|
| Jazyk: | chorvatština |
| Rok vydání: | 2019 |
| Předmět: | |
| Zdroj: | Acta medica Croatica : Časopis Akademije medicinskih znanosti Hrvatske Volume 73 Issue Suplement 1 |
| ISSN: | 1330-0164 1848-8897 |
| Popis: | Većina neuropatija u području glave javljaju se kao orofacijalne neuralgije, dakle boli u području lica i usne šupljine, a manjim dijelom u dijelu glave gdje se inače pojavljuju glavobolje. Trigeminalna neuralgija rijetko se javlja u području glave supraorbitalno (u oko 4 %). Bol se u trigeminalnoj neuralgiji liječi farmakološki primarno antikonvulzivima (karbamazepinom, okskarbazepinom), miorelaksansom baklofenom, a iznimno neuroleptikom pimozidom. U farmakorezistentnim slučajevima indicirane su kirurške i radiokirurške metode. Diferencijalno-dijagnostički idiopatsku i klasičnu trigeminalnu neuralgiju treba razlikovati od simptomskih neuralgija (postherpetična ) i neuropatija u području čela i orbita (posttraumatska, oftalmoplegična) te od primarne idiopatske probadajuće glavobolje i numularne glavobolje. Neke primarne glavobolje mogu se javljati istovremeno s trigeminalnom neuralgijom (cluster-tic sindrom, paroksizmalna hemikranija-tic sindrom i hemicrania continua-tic sindrom). U primarnim glavoboljama, kao što su migrena i glavobolja tenzijskog tipa uz klasičnu nociceptivnu i specifi čnu neurogenu bol može nastati neuropatska bol zbog centralne senzitizacije koja se klinički očituje alodinijom i hiperalgezijom. Rana primjena triptana u migrenskom napadaju sprječava pojavu centralne senzitizacije i omogućuje izbjegavanje alodinije. Centralno uzrokovana neuropatska bol u području glave nastaje kao posljedica bolesti i oštećenja u središnjem živčanom sustavu ( najčešće moždani udar ili multipla skleroza). The most common origin of neuropathic pain in the head are orofacial neuralgias; they appear mostly in the lower facial parts of the head and in the oral cavity, rarely in the upper part of the head as the main location of pain in headache disorders. Only a small proportion (4%) of patients with trigeminal neuralgia have symptoms in the supraorbital region. The fi rst choice of drugs to treat pain in trigeminal neuralgia are anticonvulsants (carbamazepine and oxcarbazepine), followed by muscle relaxants (baclofen) and pimozide (a neuroleptic drug) in most severe cases. In drug resistant cases, either conventional surgery or gamma-knife surgery may be indicated to treat pain. Differential diagnosis has to be made to distinguish both idiopathic and classical trigeminal neuralgia from symptomatic neuralgias (post-herpetic), fronto-orbital neuropathies (post-traumatic, ophthalmoplegic) and primary headaches (idiopathic stabbing headache, nummular headache). In some cases, trigeminal neuralgia may co-occur with primary headaches (syndromes labeled as cluster-tic syndrome, paroxysmal hemicrania-tic syndrome, and hemicrania continua-tic syndrome). Neuropathic pain may be evoked by central sensitization in primary headaches like migraine and tension-type headache causing allodynia and hyperalgesia along with the usual clinical presentation of classical nociceptive and specifi c neurogenic pain. Early intervention with triptans at the beginning of migraine attack is the best way to prevent central sensitization and avoid allodynia. Central neuropathic pain occurring in the head region is caused by a lesion or dysfunction in the central nervous system (stroke, multiple sclerosis). |
| Databáze: | OpenAIRE |
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