Vascular pain of the face

The vascular pain of the face (AVF) is an acute form of Céphalée. It is about an affection rare, extremely painful and invalidating for that which suffers from it. It appears on one of the halves of the head.

Signs and symptoms

The people suffering from AVF typically have an important headache close to a eye, Nez or Tempe, affection which lasts 15 minutes to 3 a.m. The headaches are unilateral, and are always located same side of the face, respecting the line of centers.

The AVF is currently better and better included/understood. The various studies which were indexed show that research progresses.

The pain increases gradually but quickly (5 with 15mn), is asymmetrical, with type of swelling, crushing, constriction, the part of the face reached; an headache is often associated when the crisis becomes severe thus signing the relationship of the AVF with the common migraine. A notable difference in the expression of the pain is agitation, the patient hopelessly seeking a position or a place or the pain would be more bearable. The AVF is often associated with at least one of the following symptoms: a falls of the eyelids, a red eye and larmoyant, a eye sunken, (these three symptoms constituting the Syndrome of Claude Bernard-Horner), of the pupils contracted, a edema of the eyelids, a nasal Congestion or a nose which run, as well as a Transpiration increased on the zone of the head where the pain appears. The Cou is often tended and of the pains to the Mâchoire S as to the Dent S were announced. The scalp hypersensitive with is touched (pains) on the side of the cephalgia.

The comparison with the AVF however is limited since the patients who had Migraine S affirm that the pain felt at the time of a AVF is definitely more important than at the time of a migraine (with a sometimes perceived intensity hundred times larger). Another analogy is that of an ice pick burning which one would insert in a way repeated through the eye and the Cerveau, of a tear or a crushing. Medicine estimates that it is about the one of the most intense pains, and that it exceeds that of a Amputation without Anesthésie.

During an attack, the person is agitated and cannot remain calm. The sensitivity to the light, the sensitivity to the sound and the Vomissement S are frequent consequences of the migraines and can also appear at the time of AVF.

The AVF often periodic and are well copied on a precise schedule. They can strike the night, per same hour or return per same hour one week later. These phenomena pushed the scientists to study the relations with the biological clock of the brain and the body (circadian Rythme). Another sign of the AVF is the Syndrome of Claude Bernard-Horner. In certain cases, the affection can even push with the Suicide in order to be released from the pain in a desperate act.

At the time of episodical attacks, the pains can arrive one or more time per day, often per same hour, over one period of several weeks. They are followed from one calm period, without headaches, which can last a few weeks, and until several years. Approximately 10 to 15% of the patients suffering from AVF have chronic cephalgias: they undergo these pains each day during years.

It is considered that the AVF are episodical when they occur in group during one period ranging between 7 and 365 days with a remission of at least a month between each period. If the pains occur over one duration longer than one year, without period of lull of at least a month, then pathology is regarded as chronicle. It happens that the nature of the evil changes the episodical one with chronicle and vice versa. It happened that people are again reached AVF after tens of years free from attacks.

Prevalence

Whereas the migraines more often appear among women, the AVF are rather a pathology concerning the men. For a woman diagnosed with a AVF, one counts 2,5 to 3 men suffering from the same affection. This difference between the two sexes is however in retreat, it is difficult to say if it is induced by better diagnoses or if the affection more often appears from now on among women. In Europe and in the United States, between 1 and 4 people out of 1000 develop these disorders. The statistics concerning the other areas of the sphere are still insufficient. The latitude seems to play a part: the AVF more often appear at the Scandinavian populations than those which live close to the equator. It is supposed that the duration of the day, which varies according to the latitude, is related to these cephalgias.

Pathophysiology

The AVF are categorized like neuro-vascular cephalgias. The intense pain is caused by the dilation of the blood-vessels which has a presentiment of the Nerve trigeminal. If the immediate reason of the pain is known, the causes of the affection remain partly ignored.

Hypothalamus

Among the advanced theories one finds that which indicates that the AVF are caused by a problem in the Hypothalamus. This thesis could explain why the headaches occur with a precise and regular chronology. One of the roles of the hypothalamus is to control the circadian Rythme. Metabolic anomalces were pointed out besides among patients.

The hypothalamus is responsible for several Hormone S, of the olfactive stimuli, information coming from the bodies (Cœur, Estomac, reproductive Appareil), of the concentrations of several substances in blood (Insuline, Leptine, etc). The gland has a big role in the stress and mood. A possible anomaly could be the source of the AVF.

Genetic factors

To date, no gene intervening in the AVF was detected. However, the direct descendants of a person suffering from AVF are likely greater to develop the affection than the remainder of the population. Contrary to the other types of cephalgias, the importance of the genetic factor seems less significant in the case of the AVF.

Releases

The Nitroglycérine can sometimes induce AVF among patients who suffer from it, in a way similar to the sudden attacks. The alcohol ingestion is a known factor which generates the appearance of pains at the affected people. The exposure to hydrocarbons (solvents, perfumes, etc) can also generate AVF. Certain people present an intolerance to heat and a too high temperature can produce an attack. AVF were also noted among certain patients following their nap. The relation between the food and the headaches is known little about and remains a discussed subject.

Differential diagnoses

Treatment

Many specialists are not accustomed to this affection and the AVF or are often badly not diagnosed at the patient.

An attack of AVF is regarded as a medical emergency because of the generated pain. However, certain doctors know this affection less better and can neglect the treatment while making await the patient. In the event of misunderstanding or of an insufficient diagnosis, the people suffering from AVF can be comparable wrongly with drug addicts in lack.

Treatment of the crisis

The drugs usually prescribed against the headaches are ineffective (Aspirine, Paracétamol and Ibuprofène). Contrary to the migraines and other cephalgias, the AVF are insensitive with the treatments by “Biofeedback”. Certain patients answer the narcotic antidouleurs partly but the need for often taking some makes them inadequate. They do not arrive in addition at completely removing the pain. Some indices show that the pains are sometimes so intense that even the Morphine sorrow to fight them. However, of new substances as the Fentanyl seem promising but must still be the subject of research.

Certain treatments give results satisfying to treat the crises:

oxygen treatment normobare (6 with 8l/mn) gives good performances: 75% of the patients are relieved if the treatment is begun at the beginning from the crisis. However conditioning, obstruction and the storage of oxygen in limit the use. The interest of this treatment is the absence of undesirable effect in the event of repeated use (more than two crises per day). In France, oxygen treatment in the vascular pain of the face is refunded by the health insurance, provided that the initial regulation is made by a neurologist, a orl or a doctor of a structure specialized in the assumption of responsibility of the pain.
According to the proposals re-examined to prescribe, the injection of sumatriptan (Imiject) is an alternative when the use of oxygen treatment is impossible. The effectiveness is same level as that of oxygen treatment, although there does not exist comparison test oxygen treatment versus sumatriptan. There exists on the other hand a certain number of undesirable effects, as well as cardiovascular risks to be taken into account, which make disadvise its use among patients having cardiovascular antecedents.

Preventive medication

Certain substances like the Vérapamil (or the Cortisone) showed an effectiveness.

gold prophylactics (preventatives). In addition, shorts-term transitional medications (such ace steroids) may Be used while prophylactic treatment is instituted and adjusted.

Abortive treatment

The most successful abortive include breathing pure oxygen (12-15 liters per minute in has non-rebreathing apparatus) and Triptan drugs like Sumatriptan and Zolmitriptan. Because off the rapid onset off year attack, the triptan drugs are usually taken nasally gold by Subcutaneous injection rather than by mouth. With lidocaine nasal spray may also Be prescribed.

Hot showers cuts helped butt 15% off people who try them. Abortive Other cure that work for nap and not for others include ice, cold showers, breathing cold air, broad cafeine, and drinking amounts off toilets in the early training courses off year attack. Vigorous exercise has been shown in effective sum boxes to Be very in relieving and aborting year acute attack. (Atkinson, 1977; Ekbom and Lindahl, 1970).

Prophylactic treatment

With wide variety off prophylactic medicines are in uses, and patient response to variable thesis is highly. Preventatives include Muscle releasing S, Lithium, Calcium Chanel blockers such ace Verapamil, Pin compounds, Prednisolone, anti-seizure medicines such ace Topiramate, and atypical anti-psychotics.

Magnesium supplements cuts been shown to Be off nap benefit in butt 40% off patient. Melatonin has also been reported to help nap. Feverfew, year herb used to treat migraine, is not clearly beneficial according to anecdotes from Web forums. With broad proportion off those trying Kudzu cuts reported suppression off the symptoms.

There is substantial anecdotal obviousness that Serotonergic psychedelics such ace Psilocybin (mushrooms) and LSD and LSA d-Lysergic acid amide (Rivea corymbosa seeds) abort cluster periods and extend remission periods. , Clinical study off thesis treatments under the auspices has off MAPS is being developed by researchers At Harvard Medical School, McLean Hospital. Melatonin, psilocybin, Serotonin, and the triptan abortive drugs are closely-related Tryptamines.

There cuts been has few boxes where has root channel treatment one has bad tooth made the headache disappear. -->

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