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From the Naval Medical Information Management Center (NMIMC)
MED-02 Operational Medicine & Fleet Support
MED-23 AEROSPACE MEDICINE
CONDITION: CRANIAL NEURALGIA
AEROMEDICAL CONCERNS: The pain of cranial neuralgia can be
incapacitating in flight. The symptoms of trigeminal neuralgia may be
stimulated by the wearing of an oxygen mask. Glossopharyngeal neuralgia
has been associated with syncope and cardiac arrest.
WAIVER: Because of the severity and chronic recurrent behavior of the
neuralgias, these are CD, waiver usually not considered (vide infra).
INFORMATION REQUIRED: Neurology or neurosurgical consultation.
TREATMENT: Pharmacological treatments (Tegretol, Triavil, Prolixin, Mexitil), although effective, are not waiverable due to their side
effects profiles. Surgical "cures" (microvascular decompression) may be
achieved for which cases waivers may be considered.
DISCUSSION: Although most cranial neuralgias are probably due to
microvascular compression at the root entry zone, other etiologies need
to be considered, especially in the young adult population in whom
demyelinating disease, aneurysms, neoplasms, and infectious etiologies
(post-herpetic, Lyme disease, etc) may be more common. The finding
of sensory loss in the company of neuralgia should alert the flight
surgeon to consider these other causes of cranial neuralgia.
Title
Head and neck pain review: traditional and new perspectives.
Author
Friedman MH; Nelson AJ Jr
Address
Department of Dentistry, Westchester County Medical Center,
Valhalla, NY USA.
Source:
J Orthop Sports Phys Ther, 24(4):268-78 1996 Oct
Abstract
A variety of conditions are frequently associated with the
occurrence of head and neck pain.
The purposes of this review are: to
describe the characteristics of several musculoskeletal, neurological,
and systemic conditions frequently cited as possible causes of head and
neck pain and to suggest a new technique for treating head and neck
pain. The characteristics of musculoskeletal conditions, such as muscle
spasm, tendinitis, trigger points, and joint inflammation, and their
relationship to head and neck pain are considered. The features and
clinical implications of neurologic conditions, such as atypical facial
pain, trigeminal and glossopharyngeal neuralgia, reflex sympathetic
dystrophy, and neurogenic inflammation, are also described. The
distinguishing characteristics of headaches, including cluster, tension,
chronic daily, rebound, posttraumatic, and postlumbar puncture, are
detailed.
This review also addresses the contributions of systemic
disorders, such as osteoarthritis, rheumatoid arthritis and the
variants, and rheumatoid-related conditions, like dermatomyositis,
temporal arteritis, Lyme's disease, and fibromyalgia, to head and neck
pain. The results of a recent pilot study of the effectiveness of
intraoral circulating ice water for resolving symptoms related to head
and neck pain secondary to neurogenic inflammation are presented in this
work.
Ice water circulating through hollow metal tubes was placed
intraorally for 15 minutes in the posterior maxillary area on 12
individuals with cervical pain and muscle spasm. In nine of these
individuals, reduced cervical pain perception, upper trapezius
electromyography signal reduction, and increased cervical range of
motion was produced. Six out of 12 individuals had accompanying
headache, which was reduced or eliminated in four cases.
These findings
suggest a strong trigemino-cervical relationship to neck pain and
headache.
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