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Close concepts: dentagra, sinusitis, headache, ear pain
As bone bosoms, teeth, arteries, cranial nerves, a nasopharynx, deep structures of a facial skeleton, intracranial educations can be a pain source in a face or it can be psychogenic, and also come from the next bodies, the considerable number of specialists, doctors and stomatologists is engaged in its treatment. The system of very various diagnostic and medical principles is developed. Chronic pains in a face happen quite often painful not only for the patient, but also for the doctor who treats him. At a large number of patients the diagnosis of a disease is made only allegedly, on the basis of a clinical current, without sufficient physical, radiological and histologic confirmations. Many of pain syndromes purely descriptive and treatment their absolutely empirical. Often headaches and pains in a face are combined as quite often the headache occupies frontal and temporal areas. It is possible even to consider pains in a face as a separate form of a headache. Objectively it is impossible to estimate pain, and even the university specialized clinics dealing with this problem and having the latest methods which are not able to make the diagnosis and to help all patients. The doctor whom the patient with pains in a face sees has to know that for the correct diagnosis and treatment it should reject or confirm a large number of etiological factors.
Considering the reasons of pains, the doctor first of all has to differentiate serious or life-threatening diseases from chronic pain syndromes, and in turn to differentiate the last from banal and short-term processes. As soon as at the patient existence of the progressing disease is rejected, it is necessary to begin persistent treatment of a pain syndrome. It is necessary to resort to use of drugs in the last turn.
The anamnesis of pains in a face
Effective treatment of the patient is possible only after establishment of the exact diagnosis. Among diagnosis components — collecting the anamnesis, physical inspection, laboratory and other additional diagnostic testings, reaction of an organism to trial treatment and supervision over the course of a disease, the assessment of the anamnesis is the most important element at treatment of pain syndromes in a face. After careful collecting the anamnesis the doctor can make rather reliable diagnostic hypothesis. When using all other diagnostic methods seldom it is possible to reveal pathology which could not be assumed on the basis of the anamnesis and physical inspection. Therefore below the technique of collecting the anamnesis in detail is considered.
Age and circumstances of developing of pain. Usually chronic pains arise at quite early age and most often have a vascular origin. Emergence of pain at mature age assumes existence of a depression and emotional factors. The pains in a face arising at patients of advanced age assume development of neuritis, temporal arteritis or other organic disease. In all age groups the beginning of pains can be connected with an injury.
Characteristic of pain. The patient has to describe a clinical current of the syndrome. The doctor needs to know the frequency and duration of attacks of pain, a clinical picture of a typical attack, including provocative factors, auras, time of emergence and character of pain and actions taken by the patient during an attack. Information on the previous treatment and response to it is important. Migraine is often observed in a face zone, pain at the same time usually unilateral, in a forehead or a temple. Migraine — the incidental disease, its attacks arise not every day. Frequency of migraine can make from two weekly to once a year.
The characteristic of pain is important. Pains of vascular genesis often happen pulsing or drilling. The pains caused by pressure can have the constant, heavy, squeezing character. Psychogenic pain is often described as a prelum, weight, a raspiraniye. It is important to know time of day when there is an attack. Migraine can develop at night, but pristupoobrazny headaches often repeat every night at the same time. Prodromal symptoms are characteristic only of migraine. It is important to know whether development of pain is connected with such signs as nausea, vomiting, a photophobia, fear of noise or feeling of any smells. The patient should be asked whether pain attacks are connected with environment factors. Bright light, change of weather, pollution of external air, carbon monoxide — all this can provoke migraine attacks. Cold weather promotes emergence of attacks of an epileptiform neuralgia. Strengthening of pain when chewing an elastic band or during meal assumes existence of pathology of teeth or a temporal and mandibular joint. The patient can report to the doctor about the emotional stress transferred him, alarm, mental tension or a depression. These states can accompany a pain syndrome. Some patients are convinced that pains can be provoked by some types of food. It is important to reveal in the anamnesis of an injury of the head, the pains preceding emergence. The patient should be asked whether he tests one or several types of pain, and in details to find out character of each of them.
Pains in a face often occur at the patients having an allergy, but to prove a causal relationship of an allergy with pain very difficult. The patient should be asked on the medicine taken by him earlier in detail. Among patients with chronic pains abuse of the anesthetizing drugs is very widespread.
Ask patients with pains in a face the same questions, as well as the patient with a headache.
The following questions are in addition set:
1. Do you have diseases of teeth or gums? If "yes", then what was appointed treatment?
2. Whether you note decrease in hearing, a ring (in ears or any allocations from ears?