DOCSLIB.ORG

Current Understanding of Trigeminal Ganglion Structure and Function In

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Current Understanding of Trigeminal Ganglion Structure and Function In Review Cephalalgia 2019, Vol. 39(13) 1661–1674 ! International Headache Society 2018 Current understanding of Article reuse guidelines: sagepub.com/journals-permissions trigeminal ganglion structure DOI: 10.1177/0333102418786261 and function in headache journals.sagepub.com/home/cep Karl Messlinger1 and Andrew F Russo2,3 Abstract Introduction: The trigeminal ganglion is unique among the somatosensory ganglia regarding its topography, structure, composition and possibly some functional properties of its cellular components. Being mainly responsible for the sensory innervation of the anterior regions of the head, it is a major target for headache research. One intriguing question is if the trigeminal ganglion is merely a transition site for sensory information from the periphery to the central nervous system, or if intracellular modulatory mechanisms and intercellular signaling are capable of controlling sensory information relevant for the pathophysiology of headaches. Methods: An online search based on PubMed was made using the keyword ‘‘trigeminal ganglion’’ in combination with ‘‘anatomy’’, ‘‘headache’’, ‘‘migraine’’, ‘‘neuropeptides’’, ‘‘receptors’’ and ‘‘signaling’’. From the relevant literature, further references were selected in view of their relevance for headache mechanisms. The essential information was organized based on location and cell types of the trigeminal ganglion, neuropeptides, receptors for signaling molecules, signaling mechanisms, and their possible relevance for headache generation. Results: The trigeminal ganglion consists of clusters of sensory neurons and their peripheral and central axon processes, which are arranged according to the three trigeminal partitions V1–V3. The neurons are surrounded by satellite glial cells, the axons by Schwann cells. In addition, macrophage-like cells can be found in the trigeminal ganglion. Neurons express various neuropeptides, among which calcitonin gene-related peptide is the most prominent in terms of its prevalence and its role in primary headaches. The classical calcitonin gene-related peptide receptors are expressed in non-calcitonin gene-related peptide neurons and satellite glial cells, although the possibility of a second calcitonin gene- related peptide receptor in calcitonin gene-related peptide neurons remains to be investigated. A variety of other signal molecules like adenosine triphosphate, nitric oxide, cytokines, and neurotrophic factors are released from trigeminal ganglion cells and may act at receptors on adjacent neurons or satellite glial cells. Conclusions: The trigeminal ganglion may act as an integrative organ. The morphological and functional arrangement of trigeminal ganglion cells suggests that intercellular and possibly also autocrine signaling mechanisms interact with intra- cellular mechanisms, including gene expression, to modulate sensory information. Receptors and neurotrophic factors delivered to the periphery or the trigeminal brainstem can contribute to peripheral and central sensitization, as in the case of primary headaches. The trigeminal ganglion as a target of drug action outside the blood-brain barrier should therefore be taken into account. Keywords Trigeminal neurons, satellite glial cells, neuropeptides, signaling, neuromodulation, CGRP Date received: 20 April 2018; revised: 24 May 2018; accepted: 9 June 2018 1Institute of Physiology and Pathophysiology, Friedrich-Alexander- Introduction University Erlangen-Nu¨rnberg, Erlangen, Germany 2Department of Molecular Physiology and Biophysics, University of Iowa, The paired trigeminal ganglion (TG), also called the Iowa City, IA, USA semilunar or Gasserian ganglion, is unique among pri- 3Iowa VA Health Care System, Iowa City, IA, USA mary afferent ganglia both in structural and functional Corresponding author: aspects. It is located inside the head and gives rise to Karl Messlinger, University of Erlangen-Nuernberg, Universitaetsstr. 17, three main peripheral nerves providing nearly all intra- Erlangen, D-91054 Germany. and extracranial structures with nerve fibers of various Email: [email protected] 1662 Cephalalgia 39(13) somatosensory functions. Some of these structures, like experiments (7) and electrophysiological recording stu- the cornea and the cranial dura, are mainly or exclu- dies in the cat (8) and the monkey (9), but there is not sively innervated by thin A-delta and C-fiber afferents much information about the topographical distribution with putative nociceptive functions (1,2,3). The of neurons innervating intracranial structures. The so-called trigeminovascular system of the meninges, problem is that the innervation territories of cutaneous denoting the afferent fibers closely associated with afferents only roughly map the territories of meningeal intracranial blood vessels, is regarded as the structural afferents in humans. Furthermore, the areas of head- substrate of headache generation. Notwithstanding, ache sensations are in no way helpful in this problem; this system keeps amazing secrets; for example, the early intraoperative experiments have shown that head- fact that stimulation of the densely innervated pial ache can be referred to areas that may be far from the blood vessels does not cause any sensation (4). meningeal sites of stimulation (10). Thus, it is not known which neurons are involved in headache gener- Location, anatomical structure and ation and it is completely unknown if these neurons are compartments of the trigeminal in any morphological or functional aspect different to ganglion the neurons innervating facial skin and other cranial organs. The TG is located in the Meckel’s cave, a cavern in the petrosal part of the temporal bone on the floor of the Morphological characteristics of cell middle crania fossa, formed by a pocket of dura mater. types in the trigeminal ganglion From the rostro-lateral border of the TG, three large nerves arise, the ophthalmic (V1), the maxillary (V2), The TG consists mainly of primary afferent neurons and the mandibular (V3) nerve (Figure 1(a)). In rodents, of the pseudo-unipolar type and glial cells. In human at their origin V2 and V3 form one thick bundle that trigeminal ganglia, 20,000–35,000 neurons and about divides more rostrally. On the caudal border, the trigem- 100 times more non-neuronal cells have been counted inal ganglion passes into the trigeminal root or so-called (11). The neurons can unequivocally be identified by trigeminal nerve, which contains the central processes of their nearly round and centrally located nucleus, in trigeminal fibers that enter the brainstem at the pontine which nucleoli and chromatin particles may be visible level. In addition, a thin bundle of trigeminal motor (12). In the rat, the diameters of neurons range from fibers passing through the ganglion accompanies the tri- about 10 to 55 mm, with more than 90% being small geminal nerve (root) medially and the mandibular nerve to medium-sized neurons measuring 15–35 mmin rostrally from the ganglion (5). After retrograde tracing diameter (13,14). The size of the somata is loosely of the rat spinosus nerve, an afferent nerve in the dura correlated with the diameters of the nerve fibers. mater arising from the mandibular area, nerve fibers lit In some sections, one or even both processes of a up in the ganglion, which obviously had no contact to neuron can be visualized but it is not entirely clear any cell body. These fibers are presumably propriocep- if both have the same origin, according to the classical tive afferents of head muscles that pass the ganglion on pseudo-unipolar type, which is certainly the case in their way to the mesencephalic nucleus in the brainstem, dorsal root ganglion neurons (15), or if they arise where their somata are located (6). independently from the cell body close to one The mass of nerve fibers is thus occupying a major another (Figure 1(b)). This question is of considerable volume within the ganglion. The fascicles of nerve fibers functional importance because, in the latter case, at separate aggregations of neurons that belong to the least parts of the cell body membrane are necessarily three partitions, V1–V3, which can be fairly distin- depolarized when action potentials travel through the guished according to their location within the ganglion. neuronal processes. In horizontal sections through the rodent TG, the oph- The TG cell bodies are surrounded by a more or less thalmic division is located rostro-medially, the maxil- tight single layer of satellite glial cells. In the embryonic lary division rostro-laterally, and the mandibular trigeminal ganglion, each neuroblast is already accom- division forms a protrusion at the caudal lateral panied by 2–4 glial cells (16). The distal and central border (Figure 1(a)). The ganglion and the three per- afferent processes are wrapped by Schwann cells. ipheral nerves are ensheathed by a tough layer of col- The Schwann cells can be either non-myelinating or lagenous tissue, a duplication of the dura mater, while can form a myelin sheath, as in the case of Ab and Ad the trigeminal root is only equipped with some sparse fibers. In addition to glia, the TG contains fibroblasts connective tissue, which may render it vulnerable to forming collagen fibers, small blood vessels (mainly mechanical impact. capillaries), and several types of immune cells, such as The functional organization of cutaneous afferents resident microglia-like macrophages (17). A functional within the TG is quite well-known from lesion crosstalk between neurons and macrophages via Messlinger and
Load more

Recommended publications
  • Trigeminal Cave and Ganglion: an Anatomical Review
    Int. J. Morphol., 31(4):1444-1448, 2013. Trigeminal Cave and Ganglion: An Anatomical Review Cavo y Ganglio Trigeminal: Una Revisión Anatómica N. O. Ajayi*; L. Lazarus* & K. S. Satyapal* AJAYI, N. O.; LAZARUS, L. & SATYAPAL, K. S. Trigeminal cave and ganglion: an anatomical review. Int. J. Morphol., 31(4):1444- 1448, 2013. SUMMARY: The trigeminal cave (TC) is a special channel of dura mater, which extends from the posterior cranial fossa into the posteromedial portion of the middle cranial fossa at the skull base. The TC contains the motor and sensory roots of the trigeminal nerve, the trigeminal ganglion (TG) as well as the trigeminal cistern. This study aimed to review the anatomy of the TC and TG and determine some parameters of the TC. The study comprised two subsets: A) Cadaveric dissection on 30 sagitally sectioned formalin fixed heads and B) Volume injection. We found the dura associated with TC arranged in three distinct layers. TC had relations with internal carotid artery, the cavernous sinus, the superior petrosal sinus, the apex of petrous temporal bone and the endosteal dura of middle cranial fossa. The mean volume of TC was 0.14 ml. The mean length and breadth of TG were 18.3 mm and 7.9 mm, respectively, mean width and height of trigeminal porus were 7.9 mm and 4.1 mm, respectively, and mean length of terminal branches from TG to point of exit within skull was variable. An understanding of the precise formation of the TC, TG, TN and their relations is important in order to perform successful surgical procedures and localized neural block in the region of the TC.
    [Show full text]
  • Clinical Anatomy of the Trigeminal Nerve
    Clinical Anatomy of Trigeminal through the superior orbital fissure Nerve and courses within the lateral wall of the cavernous sinus on its way The trigeminal nerve is the fifth of to the trigeminal ganglion. the twelve cranial nerves. Often Ophthalmic Nerve is formed by the referred to as "the great sensory union of the frontal nerve, nerve of the head and neck", it is nasociliary nerve, and lacrimal named for its three major sensory nerve. Branches of the ophthalmic branches. The ophthalmic nerve nerve convey sensory information (V1), maxillary nerve (V2), and from the skin of the forehead, mandibular nerve (V3) are literally upper eyelids, and lateral aspects "three twins" carrying information of the nose. about light touch, temperature, • The maxillary nerve (V2) pain, and proprioception from the enters the middle cranial fossa face and scalp to the brainstem. through foramen rotundum and may or may not pass through the • The three branches converge on cavernous sinus en route to the the trigeminal ganglion (also called trigeminal ganglion. Branches of the semilunar ganglion or the maxillary nerve convey sensory gasserian ganglion), which contains information from the lower eyelids, the cell bodies of incoming sensory zygomae, and upper lip. It is nerve fibers. The trigeminal formed by the union of the ganglion is analogous to the dorsal zygomatic nerve and infraorbital root ganglia of the spinal cord, nerve. which contain the cell bodies of • The mandibular nerve (V3) incoming sensory fibers from the enters the middle cranial fossa rest of the body. through foramen ovale, coursing • From the trigeminal ganglion, a directly into the trigeminal single large sensory root enters the ganglion.
    [Show full text]
  • Trigeminal Neurons (Vibria Pad/Barrels/Tract Formation/Organotypic Cocultures) REHA S
    Proc. Natl. Acad. Sci. USA Vol. 90, pp. 7235-7239, August 1993 Neurobiology Target-derived influences on axon growth modes in cultures of trigeminal neurons (vibria pad/barrels/tract formation/organotypic cocultures) REHA S. ERZURUMLU*, SONAL JHAVERI, HIROSHI TAKAHASHIt, AND RONALD D. G. MCKAY: Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA 02139 Communicated by Richard Held, April 19, 1993 ABSTRACT Cellular and molecular signals involved in formation, are also characterized by differential rates ofaxon axon elongation versus collateral and arbor formation may be extension and by changes in the levels of expression of intrinsic to developing neurons, or they may derive from specific proteins that are shipped to the growing axon tips targets. To identify signals regulating axon growth modes, we (2-10). have developed a culture system in which trigeminal ganglion Recently developed techniques for long-term coculturing cells are challenged by various target tissues. Embryonic day 15 ofbrain slices provide a powerful means for addressing issues (E15) rat trigeminal ganglion explants were placed between of axon-target interactions and for studying the regulation of peripheral (vibrissa pad) and central nervous system targets. axon growth modes in a controlled environment (11-19). Normally, bipolar trigeminal ganglion cells extend one process Investigations of axon-target relationships in organotypic to the vibrissa pad and another to the brainstem trigeminal cocultures have been undertaken for various parts of the complex. Under coculture conditions, the peripheral processes mammalian brain, including the thalamocortical projection invade the vibrissa pad explants and form a characteristic (11-15), the septohippocampal system (16), and the connec- circumfollicular pattern.
    [Show full text]
  • Atlas of the Facial Nerve and Related Structures
    Rhoton Yoshioka Atlas of the Facial Nerve Unique Atlas Opens Window and Related Structures Into Facial Nerve Anatomy… Atlas of the Facial Nerve and Related Structures and Related Nerve Facial of the Atlas “His meticulous methods of anatomical dissection and microsurgical techniques helped transform the primitive specialty of neurosurgery into the magnificent surgical discipline that it is today.”— Nobutaka Yoshioka American Association of Neurological Surgeons. Albert L. Rhoton, Jr. Nobutaka Yoshioka, MD, PhD and Albert L. Rhoton, Jr., MD have created an anatomical atlas of astounding precision. An unparalleled teaching tool, this atlas opens a unique window into the anatomical intricacies of complex facial nerves and related structures. An internationally renowned author, educator, brain anatomist, and neurosurgeon, Dr. Rhoton is regarded by colleagues as one of the fathers of modern microscopic neurosurgery. Dr. Yoshioka, an esteemed craniofacial reconstructive surgeon in Japan, mastered this precise dissection technique while undertaking a fellowship at Dr. Rhoton’s microanatomy lab, writing in the preface that within such precision images lies potential for surgical innovation. Special Features • Exquisite color photographs, prepared from carefully dissected latex injected cadavers, reveal anatomy layer by layer with remarkable detail and clarity • An added highlight, 3-D versions of these extraordinary images, are available online in the Thieme MediaCenter • Major sections include intracranial region and skull, upper facial and midfacial region, and lower facial and posterolateral neck region Organized by region, each layered dissection elucidates specific nerves and structures with pinpoint accuracy, providing the clinician with in-depth anatomical insights. Precise clinical explanations accompany each photograph. In tandem, the images and text provide an excellent foundation for understanding the nerves and structures impacted by neurosurgical-related pathologies as well as other conditions and injuries.
    [Show full text]
  • Nerve Supply of the Face 5Th &
    Nerve Supply of the Face 5th & 7th Lecture (7) . Important . Doctors Notes Please check our Editing File . Notes/Extra explanation هذا العمل مبنً بشكل أساسً على عمل دفعة 436 مع المراجعة {ومنْْيتو َ ّكْْع َلْْا ِّْللْفَهُوْْحس بهْ} َ َ َ َ َ َ َ َ َ ُ ُ والتدقٌق وإضافة المﻻحظات وﻻ ٌغنً عن المصدر اﻷساسً للمذاكرة Objectives By the end of the lecture, students should be able to: List the nuclei of the deep origin of the trigeminal and facial nerves in the brain stem. Describe the type and site of each nucleus. Describe the superficial attachment of trigeminal and facial nerves to the brain stem. Describe the main course and distribution of trigeminal and facial nerves in the face. Describe the main motor & sensory manifestation in case of lesion of the trigeminal & facial nerves. Trigeminal (V) 5th Cranial Nerve o Type: Mixed (sensory & motor). o Fibers: 1. General somatic afferent: afferent sensory Carrying general sensations from face, and anterior part of scalp. Extra 2. Special visceral efferent: efferent motor Supplying muscles developed from the 1st pharyngeal arch, (8 muscles will be mentioned in slide 5). Trigeminal Ganglion see o Site: Occupies a depression in the middle cranial fossanext )Trigeminal impression). slide o Importance: Contains cell bodies: 1. Whose dendrites carry sensations from the face and scalp. 2. Whose axons form the sensory root of trigeminal nerve. Trigeminal (V) 5th Cranial Nerve Nuclei (deep origin) 3 sensory + 1 Motor Extra Trigeminal (V) 5th Cranial Nerve Nuclei Four nuclei: (3 sensory + 1 Motor). *chewing General somatic afferent: Special visceral efferent: 1.
    [Show full text]
  • Arterial Supply of the Trigeminal Ganglion, a Micromorphological Study M
    Folia Morphol. Vol. 79, No. 1, pp. 58–64 DOI: 10.5603/FM.a2019.0062 O R I G I N A L A R T I C L E Copyright © 2020 Via Medica ISSN 0015–5659 journals.viamedica.pl Arterial supply of the trigeminal ganglion, a micromorphological study M. Ćetković1, B.V. Štimec2, D. Mucić3, A. Dožić3, D. Ćetković3, V. Reçi4, S. Çerkezi4, D. Ćalasan5, M. Milisavljević6, S. Bexheti4 1Institute of Histology and Embryology, Faculty of Medicine, University of Belgrade, Serbia 2Faculty of Medicine, Teaching Unit, Anatomy Sector, University of Geneva, Switzerland 3Institute of Anatomy, Faculty of Dental Medicine, University of Belgrade, Serbia 4Institute of Anatomy, Faculty of Medicine, State University of Tetovo, Republic of North Macedonia 5Department of Oral Surgery, Faculty of Dental Medicine, University of Belgrade, Serbia 6Laboratory for Vascular Anatomy, Institute of Anatomy, Faculty of Medicine, University of Belgrade, Serbia [Received: 13 March 2019; Accepted: 14 May 2019] Background: In this study, we explored the specific microanatomical properties of the trigeminal ganglion (TG) blood supply and its close neurovascular relationships with the surrounding vessels. Possible clinical implications have been discussed. Materials and methods: The internal carotid and maxillary arteries of 25 adult and 4 foetal heads were injected with a 10% mixture of India ink and gelatin, and their TGs subsequently underwent microdissection, observation and morphometry under a stereoscopic microscope. Results: The number of trigeminal arteries varied between 3 and 5 (mean 3.34), originating from 2 or 3 of the following sources: the inferolateral trunk (ILT) (100%), the meningohypophyseal trunk (MHT) (100%), and from the middle meningeal artery (MMA) (92%).
    [Show full text]
  • 05 Trigeminal System 2013.Pdf
    Dental Neuroanatomy Thursday February 7th, 2013 David A. Morton, Ph.D. 5. THE TRIGEMINAL SYSTEM Somatic Sensation of the Face and Head Objectives 1. Outline the two pathways for facial sensation from the head. 2. Contrast facial sensation from the head and somatic sensation from the body. In what ways are they similar? Different? Try drawing this on the Haines atlas diagram at the end of the lecture. 3. Diagram the corneal reflex: the afferent and efferent limbs as well as nuclei involved in the brainstem. 4. If a person does not blink, how would you determine if the problem were in the sensory (afferent) limb, motor (efferent) limb, or brainstem interconnections for the corneal reflex? 5. Explain how a single, small medullary vascular lesion could abolish pain and temperature from the face on the right side and pain and temperature from the body on the left side. What vessel is most likely occluded? Introduction – The trigeminal system for the face and oral cavity is organized in a manner similar to the spinal cord. It has the equivalent of both the DCML pathway and the ALS pathway. The two trigeminal pathways will converge in the thalamus. The most confusing thing is that one of them descends before crossing and the other crosses immediately. Peripheral Receptors and Sensation Structures served by trigeminal system. 1. Cornea 2. Mucocutaneous tissues around mouth and nostrils. 3. Oral and nasal mucosae 4. Paranasal sinuses 5. Tongue (anterior two thirds) 6. Teeth and gums 7. Dura of anterior and middle cranial fossae 8. Skin of face to the vertex except angle of jaw 9.
    [Show full text]
  • The Five Diaphragms in Osteopathic Manipulative Medicine: Neurological Relationships, Part 1
    Open Access Review Article DOI: 10.7759/cureus.8697 The Five Diaphragms in Osteopathic Manipulative Medicine: Neurological Relationships, Part 1 Bruno Bordoni 1 1. Physical Medicine and Rehabilitation, Foundation Don Carlo Gnocchi, Milan, ITA Corresponding author: Bruno Bordoni, [email protected] Abstract In osteopathic manual medicine (OMM), there are several approaches for patient assessment and treatment. One of these is the five diaphragm model (tentorium cerebelli, tongue, thoracic outlet, diaphragm, and pelvic floor), whose foundations are part of another historical model: respiratory-circulatory. The myofascial continuity, anterior and posterior, supports the notion the human body cannot be divided into segments but is a continuum of matter, fluids, and emotions. In this first part, the neurological relationships of the tentorium cerebelli and the lingual muscle complex will be highlighted, underlining the complex interactions and anastomoses, through the most current scientific data and an accurate review of the topic. In the second part, I will describe the neurological relationships of the thoracic outlet, the respiratory diaphragm and the pelvic floor, with clinical reflections. In literature, to my knowledge, it is the first time that the different neurological relationships of these anatomical segments have been discussed, highlighting the constant neurological continuity of the five diaphragms. Categories: Medical Education, Anatomy, Osteopathic Medicine Keywords: diaphragm, osteopathic, fascia, myofascial, fascintegrity,
    [Show full text]
  • Trigeminal Ganglion Innervates the Auditory Brainstem
    THE JOURNAL OF COMPARATIVE NEUROLOGY 419:271–285 (2000) Trigeminal Ganglion Innervates the Auditory Brainstem SUSAN E. SHORE,1,2* ZOLTAN VASS,3 NOEL L. WYS,1 AND RICHARD A. ALTSCHULER1 1Kresge Hearing Research Institute, University of Michigan, Ann Arbor, Michigan 48109-0506 2Department of Otolaryngology, Medical College of Ohio, Toledo, Ohio 43699 3Department of Otolaryngology, Albert Szent-Gyorgyi Medical University, Szeged, Hungary ABSTRACT A neural connection between the trigeminal ganglion and the auditory brainstem was investigated by using retrograde and anterograde tract tracing methods: iontophoretic injec- tions of biocytin or biotinylated dextran-amine (BDA) were made into the guinea pig trigem- inal ganglion, and anterograde labeling was examined in the cochlear nucleus and superior olivary complex. Terminal labeling after biocytin and BDA injections into the ganglion was found to be most dense in the marginal cell area and secondarily in the magnocellular area of the ventral cochlear nucleus (VCN). Anterograde and retrograde labeling was also seen in the shell regions of the lateral superior olivary complex and in periolivary regions. The labeling was seen in the neuropil, on neuronal somata, and in regions surrounding blood vessels. Retrograde labeling was investigated using either wheatgerm agglutinin- horseradish peroxidase (WGA-HRP), BDA, or a fluorescent tracer, iontophoretically injected into the VCN. Cells filled by retrograde labeling were found in the ophthalmic and mandib- ular divisions of the trigeminal ganglion. We have previously shown that these divisions project to the cochlea and middle ear, respectively. This study provides the first evidence that the trigeminal ganglion innervates the cochlear nucleus and superior olivary complex.
    [Show full text]
  • Intrinsic Brain Activity Triggers Trigeminal Meningeal Afferents in a Migraine Model
    ARTICLES Intrinsic brain activity triggers trigeminal meningeal afferents in a migraine model HAYRUNNISA BOLAY1, UWE REUTER1, ANDREW K. DUNN2, ZHIHONG HUANG1, DAVID A. BOAS2 & MICHAEL A. MOSKOWITZ1 1Stroke and Neurovascular Regulation Laboratory and 2NMR Center, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA H.B., U.R. and A.K.D. contributed equally to this study. Correspondence should be addressed to M.A.M.; email: [email protected] Although the trigeminal nerve innervates the meninges and participates in the genesis of mi- graine headaches, triggering mechanisms remain controversial and poorly understood. Here we establish a link between migraine aura and headache by demonstrating that cortical spreading depression, implicated in migraine visual aura, activates trigeminovascular afferents and evokes a series of cortical meningeal and brainstem events consistent with the development of headache. Cortical spreading depression caused long-lasting blood-flow enhancement selectively within the middle meningeal artery dependent upon trigeminal and parasympathetic activation, and plasma protein leakage within the dura mater in part by a neurokinin-1-receptor mechanism. Our findings provide a neural mechanism by which extracerebral cephalic blood flow couples to brain events; this mechanism explains vasodilation during headache and links intense neurometabolic brain activity with the transmission of headache pain by the trigeminal nerve. Although approximately 15–20% of the general population fected hemisphere. Although a link between aura and suffers from migraine headaches, little is known about its headache was suspected15, the cause for the pain remains un- pathogenesis. The headaches are often associated with stress, known. Because the trigeminal nerve transmits cephalic pain emotion or sleep disturbance, but the role of brain in migraine and each trigeminal nerve projects primarily to one side, we © http://medicine.nature.com Group 2002 Nature Publishing is still controversial.
    [Show full text]
  • Craniofacial Pain
    DIAGNOSIS AND INTERVENTIONAL TREATMENT OF CHRONIC FACIAL PAIN MILES DAY MD, DABA-PM, FIPP, DABIPP TRAWEEK-RACZ ENDOWED PROFESSOR IN PAIN RESEARCH MEDICAL DIRECTOR – THE PAIN CENTER AT GRACE CLINIC PAIN MEDICINE FELLOWSHIP DIRECTOR DEPARTMENT OF ANESTHESIOLOGY TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER LUBBOCK, TEXAS USA [email protected] “HOW TO MAKE $70 PLACING NEEDLES INTO SMALL HOLES WHILE MAINTAINING EXCELLENT RECTAL TONE” DISCLOSURES • PRODUCT ROYALTY FROM EPIMED INTERNATIONAL • FORMER ADVISORY BOARD MEMBER OF AIS OBJECTIVES • REVIEW THE WORK UP FOR FACIAL PAIN • DIFFERENTIAL DIAGNOSIS FOR FACIAL PAIN • REVIEW THE TRIGEMINAL NERVE BLOCK • REVIEW THE SPHENOPALATINE GANGLION BLOCK • REVIEW THE GLOSSOPHARYNGEAL NERVE BLOCK PAIN IN FACE ≠ TRIGEMINAL NEURALGIA FACIAL PAIN • PAIN IN THE HEAD AND NECK IS MEDIATED BY AFFERENT FIBERS IN THE TRIGEMINAL NERVE, NERVUS INTERMEDIUS, GLOSSOPHARYNGEAL AND VAGUS NERVES AND THE UPPER CERVICAL ROOTS VIA THE OCCIPITAL NERVES • STIMULATION OF THESE NERVES BY COMPRESSION, DISTORTION, EXPOSURE TO COLD OR OTHER FORMS OF IRRITATION OR BY A LESION IN CENTRAL PATHWAYS MAY GIVE RISE TO STABBING OR CONSTANT PAIN FELT IN THE AREA INNERVATED • CAUSE MAY BE CLEAR, BUT IN SOME CASES THERE MAY BE NO CAUSE APPARENT FOR NEURALGIC PAIN EVALUATION • THOROUGH HISTORY • SOMETIMES THE PAIN THE PATIENT PRESENTS WITH IS NOT THE SAME PAIN THE PATIENT STARTED WITH • PHYSICAL EXAM • EVALUATE THE FACE AS WELL AS THE NECK • PAIN ORIGINATING IN THE NECK CAN PRESENT ITSELF AS PAIN IN THE FACE • CRANIAL NERVES AS WELL AS C2 AND C3 • RADIOLOGICAL EVALUATION • USUALLY MRI Haldeman S, Dagenais S. Cervicogenic headaches: a critical review. Spine J 2001;1:31–46.
    [Show full text]
  • Nitroxidergic System in Human Trigeminal Ganglia Neurons A
    Acta histochemica 112 (2010) 444—451 www.elsevier.de/acthis Nitroxidergic system in human trigeminal ganglia neurons: A quantitative evaluation Elisa Borsania, Sara Giovannozzia, Ramon Boninsegnaa, Rita Rezzania, Mauro Labancaa,b, Manfred Tschabitscherc, Luigi F. Rodellaa,Ã aDivision of Human Anatomy, Department of Biomedical Sciences and Biotechnologies, University of Brescia, Viale Europa 11, 25123 Brescia, Italy bDepartment of Dentistry, University ‘Vita e Salute’ S. Raffaele, Milan, Italy cCenter of Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria Received 23 July 2008; received in revised form 16 April 2009; accepted 21 April 2009 KEYWORDS Summary Trigeminal ganglia; The trigeminal ganglia are involved in transmission of orofacial sensitivity. The free Nitroxidergic radical gas nitric oxide (NO) has recently been found to function as a messenger system; molecule in both central and peripheral trigeminal primary afferent neurons. NO is Orofacial pain; produced within neurons mainly by two enzymes: a constitutive (neuronal) form of Human NO synthase (nNOS) or an inducible form of NOS (iNOS). The aim of the study was to evaluate the distribution of trigeminal neurons according to size (small, medium and large neurons) and to correlate the percentage of NOS-immunopositive neurons with regard to neuronal size. The results showed a significant relationship between the percentage of nNOS-immunopositive neurons and the size of neurons. Evaluation of the percentage of nNOS-immunopositive neurons showed that they constitute about 50% of the total number of neurons and that they are represented mainly as large- sized neurons. The iNOS immunolabelling was very faint in all neuronal types. Since the nitroxidergic system is well represented in human trigeminal ganglia, this study indicates that it could play a relevant role in trigeminal neurotransmission.
    [Show full text]