A Review of Current Perspectives on Facial Presentations of Primary Headaches

Abstract

Orofacial pain (OFP) has recently been classified and subdivided into a number of groups, similar to headache disorders in the International Classification of Headache Disorders (ICHD). A novel group of OFP has been established whose major feature is that they resemble primary headache disorders occurring in the V2 or V3 dermatomes. These follow the clinical criteria and associated symptoms of the eponymous headache syndromes. Following the recent International Classification of Orofacial Pain (ICOP), three types are differentiated: Headache which spread into the face (type 1), facial pain which replaced headache but maintained the same characteristics and associated symptoms of the former headache (type 2), and de-novo orofacial pain that resembles primary headache types without any involvement of the ophthalmic trigeminal branch (type 3). The epidemiology is unclear: type 1 and 2 are not exactly common, they certainly exist in a notable proportion of headache patients, whereas type 3 may be rather rare. Since effective treatment options are available, it is important for clinicians to recognize such syndromes early to avoid misdiagnosis and unnecessary treatment, which most of these patients still experience. This review gives an up-to-date summary of diagnosis, pathophysiology and treatment of attack-like non-dental facial pain disorders.

Orofacial Migraine and Other Idiopathic Non-Dental Facial Pain Syndromes: A Clinical Survey of a Social Orofacial Patient Group

“…Finally, the sample confirmed the results of the literature [6,8] as subjects with orofacial pain frequently undergo visits by specialists of different specializations and receive multiple treatments, both pharmacological and non-pharmacological. However, the degree of dissatisfaction with both doctors and treatments remains high, with a reported high rate of side effects.…”

“…To establish and organize an adequate diagnostic path within the health system, it is essential to know which current diagnostic-therapeutic stages patients suffering from orofacial pain frequently face and whether they are satisfied with the type of attention and care received [4][5][6][7][8]. The collaboration of one of us with a group of patients gathered in an association via social media allowed us to interrogate a large group of subjects, who were not selected for affiliation to a specific specialist center but joined only by the common symptom of orofacial pain, where the diagnostic attribution of trigeminal neuralgia was common.…”

“…On the other hand, the recent scientific literature shows that primary headaches can involve the lower half of the skull in about 10-20% of cases [4,5,8,9]. This aspect must be kept in mind because these patients could be mistakenly subjected to invasive interventions, especially dental ones.…”

“…This type of pain may chronicize after invasive procedures; therefore, dental procedures should not be performed if the teeth are healthy. The treatments are mainly antidepressant and anticonvulsive drugs [3][4][5][6][7][8]. While the first three groups primarily refer to a dentistry specialist, and the patients frequently find a good diagnostic and clinical response, the last three groups are often a clinical challenge because the symptoms may be very similar or common among the different disorders.…”

“…While the first three groups primarily refer to a dentistry specialist, and the patients frequently find a good diagnostic and clinical response, the last three groups are often a clinical challenge because the symptoms may be very similar or common among the different disorders. Not rarely, all diagnostic attempts can remain unsuccessful without revealing a definite physical intra-or extraoral pain correlation [3][4][5][6][7][8]. For this reason, subjects with OFP often turn to more specialists without obtaining a definitive diagnosis [5].…”