Hemicrania continua in a patient with concomitant dental disease

Hemicrania continua: Case series presenting in an orofacial pain clinic

“…It is important to point out that a patient reporting “shooting” pain, suggestive of trigeminal neuralgia, was not the one with a comorbid disorder of trigeminal neuralgia in our case series (see Table 1). Similar to our experience, two cases of HC with concomitant TMD have been described by a neurologist (12) and dentists (13) when initial treatment for either one of the disorders provided only incomplete remission of the pain. To achieve adequate pain control, both comorbid pain disorders need to be diagnosed and treated to avoid a situation where only partial pain control is achieved, leading to patient perception of treatment failure when only one of the pain disorders is addressed.…”

“…To the best of our knowledge, besides three individual case reports (7,13,15), this is the first case series providing group-wise data on HC patients seen in an orofacial pain setting. Our data suggests that such patients present to orofacial pain practitioners having HC and seeking care for pain that they describe in terms other than “headache”, with the most common complaint being “facial pain”.…”

“…Given that indomethacin belongs to the group of NSAIDs, which are commonly used for inflammatory and musculoskeletal pains, it would be expected that they would alleviate pain associated with other craniofacial disorders. Although three cases of HC presenting as or with TMD have been described by dentists (4,13), the reports lacked elaborate patient and pain characterization, comprehensive diagnostic work-up, or adequate timeline to assess TMD treatment response when ruling out TMD as the sole cause for the headache pain, and attributing it to HC based primarily on the response to indomethacin. It could potentially lead to HC over-diagnosis in cases of other chronic continuous orofacial pain, such as TMD.…”

“…Misdiagnosis and inappropriate treatment have been attributed to the rarity of HC, as well as paucity of autonomic symptoms, medication overuse, clinical similarities with migraine, half-sided tension-type and cluster headaches, and dental or atypical facial pain (3,5–10). Moreover, HC may co-exist with other primary headache disorders (2), trigeminal neuralgia (11), or temporomandibular disorder (TMD) (12,13).…”

Abstracts and Citations

“…Then again, infrequent but diagnostic is a sensation of sand or grit in the unilateral eye. As in the Rozen 3 and Noma 4 abstracts, even with an enucleated eye or dental disease we should be able to recognize HC. Lastly, I alert the reader to the Goadsby 5 review on this topic and other trigeminal autonomic cephalalgias in the American Academy of Neurology Continuum series in which R.G.K authored a tension‐type headache review.…”