Midfacial segment pain: implications for rhinitis and sinusitis

Abstract

During the past decade, studies on facial pain have shown that there is a distinct group of patients who have a form of facial neuralgia that has all the characteristics of tension-type headache, except that it affects the midface; it is called midfacial segment pain. The pain is described as a feeling of pressure, although some patients might feel that their nose is blocked when they have no nasal airway obstruction. Midfacial segment pain is symmetric, and it might involve areas of the nasion (the root of the nose), under the bridge of the nose, on either side of the nose, the peri- or retro-orbital regions, or across the cheeks. There might be hyperesthesia of the skin and soft tissues over the affected area. Nasal endoscopy and CT scans are typically normal. Most patients with this condition respond to low-dose amitriptyline, but noticeable improvement might require up to 6 weeks.

Prospective three-year follow up of a cohort study of 240 patients with chronic facial pain

“…6 Jones described mid-facial segmental pain as a tension-type pain of neurological origin, pressing or aching in quality, with a bilateral distribution involving the nasion, peri-orbital regions, cheeks or paranasal areas. 7 Mid-facial segmental pain involves the frontal, parietal and occipital regions and is associated with tension-type headaches. 8 Tension-type pain is thought to be due to sensitisation of second order neurons at the trigeminal nucleus subcaudalis, which is the facial equivalent of the dorsal horn of the spinal cord ( Figure 1).…”

“…7 Mid-facial segmental pain involves the frontal, parietal and occipital regions and is associated with tension-type headaches. 8 Tension-type pain is thought to be due to sensitisation of second order neurons at the trigeminal nucleus subcaudalis, which is the facial equivalent of the dorsal horn of the spinal cord ( Figure 1). 9 Face, head and neck afferents converge onto the subnucleus caudalis.…”

“…7 Tricyclic antidepressants are known to be effective in the prophylaxis of tension-type headache and are thought to reduce the sensitivity of second order neurons at the level of the spinal cord. 12 In chronic tension-type headache, as defined by the International Headache Society classification 2.3, patients have at least 15 days per month with headache along with the characteristics detailed in Table I.…”

Vasomotor Rhinitis

“…Patients describe nasal pressure, heaviness, or tightness and feel that their nostrils are blocked even when there is no obstruction to nasal flow. CT scans and nasal endoscopy are typically normal [41].…”

“…This treatment can reduce nasal congestion for up to 6 months. Low daily dose amitriptyline (20 mg/d) for 6 months has been shown to be beneficial in treating midfacial syndrome [41].…”