Neurovascular Pains: Implications of Migraine for the Oral and Maxillofacial Surgeon

Abstract

SynopsisEpidemiological studies have shown that migraine headaches are a common finding in the general population, often associated with a high degree of disability. Additionally, migraine has a reported co-morbidity with other medical conditions, most notably with chronic pains such as temporomandibular disorders (TMD). The pathophysiological mechanisms involved with migraine are suggestive of an increased and prolonged hyperexcitability to stimuli, especially within the trigeminal distribution. Since migraine is mediated via branches of the trigeminal nerve it has the potential to mimic other types of pains, such as toothache or sinusitis. Therefore, it is recommended that oral and maxillofacial surgeons be familiar with the diagnostic criteria for migraine headaches in order to identify and appropriately treat such individuals who present to their clinics. KeywordsMigraine Headache; Diagnosis; Epidemiology; Pathophysiology; Oral Surgery; Pain IntroductionNeurovascular pains, otherwise known as headaches, are a group of pain disorders that are felt as cephalalgias, or pains in the head. Likely they are a heterogeneous group of disorders that share a common anatomic region of presentation, the head, but have somewhat separate pathophysiological mechanisms. For the most part, neurovascular pains are currently viewed Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. as arising from neuronal firing of nociceptors associated with intracranial blood vessels and dura. For this reason these pain disorders were historically referred to as 'vascular pains' [1], but further research has identified both peripheral and central aspects of the nervous system are playing crucial roles in the initiation and perpetuation of these pains [2,3]. This brought about a change in nomenclature regarding headache, which are now referred to as 'neurovascular pains disorders', stressing the neuropathic aspect of migraine. (Table 1) Research has continued to more closely associate headache disorders with neuropathic mechanisms, which is starting to result in a shift in how headaches are viewed -from both clinical and research perspectives. In the midst of this paradigm shift this article seeks to provide an overview of the epidemiologic data and pathophysiologic mechanisms of one type of neurovascular pain, that being migraine headaches. The reason for focusing on migraine headache is because they are known to be common in the population [4,5] and have been reported to have the most disability associated with them [6,7], making migraine headache the prototypic neurovascular pain disorder. Migraine hea...

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“…It is a dysfunction of sensory processing of painful stimuli (24). Pain is generated either peripherally from trigeminocervical neurons through abnormal activation at primary afferents (25) or centrally due to anomalous modulation at second-order neurons (26)(27)(28). Once nociceptive primary afferent trigeminocervical systems are peripherally activated, signals travel orthodromically and neuropeptides are released onto receptors on secondorder neurons of the trigeminal nucleus caudalis (23,29,30).…”

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“…The headache is usually aggravated with routine physical activity such as walking up stairs. A migraine is a common headache, with about 18% of females and 6% of males experiencing this type of headache . It is associated with significant amounts of disability, which is the motivating factor that brings the patient to seek care and the reason why this type of headache is the one most often seen in medical clinics.…”

“…It is associated with significant amounts of disability, which is the motivating factor that brings the patient to seek care and the reason why this type of headache is the one most often seen in medical clinics. A migraine may present as a toothache as do most common neurovascular disorders .…”

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“…and associated features of primary headaches as described in the ICHD-3, but with no head pain. For endodontists, these conditions are important to be aware of since tooth pain can be a part of the clinical presentation, and sometimes the only finding (15)(16)(17). Moreover, the clinical presentation may be very misleading having signs and symptoms similar to pulpitis (18).…”