Facial presentations of primary headache disorders

Abstract

Background Many patients with mid-face or lower face craniofacial pain are diagnosed, based on accompanying signs and symptoms and features other than location, as either atypical migraines or atypical TACs. Distinguishing features of headache disorders as a cause of facial pain include the temporal pattern of pain, associated symptoms including light and sound sensitivity and nausea, cranial autonomic symptoms, and the lack of local triggering among others. Results An intraoral neurovascular pain has been observed, and was termed neurovascular orofacial pain (NVOP). Due to its location, and signs imitating dental pulpitis, it has great diagnostic and therapeutic importance for differentiating NVOP from dental pathology. The hypothesized mechanism is neurogenic inflammatory activation within the space confined by dentine around the dental pulp, expressed in strong paroxysmal pain and typical allodynia to cold foods. Conclusion Facial manifestations of headache disorders and primary facial pain disorders share common trigeminal nerve input, yet they are highly distinct disorders. Somatotopic segregation may occur at the level of the trigeminal nucleus, thalamus, and somatosensory cortex, and distinct ionic or neurochemical signaling pathways may be involved. Further investigation of facial presentations of headache disorders has the potential to provide new insight into the interface between headache and facial pain.

Keywords: Migraine; facial migraine; facial pain; neurovascular orofacial pain (NVOP).