Migraine presenting as isolated facial pain: A prospective clinical analysis of 58 cases.

BACKGROUND: Sparse evidence has detailed the clinical phenotype of migraine presenting as isolated facial pain.Objective and methods: This was a prospective audit, part of our multidisciplinary facial pain service evaluation, aiming to phenotype patients with migraine presenting as isolated facial pain who attended our service between 2013 and 2018. RESULTS: Fifty-eight patients were diagnosed with migraine with isolated facial pain (F = 46, 79.3%; mean age: 49.0 years, ± 9.85). Sixty-six percent of patients met the criteria for episodic migraine. The pain was strictly unilateral in 79% and located over the maxillary region in 85% of patients. Associated cranial autonomic signs/symptoms were reported by 45% of our cohort. A percentage of 77% of patients was triptan responders. CONCLUSIONS: Migraine presenting as isolated facial pain is a rare but treatable condition with some distinct demographic and clinical characteristics. It is a diagnosis of exclusion that should be evaluated in specialised multidisciplinary facial pain clinics.

Is painful temporomandibular disorder a real headache for many patients?

Temporomandibular disorders (TMDs) and primary headaches are common pain conditions and often co-exist. TMD classification includes the term 'headache secondary to TMD' but this term does not acknowledge the likelihood that primary headache pathophysiology underpins headache causing painful TMD signs and symptoms in many patients. The two disorders have a complex link and we do not fully understand their interrelationship. However, growing evidence shows a significant association between the two disorders. This article reviews the possible connection between temporomandibular disorders and primary headaches, specifically migraine, both anatomically and pathogenetically.

The psychosocial and affective burden of posttraumatic neuropathy following injuries to the trigeminal nerve.

AIMS: To explore the impact of trigeminal nerve injuries on quality of life, including the effect of pain on psychological and affective function. METHODS: An observational, cross-sectional survey design was employed. Fifty-six patients with inferior alveolar nerve injury (IANI) and 33 patients with lingual nerve injury (LNI) completed standardized self-report measures of pain intensity, pain catastrophizing, self-efficacy to cope with pain, and mood, in addition to generic and oral health-related quality of life (HRQoL) indicators. The impact of pain severity on these aspects of psychosocial function was examined. Summary statistics were calculated for all measures and compared with norms or values of other relevant studies, when available, using t tests. The impact of pain severity on these aspects of psychosocial function was examined using analysis of variance and hierarchical multivariate regression models. RESULTS: The majority of patients reported pain associated with their nerve injury (86%). Nerve injury had a significant impact on all investigated domains, and this was closely linked with reported pain levels. Patients with severe pain showed particularly elevated levels of depression and pain catastrophizing, as well as substantially reduced HRQoL and coping efficacy levels. Pain intensity level was a significant predictor in all models except anxiety, uniquely contributing between 17% and 26% of variance to the prediction of pain catastrophizing, depression, coping efficacy, and generic and oral HRQoL. CONCLUSION: Traumatic injury to the trigeminal nerve is associated with a substantial patient burden, particularly in patients who experience severe neuropathic pain as part of their condition. These findings highlight the need to identify, develop, and evaluate more effective treatments for neuropathic pain in trigeminal nerve injury that will not only provide clinically meaningful reductions in pain but also improve patients' quality of life.