Persistent Idiopathic Facial Pain

2018 ◽  
pp. 279-286
Author(s):  
Trevor Van Oostrom
Keyword(s):  
Differential Diagnosis ◽  
Diagnostic Criteria ◽  
Psychological Factors ◽  
Facial Pain ◽  
Treatment Options ◽  
Headache Disorders ◽  
Diagnostic Challenge ◽  
Persistent Idiopathic Facial Pain ◽  
Case Based

Persistent idiopathic facial pain (PIFP) is an enigmatic condition which has caused a great deal of suffering yet has been difficult to define and remains a challenging disorder to treat. In addition, the presentation of PIFP has considerable overlap with many other causes of facial pain making the malady a diagnostic challenge. The condition is often resistant to treatment and patients often have comorbid syndromes or psychological factors. This chapter reviews the history and development of the current diagnostic criteria of PIFP according to the latest edition of the International Classification of Headache Disorders (ICHD). Using a case-based approach, the pathophysiology, epidemiology, differential diagnosis, and treatment options of PIFP are explored.

scholarly journals Persistent idiopathic facial pain

Cephalalgia ◽  
2017 ◽  
Vol 37 (7) ◽  
pp. 680-691 ◽  
Author(s):  
Rafael Benoliel ◽  
Charly Gaul
Keyword(s):  
Differential Diagnosis ◽  
Diagnostic Criteria ◽  
Facial Pain ◽  
Myofascial Pain ◽  
Current Knowledge ◽  
Early Stage ◽  
Treatment Strategies ◽  
Future Research ◽  
Persistent Idiopathic Facial Pain ◽  
Pain Syndromes

Background Persistent idiopathic facial pain (PIFP) is a chronic disorder recurring daily for more than two hours per day over more than three months, in the absence of clinical neurological deficit. PIFP is the current terminology for Atypical Facial Pain and is characterized by daily or near daily pain that is initially confined but may subsequently spread. Pain cannot be attributed to any pathological process, although traumatic neuropathic mechanisms are suspected. When present intraorally, PIFP has been termed ‘Atypical Odontalgia’, and this entity is discussed in a separate article in this special issue. PIFP is often a difficult but important differential diagnosis among chronic facial pain syndromes. Aim To summarize current knowledge on diagnostic criteria, differential diagnosis, pathophysiology and management of PIFP. Methods We present a narrative review reporting current literature and personal experience. Additionally, we discuss and differentiate the common differential diagnoses associated with PIFP including traumatic trigeminal neuropathies, regional myofascial pain, atypical neurovascular pains and atypical trigeminal neuropathic pains. Results and conclusion The underlying pathophysiology in PIFP is still enigmatic, however neuropathic mechanisms may be relevant. PIFP needs interdisciplinary collaboration to rule out and manage secondary causes, psychiatric comorbidities and other facial pain syndromes, particularly trigeminal neuralgia. Burden of disease and psychiatric comorbidity screening is recommended at an early stage of disease, and should be addressed in the management plan. Future research is needed to establish clear diagnostic criteria and treatment strategies based on clinical findings and individual pathophysiology.

Facial pain in a Neurological Tertiary Care Centre — Evaluation of the International Classification of Headache Disorders

Cephalalgia ◽  
2005 ◽  
Vol 25 (9) ◽  
pp. 689-699 ◽  
Author(s):  
K Zebenholzer ◽  
C Wöber ◽  
M Vigl ◽  
P Wessely ◽  
CL Wöber-Bingöl
Keyword(s):  
Trigeminal Neuralgia ◽  
Facial Pain ◽  
Tertiary Care ◽  
International Classification ◽  
Care Centre ◽  
Headache Disorders ◽  
Tertiary Care Centre ◽  
Persistent Idiopathic Facial Pain ◽  
Number Of Patients

The aim of this study was to examine the diagnostic spectrum of facial pain and to evaluate the clinical features relevant to the differential diagnosis in a neurological tertiary care centre. This is the first investigation comparing the first with the second edition of the International Classification of Headache Disorders (ICHD-I, ICHD-II) in consecutively referred patients comprising a broad spectrum of disorders without restricting the inclusion to certain diagnoses. Studying 97 consecutive patients referred for facial pain, we found trigeminal neuralgia or other types of cranial neuralgia in 38% and 39% according to ICHD-I and ICHD-II, respectively; persistent idiopathic facial pain was diagnosed in 27% and 21%, respectively. The proportion of patients who could not be classified was 24% in ICHD-I and 29% in ICHD-II. Six per cent of the patients had cluster headache or chronic paroxysmal hemicrania, the remaining 5% had various other disorders. The agreement between ICHD-I and ICHD-II was very good to perfect. In ICHD-II, sensitivity and specificity were similar to ICHD-I, the specificity and negative predictive value were imrpoved in single features of trigeminal neuralgia, but were widely unchanged in persistent idiopathic facial pain. The number of patients who could not be classified was larger in ICHD-II than in ICHD-I. Modifying the diagnostic criteria for different types of facial pain, in particular changes in the criteria of persistent idiopathic facial pain, might be helpful in reducing the number of patients with unclassifiable facial pain.

scholarly journals Facial Pain: A Comprehensive Review and Proposal for a Pragmatic Diagnostic Approach

2020 ◽  
Vol 83 (1) ◽  
pp. 5-16 ◽  
Author(s):  
Laura Van Deun ◽  
Muriel de Witte ◽  
Thaïs Goessens ◽  
Stijn Halewyck ◽  
Marie-Christine Ketelaer ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Classification System ◽  
Facial Pain ◽  
Correct Diagnosis ◽  
Headache Disorders ◽  
Comprehensive Review ◽  
Pain Condition ◽  
Throat Pain ◽  
Generic Framework

Background: Facial pain, alone or combined with other symptoms, is a frequent complaint. Moreover, it is a symptom situated at, more than any other pain condition, a crosspoint where several disciplines meet, for example, dentists; manual therapists; ophthalmologists; psychologists; and ear-nose-throat, pain, and internal medicine physicians besides neurologists and neurosurgeons. Recently, a new version of the most widely used classification system among neurologists for headache and facial pain, the International Classification of Headache Disorders, has been published. Objective: The aims of this study were to provide an overview of the most prevalent etiologies of facial pain and to provide a generic framework for the neurologist on how to manage patients presenting with facial pain. Methods: An overview of the different etiologies of facial pain is provided from the viewpoint of the respective clinical specialties that are confronted with facial pain. Key message: Caregivers should “think outside their own box” and refer to other disciplines when indicated. If not, a correct diagnosis can be delayed and unnecessary treatments might be given. The presented framework is aimed at excluding life- or organ-threatening diseases, providing several clinical clues and indications for technical investigations, and ultimately leading to the correct diagnosis and/or referral to other disciplines.

A prospective study on osmophobia in migraine versus tension-type headache in a large series of attacks

Cephalalgia ◽  
2019 ◽  
Vol 40 (4) ◽  
pp. 337-346 ◽  
Author(s):  
Alberto Terrin ◽  
Federico Mainardi ◽  
Carlo Lisotto ◽  
Edoardo Mampreso ◽  
Matteo Fuccaro ◽  
...  
Keyword(s):  
Prospective Study ◽  
Diagnostic Criteria ◽  
Migraine Without Aura ◽  
Tension Type Headache ◽  
Headache Disorders ◽  
Headache Attack ◽  
Accompanying Symptoms ◽  
Type Headache ◽  
A Prospective Study

Background In literature, osmophobia is reported as a specific migrainous symptom with a prevalence of up to 95%. Despite the International Classification of Headache Disorders 2nd edition proposal of including osmophobia among accompanying symptoms, it was no longer mentioned in the ICHD 3rd edition. Methods We conducted a prospective study on 193 patients suffering from migraine without aura, migraine with aura, episodic tension-type headache or a combination of these. After a retrospective interview, each patient was asked to describe in detail osmophobia, when present, in the following four headache attacks. Results In all, 45.7% of migraine without aura attacks were associated with osmophobia, 67.2% of migraineurs reported osmophobia in at least a quarter of the attacks. No episodic tension-type headache attack was associated with osmophobia. It was associated with photophobia or phonophobia in 4.3% of migraine without aura attacks, and it was the only accompanying symptom in 4.7% of migraine without aura attacks. The inclusion of osmophobia in the ICHD-3 diagnostic criteria would enable a 9.0% increased diagnostic sensitivity. Conclusion Osmophobia is a specific clinical marker of migraine, easy to ascertain and able to disentangle the sometimes challenging differential diagnosis between migraine without aura and episodic tension-type headache. We recommend its inclusion among the diagnostic criteria for migraine as it increases sensitivity, showing absolute specificity.

Headache

2017 ◽  
Author(s):  
Kurt F. Dittrich
Keyword(s):  
Social Factors ◽  
Alternative Treatment ◽  
Treatment Options ◽  
Signs And Symptoms ◽  
Headache Disorders ◽  
Nonpharmacological Treatment ◽  
Anatomy And Physiology ◽  
Headache Management

Having a solid grasp of headaches is essential for the pain provider. This required knowledge should include understanding the anatomy and physiology of headaches; knowing how to classify headaches using the second edition of the International Classification of Headache Disorders; recognizing the physical, psychological, and social factors that may contribute to headaches; and understanding the role of counseling and nonpharmacological treatment options. It is essential to understand the pharmacological aspects of headache management as well as some of the nuances of the specific medications most often used. A pain provider should be able to recognize when signs and symptoms of a headache warrant further investigation as well as when to offer alternative treatment options to patients. The questions in this chapter are designed to assist in gathering this knowledge base and assist the pain provider in analyzing the headache condition.

scholarly journals International Classification of Headache Disorders - ICHD-4. Will medication-overuse headache survive?

2021 ◽  
pp. 72-74
Author(s):  
Mario Fernando Prieto Peres ◽  
Thaiza Agostini Córdoba de Lima ◽  
Marcelo Moraes Valença
Keyword(s):  
Clinical Practice ◽  
Diagnostic Criteria ◽  
Critical Analysis ◽  
Medication Overuse ◽  
Medication Overuse Headache ◽  
International Classification ◽  
Headache Disorders ◽  
Critical View

The article is a critical analysis of the diagnostic criteria for medication-overuse headache. This is an important discussion to improve the criteria in the next update, as well as providing a critical view for neurologists when applying the criteria to their clinical practice.

scholarly journals Napping the Day Away

2019 ◽  
pp. 397-417
Author(s):  
Erin Golden ◽  
Maja Tippmann-Peikert
Keyword(s):  
Differential Diagnosis ◽  
Clinical Evaluation ◽  
Treatment Options ◽  
Evaluation Study ◽  
Disturbed Sleep ◽  
Study Results ◽  
Nonpharmacologic Treatment ◽  
Underlying Pathophysiology

This chapter describes a patient with narcolepsy type 1, a disorder of central hypersomnolence. His history, clinical evaluation, study results, treatment, and clinical course are detailed. The disorder is then reviewed, highlighting its classic clinical features—hypersomnia, cataplexy, sleep paralysis, hypnagogic and hypnopompic hallucinations, and disturbed sleep—and its underlying pathophysiology. The differential diagnosis is discussed, and recommendations for clinical evaluation are provided with official diagnostic criteria from the International Classification of Sleep Disorders, 3rd edition. Pharmacologic and nonpharmacologic treatment options are then addressed, along with their respective benefits and side-effect profiles.

VESTIBULAR MIGRAINE-UPDATES AND CHALLENGES: REVIEW OF LITERATURE

2021 ◽  
pp. 1-5
Author(s):  
Aravind Varma Datla ◽  
Sibasankar Dalai
Keyword(s):  
Differential Diagnosis ◽  
Diagnostic Criteria ◽  
Clinical Characteristics ◽  
Vestibular Migraine ◽  
Review Of Literature ◽  
Headache Disorders ◽  
Classi Cation

Complaints of dizziness or vertigo entirely are common in patients with migraines, at least occasionally. Vestibular migraine was recently integrated as an independent article in the International Classication of Headache Disorders 3-beta appendix. Despite this, it is still an underdiagnosed condition. The exact mechanism of vestibular migraine is still unclear. This review presents an overview of the history, epidemiology, pathophysiology, clinical characteristics, diagnostic criteria, differential diagnosis and the treatment of VM.

scholarly journals Controversies and Considerations in the Diagnosis of Primary Cutaneous CD4+ Small/Medium T-Cell Lymphoma

2014 ◽  
Vol 138 (10) ◽  
pp. 1307-1318 ◽  
Author(s):  
Thanh T. Ha Lan ◽  
Noah A. Brown ◽  
Alexandra C. Hristov
Keyword(s):  
Differential Diagnosis ◽  
T Cell ◽  
Cell Lymphoma ◽  
Treatment Options ◽  
Lymphoid Hyperplasia ◽  
T Cell Lymphoma ◽  
Reactive Lymphoid Hyperplasia ◽  
Genetic Features ◽  
Patient Prognosis

Context.—Primary cutaneous CD4+ small/medium T-cell lymphoma is a provisional and controversial entity with a broad differential diagnosis. Despite being an uncommon lymphoma, it is a frequent diagnostic consideration in cutaneous biopsies with a dense lymphoid infiltrate because it shows overlapping features with reactive lymphoid hyperplasia (pseudolymphoma) and a variety of other primary cutaneous and systemic lymphomas. However, proper classification of this process is important for determining patient prognosis and treatment options. Objective.—To review the clinical, morphologic, immunophenotypic, and genetic features of primary cutaneous CD4+ small/medium T-cell lymphoma and contrast those features with entities in the differential diagnosis. Data Sources.—Applicable literature will be reviewed with emphasis on current controversies and distinguishing characteristics. Conclusions.—Although many consider primary cutaneous CD4+ small/medium T-cell lymphoma to be indistinguishable from reactive lymphoid hyperplasia/pseudolymphoma, it can be differentiated from other primary cutaneous and systemic lymphomas. Patients with solitary lesions of primary cutaneous CD4+ small/medium T-cell lymphoma generally have an excellent prognosis. Nevertheless, a subset of patients who have been reported to meet criteria for this lymphoma have followed a more-aggressive course; however, those patients show some differing clinical, morphologic, and immunophenotypic features.

Ophthalmoplegic migraine: From questions to answers

Cephalalgia ◽  
2014 ◽  
Vol 34 (11) ◽  
pp. 914-919 ◽  
Author(s):  
Paolo Ambrosetto ◽  
Francesca Nicolini ◽  
Matteo Zoli ◽  
Luigi Cirillo ◽  
Paola Feraco ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Facial Pain ◽  
Cranial Nerves ◽  
Imaging Findings ◽  
Headache Disorders ◽  
Entry Zone ◽  
Root Entry Zone ◽  
Ophthalmoplegic Migraine ◽  
Cranial Neuralgias

Introduction The International Classification of Headache Disorders classifies ophthalmoplegic migraine (OM) under “cranial neuralgias and central causes of facial pain.” OM is diagnosed when all the following criteria are satisfied: At least two attacks fulfilling criterion B. Migraine-like headache accompanied or followed within four days of its onset by paresis of one or more of the III, IV and/or VI cranial nerves. Parasellar orbital fissure and posterior fossa lesions ruled out by appropriate investigations. In children the syndrome is rare and magnetic resonance (MR) shows strongly enhancing thickened nerve at the root entry zone (REZ). Method The authors review the literature focusing on pathogenesis theories. Results The authors suggest that ischemic reversible breakdown of the blood-nerve barrier is the most probable cause of OM and to include MR findings in the hallmarks of the disease. Conclusion OM is the same disease in adulthood and childhood, even if in adults the MR imaging findings are negative. In the authors’ opinion, OM should be classified as migraine.

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