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.

Chronobiology differs between men and women with cluster headache, clinical phenotype does not

Neurology ◽  
2017 ◽  
Vol 88 (11) ◽  
pp. 1069-1076 ◽  
Author(s):  
Nunu Lund ◽  
Mads Barloese ◽  
Anja Petersen ◽  
Bryan Haddock ◽  
Rigmor Jensen
Keyword(s):  
Cluster Headache ◽  
Clinical Characteristics ◽  
Clinical Phenotype ◽  
Correct Diagnosis ◽  
Diagnostic Delay ◽  
Headache Disorders ◽  
Structured Interviews ◽  
Secondary Sector ◽  
Headache Center

Objective:To describe differences between the sexes in the phenotype of cluster headache (CH) in a large, well-characterized clinical CH population.Methods:Patients from the Danish CH survey aged 18–65 years, diagnosed with CH according to International Classification of Headache Disorders, second edition, completed questionnaires and structured interviews.Results:A total of 351 patients with CH participated, with a male:female ratio of 2:1. The diurnal variation of attacks showed moments of peak prominence in men’s attack cycle to be advanced by 1 hour compared to women’s, despite no difference in self-reported bedtime or chronotype (p = 0.31). The onset of CH decreased with increasing age for both sexes. Diagnostic delay was numerically longer for men vs women (6.56 vs 5.50 years, p = 0.21); however, more women had previously been misdiagnosed (61.1% vs 45.5%, p < 0.01) and received the correct diagnosis at a tertiary headache center (38.8% vs 20.9%, p < 0.001). Only minor sex differences in clinical characteristics were found but chronic CH was more prevalent in women compared to men (44.0% vs 31.9%, p < 0.05).Conclusions:Despite a similar clinical phenotype, diurnal attack cycle is advanced by 1 hour in men with CH compared to women. Rhythmicity is a defining characteristic of CH and these findings suggest differences in the hypothalamus’ influence on attack occurrence between the sexes. In addition, women were more often misdiagnosed and diagnosis in the primary or secondary sector more often failed. Furthermore, women had chronic CH more frequently than men. A long diagnostic delay and frequent misdiagnosis emphasize the need for increased awareness of CH in both sexes.

scholarly journals Classification: The key to understanding facial pain

Cephalalgia ◽  
2017 ◽  
Vol 37 (7) ◽  
pp. 609-612 ◽  
Author(s):  
Peter Svensson ◽  
Arne May
Keyword(s):  
Facial Pain ◽  
Conceptual Models ◽  
Temporomandibular Disorder ◽  
Classification Systems ◽  
Pain Condition ◽  
Good Classification ◽  
Rater Variability ◽  
Future Work ◽  
Homogenous Population

It is indisputable that the global scientific advances in headache research, be it bench or bedside, have benefited enormously from the operational diagnostic criteria published in 1988. Today, this classification system is indispensable. The reason for this success is a low inter-rater variability. In general, orofacial pain conditions are less well characterised – with the noticeable exemption of temporomandibular disorder pain. Tremendous work has been put into changing this, and significant progress has been achieved – in particular, in terms of the clinical implications and overriding conceptual models for oro-facial pain. Scientific classifications have only one goal: To provide a scientific agreement about the main features of an object of research and a scientific consensus regarding the name. The main significance is not the fact that a good classification offers a detailed and accurate image of the reality. If we want to overcome the obstacles of different competing classification systems, we need to overcome specialisation borders. The key to success is to understand that such a definition does not mirror all possible clinical facets of a given pain condition but is simply a convention – that is, a consensus on a word used for a pain condition. Simply speaking, a classification creates a common language to be used by more than one profession. It will be crucial to define any given pain condition as precisely and rigid as possible, in order to ensure a homogenous population. Only this ensures a low inter-rater variability, which consequently allows combining and comparing research on a population across different professional settings. This is not easy for chronic facial pain without verifiable morphological cause or structural lesions, as these syndromes are often rather featureless. The new IASP classification of chronic pain is a big step forward to a better characterisation of such conditions, and will trigger future work on a new and operationalised classification of oro-facial pain.

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.

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.

scholarly journals A Mathematical Interpretation of the International Classification of Headache Disorders 3rd Edition

2021 ◽  
Author(s):  
Pengfei Zhang
Keyword(s):  
Facial Pain ◽  
International Classification ◽  
Significant Implication ◽  
Headache Disorders ◽  
Categorical Approach ◽  
Mathematical Basis ◽  
Definition Of ◽  
Diagnosis Criterion ◽  
Mathematical Interpretation

International Classification of Headache Disorders (ICHD3) provides definition of headache disorders that can be used to construct a mathematical basis for headache classification. We seek to construct a theoretical framework for such a construction.Headache and facial pain conditions are interpreted as bundles of phenotypes. ICHD3 diagnoses are then defined as sets. We proceed to show that observations, in the form of theorems, can be proved with our set theoretic construction for the ICHD3.The all-present “not accounted for by another ICHD3 diagnosis” criterion must be removed in order for our system to be set theoretic consistent. Furthermore, our system can be used to construct a categorical approach to headache medicine in the tradition of category theory.Mathematical interpretation of ICHD3 is possible and may provide significant implication for understanding the structure and organization of headache diagnostic classification.

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 P.086 The clinical significance of trigeminal neuralgia nomenclature

2016 ◽  
Vol 43 (S2) ◽  
pp. S40-S40
Author(s):  
SV Nolin ◽  
L Barchet ◽  
A Kaufmann
Keyword(s):  
Trigeminal Neuralgia ◽  
Facial Pain ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Classification Systems ◽  
Headache Disorders ◽  
Trigeminal Neuropathy ◽  
Study Population ◽  
Surgical Treatments

Background: A diagnosis of trigeminal neuralgia (TN) may be broadly applied to many neuralgic facial pains, while more stringent criteria are required for management decisions, outcome assessment, and pathophysiological correlations. Our aim was to evaluate existing classification systems of facial pain. Methods: The study population was comprised of 534 Manitobans referred to neurosurgery for facial pain from 2001 to 2013. A retrospective chart review identified presenting features; pain distribution, nature, and duration. The recorded diagnoses (rDx) were then re-classified according to the International Classification of Headache Disorders (ICHD-3) and Burchiel System of TN1 and TN2. Results: There was complete correlation between rDx and ICHD-3 for typical TN (tTN) in 266(49.8%) patients, atypical TN (aTN) in 39(7.3%), and idiopathic facial pain (IFP) in 59(11%). Idiopathic trigeminal neuropathy (iTn) in 35(6.6%) was not classified in ICHD-3. Burchiel-TN1 included heterogeneous diagnoses including tTN (266), aTN (27), iTn (2) and IFP (8); Burchiel-TN2 included aTN (10), iTn (23), and IFP (15). Another 135(25.5%) had other facial pain diagnoses. Conclusions: Classification of TN is especially important when selecting and evaluating surgical treatments. Diagnostic criteria should clearly differentiate between unique conditions and ideally have basis on underlying etiology. The ICHD-3 nomenclature best satisfies these aims although should be expanded to include iTn.

Facial Pain and the Second Edition of the International Classification of Headache Disorders

2006 ◽  
Vol 46 (2) ◽  
pp. 259-263 ◽  
Author(s):  
Karin Zebenholzer ◽  
Christian Wober ◽  
Marion Vigl ◽  
Peter Wessely ◽  
Cicek Wober-Bingol
Keyword(s):  
Facial Pain ◽  
International Classification ◽  
Headache Disorders

The Historical Development of Burden of Treatment Compliance

2014 ◽  
Vol 19 (5) ◽  
pp. 13-15
Author(s):  
Stephen L. Demeter
Keyword(s):  
Internal Medicine ◽  
Treatment Compliance ◽  
World Health ◽  
International Classification Of Functioning ◽  
Sixth Edition ◽  
Burden Of Treatment ◽  
Specific Goal ◽  
Surrogate Measure ◽  
Health Organization

Abstract A long-standing criticism of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) has been the inequity between the internal medicine ratings and the orthopedic ratings; in the comparison, internal medicine ratings appear inflated. A specific goal of the AMA Guides, Sixth Edition, was to diminish, where possible, those disparities. This led to the use of the International Classification of Functioning, Disability, and Health from the World Health Organization in the AMA Guides, Sixth Edition, including the addition of the burden of treatment compliance (BOTC). The BOTC originally was intended to allow rating internal medicine conditions using the types and numbers of medications as a surrogate measure of the severity of a condition when other, more traditional methods, did not exist or were insufficient. Internal medicine relies on step-wise escalation of treatment, and BOTC usefully provides an estimate of impairment based on the need to be compliant with treatment. Simplistically, the need to take more medications may indicate a greater impairment burden. BOTC is introduced in the first chapter of the AMA Guides, Sixth Edition, which clarifies that “BOTC refers to the impairment that results from adhering to a complex regimen of medications, testing, and/or procedures to achieve an objective, measurable, clinical improvement that would not occur, or potentially could be reversed, in the absence of compliance.

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