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Friday, January 1, 2010

Facial pain: Migraine or symptom of TMD

A recent abstract discussed a facial pain and failure of numerous treatments. It was then dcided the patient had atypical migraine. The abstract is reprinted with my comments following.
Acta Neurol Belg. 2009 Sep;109(3):235-7.
Migraine presenting as chronic facial pain.
Debruyne F, Herroelen L.

Headache Clinic, Department of Neurology, University Hospital UZ Gasthuisberg, Leuven, Belgium. freddebruyne@yahoo.com
We report the case of a 44-year-old woman with chronic facial pain. She was treated with several analgesics, prophylactic medications and infiltrations, but all treatment modalities were ineffective. Finally, the diagnosis of medication-overuse headache complicating migraine without aura was made and an appropriate treatment was initiated. Migraine is a very common primary headache and rarely presents as isolated facial pain. Stimulation of the dura with activation of the trigeminovascular system can result in pain in any of the three divisions of the trigeminal nerve. This is the anatomic basis of migraine pain presenting as referred pain to the second division of the trigeminal nerve. The atypical presentation of migraine pain can easily lead to inappropriate treatment regimens.

This patient had chronic facial pain and was treated with numerous drugs and then diagnosed as medication overuse headache and complicating migraine without aura. They used drug therapy but no mention is made of use of an orthotic. This myoptic type of treatment is common. Throw a drug at the problem , then another and another.

The conclusion that atypical pain can lead to inappropriate treatments regimens speaks for itself. When pain is from the maxillary branch of the trigeminal nerve it would seem appropriate to evaluate the masticatory system first.

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posted by Dr Shapira at 2:42 AM

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