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Monday, February 15, 2010

Facial Pain and Headache: Incidence of Facial Pain

A recent article in the Journal Pain looked at incidence of facial pain in the Netherlands. The authors wanted to " The aim was therefore to estimate the incidence rate (IR) of trigeminal neuralgia (TGN), postherpetic neuralgia (PHN), cluster headache (CH), occipital neuralgia (ON), local neuralgia (LoN), atypical facial pain (AFP), glossopharyngeal neuralgia (GPN) and paroxysmal hemicrania (PH)"

Trigeminal Neuralgia and Cluster Headaches were the most common types and both increased with age. This study found that facial pain was rare but more common than expected prior to the study. The trigeminal nerve is frequently a culprit in many types of pain disorders. Many, but not all patients with trigeminal neuralgia diagnosis will respond positively to neuromuscular treatment.

My take on this is a little different because I frequently see patients who complain of sinus pain, tooth pain eye pain while pointing to painful areas. Thsi study would have ignored thos findings. Over the years I frequently see patients that have been given a diagnosis of a disorder neuromuscular dentistry can't treat yet they get better with an orthotic. This does not mean the orthotic can treat those conditions and often just points out a misdiagnosis. I have had patients diagnosed with MS whose symptoms disappeared with my treatment. That does not mean I treated the MS, it may just mean that the diagnosis was incorrect.

There is no harm in a second or third opinion.

Pain. 2009 Dec 15;147(1-3):122-7. Epub 2009 Sep 26.
Incidence of facial pain in the general population.
Koopman JS, Dieleman JP, Huygen FJ, de Mos M, Martin CG, Sturkenboom MC.

Dept. of Medical Informatics, Erasmus MC, Rotterdam, The Netherlands. skoop29@gmail.com
Facial pain has a considerable impact on quality of life. Accurate incidence estimates in the general population are scant. The aim was therefore to estimate the incidence rate (IR) of trigeminal neuralgia (TGN), postherpetic neuralgia (PHN), cluster headache (CH), occipital neuralgia (ON), local neuralgia (LoN), atypical facial pain (AFP), glossopharyngeal neuralgia (GPN) and paroxysmal hemicrania (PH) in the Netherlands. In the population-based Integrated Primary Care Information (IPCI) medical record database potential facial pain cases were identified from codes and narratives. Two medical doctors reviewed medical records, questionnaires from general practitioners and specialist letters using criteria of the International Association for the Study of Pain. A pain specialist arbitrated if necessary and a random sample of all cases was evaluated by a neurologist. The date of onset was defined as date of first specific symptoms. The IR was calculated per 100,000PY. Three hundred and sixty-two incident cases were ascertained. The overall IR [95% confidence interval] was 38.7 [34.9-42.9]. It was more common among women compared to men. Trigeminal neuralgia and cluster headache were the most common forms among the studied diseases. Paroxysmal hemicrania and glossopharyngeal neuralgia were among the rarer syndromes. The IR increased with age for all diseases except CH and ON, peaking in the 4th and 7th decade, respectively. Postherpetic neuralgia, CH and LoN were more common in men than women. From this we can conclude that facial pain is relatively rare, although more common than estimated previously based on hospital data.

PMID: 19783099 [PubMed - in process]

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posted by Dr Shapira at 8:56 PM

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