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From the otolaryngologist's point of view, there are multiple causes for the frequent symptom of facial and head pain: headaches due to ear diseases: pain extending to the ear region, with special regard to "referred otalgia" involving the cranail nerves V, IX, X; facial pain due to temporomandibular dysfunction; rhinological causes of facial and head pain, including posttraumatic trigeminal neuralgia and "facial sympathalgies"; the syndrome of the elongated styloid process. The diagnosis and therapy of the "typical" ENT diseases is not described in detail since the paper deals mainly with less known and, regarding their diagnosis and treatment, problematic diseases.
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PMID:[Facial and head pain from the otorhinolaryngologist's point of view (author's transl)]. 14 Sep 75

To the otolaryngologist, there are multiple causes for head or facial pain: headaches due to ear diseases; idiopathic neuralgias; "referred otalgia" involving cranial nerves V, IX, X; temporomandibular joint dysfunction; rhinological pathologies, including post-traumatic trigeminal neuralgia; "facial sympathalgias"; the styloid process syndrome; and cervical spine problems. Less known causes of head and neck pain are stressed, and emphasis placed on their diagnosis and treatment.
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PMID:[ENT considerations of head and facial pain (author's transl)]. 39 37

In this paper the painful syndromes of temporal arteritis, polymyalgla rheumatica, glaucoma, trigeminal neuralgia, post-herpetic neuralgia, and temporomandibular joint dysfunction have been described. These conditions occur commonly in the elderly. The dangers of blindness occurring in temporal arteritis or polymyalgia rheumatica, the importance of early diagnosis in glaucomatous headache, the value of Tegretol in trigeminal neuralgia, the paucity of therapeutic agents in post-herpetic neuralgia and the value of dental treatment in tempor-mandibular joint dysfunction have been stressed.
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PMID:Chronic pain syndromes in the elderly. 88 Jan 67

We have reported a case of paratrigeminal epidermoid originated in the Meckel's cave. A 30 years old man was admitted to the department of neurosurgery with chief complaints of continuous right facial pain and numbness of entire right side of the face of three years duration. The positive neurological findings were hypesthesia over the distribution of the right trigeminal nerve, absence of the right corneal reflex and nystagmus on left lateral gaze. Caloric response was absent on the right side, however the audiogram showed normal. Cerebrospinal fluid examination was within normal limit. Electromyography showed giant spike in the right masseter and temporal muscles. Radiogram of the skull revealed a bone-destroying lesion over the medial florr of the right middle fossa involving the apex of the petrous bone (Fig 1). Right carotid angiography showed straightening and forward displacement of C4- C5 portion of the carotid siphon in the lateral view, and vertebral angiography showed displacement of basilar artery to the left side, upward displacement of the right posterior cerebral and superior cerebellar artery in the frontal view (Fig. 2, 3). At the time of operation, an epidermoid was identified in the Meckel's cave and totally removed microsurgically. Small amount of the tumor extending into the posterior fossa was also removed (Fig. 4, 5, 6, 7). Postoperative course was uneventfull except for an episode of headache and high fever of short duration, suggesting the signs of meningial irritation. Two months postoperativelly patient was relived of facial pain and was discharged with sensory impairment of the right trigeminal nerve distribution. Only 11 cases of paratrigeminal epidermoid, including the cases localized in the Meckel's cave have been reported in the past literatures (Table 1). In this paper we have discussed about the symptomatology and clinical data of paratrigeminal epidermoid and compared with those of trigeminal neurinoma, and meningioma originated in the same region. We would like to emphasize that the importance of differentiating the idiopathic trigeminal neuralgia from the paratrigeminal epidermoid, if the initial symptom of this tumor were tic douloureux. The total removal of epidermoid with capsule is essential treatment following the early diagnosis, however the attempt of total removal is sometimes difficult because of the relationship between the origin, size and extension of this kind of tumor to other important brain structures. And if some of the tumor is left behind at the time of operation, cholesterin meningitis is an important complication.
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PMID:[Paratrigeminal epidermoid originated in the meckel's cave (author's transl)]. 94 82

This paper reviewed the clinical features of the facial neuralgias, and described the demographic data for 24 cases of atypical facial neuralgia, seven cases of trigeminal neuralgia, two cases of cluster headache and one of glossopharyngeal neuralgia, which were all referred for investigation and treatment over a three-month period to a teaching hospital dental department.
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PMID:Facial neuralgias: a clinical review of 34 cases. 133 78

SUNCT is a unilateral headache syndrome with shortlasting attacks, accompanied by e.g. conjunctival injection and lacrimation on the painful side. Intraocular pressure (IOP), corneal indentation pulse (CIP) amplitudes, episcleral venous pressure, and corneal, tympanic, and facial temperature have been studied in 6 SUNCT patients. IOP and CIP amplitudes increased on the painful side during headache paroxysms, while episcleral venous pressure remained unchanged. Corneal temperature seemed to increase during attack on both sides. However, the number of observations during attacks is scanty. Outside of attacks, the corneal temperature on the symptomatic side seemed to be higher when compared with the non-symptomatic side (generally > or = 0.5 degrees C), provided that the attack frequency was high. The facial temperature seemed to be even on both sides or slightly higher on the symptomatic than on the non-symptomatic side in the periocular area. This pattern seems to be different from the one in trigeminal neuralgia, in which the temperature has been reported to be lowest on the painful side of the face. During attacks, there seemed to be a tendency for the temperature to increase in the periocular area, but not over the mandible or in the neck. The results obtained could be caused by increased blood supply to the eye (and the surrounding skin) on the symptomatic side because of vasodilatation during repeated pain attacks. As far as the ocular changes are concerned, probably the arteriolar side of the vascular bed is involved.
Headache 1992 Nov
PMID:SUNCT syndrome: VII. Ocular and related variables. 146 6

Multiple sclerosis (MS) is frequently regarded as a painless condition. A review of the literature reveals that approximately 2/3 of the patients with multiple sclerosis will experience painful syndromes during the course of disease and that these are associated with the disease. Acute syndromes are described: Trigeminal neuralgia, Lhermitte's sign, optic neuritis and tonic seizure. Chronic syndromes: Dysaesthesia, pain in extremities, muscular spasms, low back pain and headache. The frequency, causes and suggestions for treatment are mentioned. A Danish investigation has revealed that only 42% of a representative section of DS patients received adequate treatment for pain. It is thus concluded that optimal treatment of pain in MS patients is necessary.
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PMID:[Painful syndromes connected with disseminated sclerosis]. 153 48

Our purpose was to examine the MMPI profiles of 157 patients with chronic headache or facial pain. The following diagnostic groups were considered: tension-type headache (n = 44); migraine + cluster headache + chronic paroxysmal hemicrania (20); trigeminal neuralgia (7); atypical facial pain (AFP) (33); temporomandibular joint dysfunction (TMJ) (53). There were two control groups: C1 of 27 healthy individuals and C2 of 18 patients with chronic pain located elsewhere. A "Pain Index" was calculated (0-10) which quantified pattern, duration and frequency of pain. The Italian MMPI abbreviated version was administered to all subjects. One-way Anova, the Duncan test and correlation analysis were performed. Of the diagnostic groups, AFP scored highest and TMJ lowest in all except three scales. In the AFP group, all neurotic scales scored above 70. The Pain Index correlated with higher scores on most scales. Chronic pain may lead to personality alterations, but some features of craniofacial pain correlate with specific personality disturbances.
Cephalalgia 1992 Apr
PMID:MMPI profiles in patients with headache or craniofacial pain: a comparative study. 157 44

SUNCT is a recently described unilateral headache with frequently occurring, shortlasting pain attacks in the ocular area accompanied by ipsilateral conjunctival injection, lacrimation, and (subclinical) forehead sweating. In some patients, attacks may be triggered by cutaneous stimuli. In this communication, SUNCT patients (n = 5) are compared with the considerable clinical series of trigeminal neuralgia in the literature (e.g. Harris, 1940, 1433 cases). In several respects (unilaterality, triggering, brevity and frequency of paroxysms), SUNCT shows similarity to trigeminal neuralgia. SUNCT seems to differ clearly from trigeminal neuralgia in other respects: sex distribution (SUNCT patients are often males), pain localization (SUNCT patients have the pain in the ocular area), the carbamazepine effect, presence of conjunctival injection, lacrimation, etc. SUNCT may accordingly altogether seem to be distinct from trigeminal neuralgia.
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PMID:Trigeminal neuralgia and "SUNCT" syndrome: similarities and differences in the clinical pictures. An overview. 160 24

Trigeminal neuralgia results from disturbances in the trigeminal root entry zone which generate repetitive action potentials. Drugs which relieve the pain of trigeminal neuralgia depressed these potentials. Anticonvulsants which exert this or related effects, and which have been demonstrated to be efficacious in trigeminal neuralgia, include carbamazepine, phenytoin, clonazepam, and valproic acid. Baclofen may act by facilitating segmental inhibition of the trigeminal complex. The mechanism of action of pimozide for treating trigeminal neuralgia is not known. Carbamazepine is suggested as the drug of first choice; baclofen or clonazepam could be added if carbamazepine monotherapy is ineffective. When these fail, monotherapy with phenytoin, pimozide, or valproic acid would be a reasonable next step.
Headache 1991 Oct
PMID:Review article: the medical management of trigeminal neuralgia. 177 73


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